Work Permit Review Checklist

• Document No.

• Work Permit Review Checklist

• Conducted on

  Date

• Kharil Ashidi Bin Abdul Jabar

• Location
  Address

• Personnel

Section 1: WORK PERMIT REFERENCE

• Work Permit Reference Number

• Reviewed by:

• Date of Reviewed:

• Work Description:

Section 2: SAFETY REQUIREMENTS

• If any unsafe condition discovered during the Work Permit review, work must be stop immediately, the work permit withdrawn and the situation reported to the Area Authority (Specify the Unsafe Condition found).

Section 3: WORK PERMIT / WORKSITE CHECKS

• All copies 1, 2 & 3 of the Work Permits posted at the correct locations?

  Yes

  No

  N/A

• Are all copies of the Work Permit legible?

  Green

  Red

  Amber

• Are the appropriate Safety Checklist's attached to the permit?

  Yes

  No

  N/A

• Has the Work Permit Issue / re-issue been correctly carried out?

  Yes

  No

  N/A

• Does section 1 of the Work Permit accurately reflect the activities taking place?

  Yes

  No

  N/A

• Are the hazards associated with the work activity properly defined on the Safety Checklist and appropriate safety precaution taken?

  Yes

  No

  N/A

• Is the Work Leader aware of what action to take in the event of an emergency?

  Yes

  No

  N/A

• Is the Permit User aware of what action to take in the event of an emergency?

  Yes

  No

  N/A

• Was the Pre-job Safety meeting held?

  Yes

  No

  N/A

• Do all personnel performing the work understand the requirements of the Work Permit?<br>Have they signed the back of copy 1 of the Permit?

  Yes

  No

  N/A

• Is the correct equipment information given? (where applicable)

  Yes

  No

  N/A

• Are colour codes on lifting gear and portable loads current?

  Yes

  No

  N/A

• Is the correct personal safety equipment / clothing being worn?

  Yes

  No

  N/A

• Is the work being performed in a safe manner?

  Yes

  No

  N/A

• Is the worksite housekeeping satisfactory?

  Yes

  No

  N/A

• There should be no conflict with other work activities, is this the case? (Answer NO if there is a conflict)

  Yes

  No

  N/A

• Do all personnel performing the work understand the contents of the risk assessment?

  Yes

  No

  N/A

• All permits issued from Control Room / Permit Control Point?

  Yes

  No

  N/A

• Other (specify)

  Yes

  No

  N/A

• Is the Isolation Certificate (ISC) correctly completed?

  Yes

  No

  N/A

• Does the isolation standard meet or exceed the OIQC Guidelines to safe Isolations? (Ref.: Exhibits R, S & T)

  Yes

  No

  N/A

• If the OIAC standard has not been met and a Risk Assessment carried out - have the risk reduction measures been implemented? (Answer N/A if the answer to 21 is YES)

  Yes

  No

  N/A

• Are individual isolations clearly labelled, effective and secure?

  Yes

  No

  N/A

• Yes

  No

  N/A

Section 4: COMMENTS

Section 5: COMPLETION

• I am aware of this Work Permit Review and its results.

• Authorised Signature

  Sign

• Select date

  Date