Title Page

  • Audit Title

  • Date of assurance

  • Completed by

  • Site
  • Number of PTW reviewed:

  • 1. PTW is issued by Authorized PTW Issuers?<br>(Verify the names in PTW issuer authorized list)

  • 2. Was the work well defied (description) in PTW?<br>(Review at least 50% PTW issued in the last 3 months)

  • 3. Was Job Hazard Analysis (JHA) submitted for the required work?<br>(JHA must identify all critical steps of activity)

  • 4. Issued PTW were completed with all the required information.

  • 5. Daily site check were completed and signed by issuer and requestor.

  • 6. Was required TASK SHEET attached with PTW?<br>(Review at least 50% PTW issued in the last 3 months)

  • 7. Was physical barriers and signage erected to prevent access to affected work area?

  • 8. Were permit issuer completed visit to work site before signing the permit? <br>(Verify at least 3 months with cross reference or interview)

  • 9. Were necessary PPE, required to completed the task mentioned in PTW?

  • 10. Were PTW closed and signed after the completion of the work?

  • I have conducted the self-assessment for the issued for the above mentioned site.

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