WORKPLACE INSPECTION NO 36: PERMIT TO WORK

• Inspector:

• Supervisor:

• Company:

• Location:
  Address

• Date:

  Date

INSPECTION

• Is the applicable PTW readily available in the task location with the JobSTART and does it define works being undertaken?

  Yes

  No

  N/A

• Is the PTW issued by an Authorised Person (Permit Issuer)? Record details of Permit Issuer on this inspection report and follow up if necessary to confirm PTW Issuer is Authorised to issue type of permit

  Yes

  No

  N/A

• Is the PTW receiver signed on to the permit and is present/supervising the works being undertaken?

  Yes

  No

  N/A

• Are applicable work permits readily available in the vicinity of the task location, with the applicable JobSTART / SWMS?

  Yes

  No

  N/A

• Have the workers been briefed on the Permit requirements and signed onto the PTW, JobSTART\SWMS?

  Yes

  No

  N/A

• Does the PTW identify any other activities impacted by the work (including adjacent environments)

  Yes

  No

  N/A

• Have workers been briefed on the permit and SHEWMS/JSEA requirements and signed on?

  Yes

  No

  N/A

• Are risk controls documented in the applicable Permit(s) and JobSTART in place and relevant?

  Yes

  No

  N/A

• All the necessary isolations are in place and have been appropriately locked and tagged? Record details of persons who applied isolations on this inspection report

  Yes

  No

  N/A

• Does the PTW specify the personnel authorised to do the work and identify the responsible competent person (Permit Receiver)?

  Yes

  No

  N/A

• Has permit been revalidated when longer than 1 shift or when there has been a change in personnel?

  Yes

  No

  N/A

Inspection Team

• Signature:

  Sign

• Signature:

  Sign

• Signature:

  Sign