Title Page
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Audit Title
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Date of assurance
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Completed by
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Site
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Number of PTW reviewed:
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1. PTW is issued by Authorized PTW Issuers?<br>(Verify the names in PTW issuer authorized list)
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2. Was the work well defied (description) in PTW?<br>(Review at least 50% PTW issued in the last 3 months)
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3. Was Job Hazard Analysis (JHA) submitted for the required work?<br>(JHA must identify all critical steps of activity)
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4. Issued PTW were completed with all the required information.
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5. Daily site check were completed and signed by issuer and requestor.
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6. Was required TASK SHEET attached with PTW?<br>(Review at least 50% PTW issued in the last 3 months)
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7. Was physical barriers and signage erected to prevent access to affected work area?
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8. Were permit issuer completed visit to work site before signing the permit? <br>(Verify at least 3 months with cross reference or interview)
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9. Were necessary PPE, required to completed the task mentioned in PTW?
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10. Were PTW closed and signed after the completion of the work?
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I have conducted the self-assessment for the issued for the above mentioned site.
