Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Department/Area:
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Permit Number:
Audit Criteria
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1. Name and details of Acceptor
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2. Workplace / Locality / Equipment
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3. Details of work to be carried out
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4. Valid for date & times, extensions
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5. Valid for ... (Type of risk/work)
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6. HIRA correctly done and followed up
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7. Classification of risk correct
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8. Possible hazards identified
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9. Isolation management, signatures complete
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10. Control measures correctly completed
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11. Preparation complete
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12. Precautions to be taken, PPE to be used
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13. Notifications listed
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14. Team trained to use safety system
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15. Precautions critical systems correctly done
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16. Mechanical isolation, signature
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17. Electrical isolation, signature
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18. Hot work near flammable material correct
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19. High risk authorization correct
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20. Gas tests correct
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21. Confined space entry >8 hours authorised
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22. Valid for date & times, extension
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23. Sentry/fire standby duties, trained
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24. Authority to proceed with job
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25. Handing back/cancellation of job
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26. Hand back by acceptor, signature, time
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27. Hand back by any other acceptor official
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28. Hand back by electrician
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29. Authorized initiator trained
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30. Authorized initiator appointed
Photo(s):
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Add media
General Comments / Observations
Signatures:
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Auditor:
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Acknowledgement of Audit:
