Yarwun Clearance Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Purpose, Standard & Outcome

• Performance Standard: Clearances are complete with no major non conformance

• Major Non Conformance: Key element of clearance form omitted or not adequately completed which has the potential to lead to a major incident

• Action on Non Compliance: Clearance authoriser to undergo additional training

Clearance Details

• Clearance No

• Clearance Type

• Clearance Authoriser

• Clearance Recipient

• Clearance Date

  Date

1 Work Scope

• 1.1 Is the task adequately described in the Job Description?

  Yes

  No

  N/A

• 1.2 Is the scope of the work clearly defined and adequately describes all the job steps?

  Yes

  No

  N/A

• 1.3 Does the authoriser have a complete understanding of the nature and scope of the work including all steps, equipment to be used, access requirements, etc ?

  Yes

  No

  N/A

• 1.4 Does the recipient have a complete understanding of the nature and scope of the work including all steps, equipment to be used, access requirements, etc?

  Yes

  No

  N/A

2 Job Safety Analysis

• 2.1 Have all the hazards associated with each of the job steps been identified on the JRA?

  Yes

  No

  N/A

• 2.2 Do each of the hazards have an appropriate control(s) specified?

  Yes

  No

  N/A

• 2.3 PPE<br>Has all the PPE been specified correctly?<br>Are the PPE requirements specific, ie type of gloves worn?<br>Is it being worn as per the clearance?

  Yes

  No

  N/A

• 2.4 Has the JRA been signed by all parties involved?<br><br>All recipients?

  Yes

  No

  N/A

• 2.5 Is the job copy of the clearance and signed JRA with the recipient?

  Yes

  No

  N/A

• 2.6 When breaking into ammonia lines has the correct respiratory requirements been specified?<br><br>Ammonia gas service - canister mask?<br>Ammonia liquid service - SCBA/LLB & chemical suit?

  Yes

  No

  N/A

3 Permits

• 3.1 Have any special clearances or permits been soecified?<br>Confined space?<br>Working at heights?<br>Excavation/break in?<br>Electrical live work etc ?<br>

  Yes

  No

  N/A

• 3.2 If so, are they adequately cross referenced?

  Yes

  No

  N/A

4 Isolations

• 4.1 Has the SIS been adequately completed including the hazards and controls associated with preparing the isolations?

  Yes

  No

  N/A

• 4.2 Are all the isolations listed on the SIS with relevant<br>line number ?<br>Description?<br>Isolation method ?<br>Tag number ?

  Yes

  No

  N/A

• 4.3 Has a marked up ELD been attached, if appropriate

  Yes

  No

  N/A

• 4.4 Are the specified isolations correct? Do they meet the isolation standards?

  Yes

  No

  N/A

• 4.5 Are all the isolations listed on the SIS signed by the authorised person to indicate they are isolated?

  Yes

  No

  N/A

• 4.6 If a MIS or Confined Space Clearance was used, has it been adequately cross referenced?

  Yes

  No

  N/A

• 4.7 Have the authoriser and recipient inspected the equipment being isolated to ensure that all the necessary isolations are in place?

  Yes

  No

  N/A

• 4.8 Are the isolations locked?

  Yes

  No

  N/A

• 4.9 Are all isolations identified with a "Danger - Do No Operate" which is cross referenced to the clearance by stating the clearance number?

  Yes

  No

  N/A

• 4.10 Is electrical test running required?<br>Has this requirement been identified on the JSA?<br>Has the removal and replacement of isolations been managed by the SIS?<br>Has a standby person (factory rep or authorised person) been in attendance?

  Yes

  No

  N/A

• 4.11 On completion of the job:<br>Have the isolations been removed?<br>Are they signed as removed in the standard isolation sheet?

  Yes

  No

  N/A

5 Contractor Management

• 5.1 Does the authorised person and recipients know who the Factory Representative is for the job and were they involved at clearance issue?

  Yes

  No

  N/A

• 5.2 Is the Factory Representative physically checking the contractor's job performance:<br>Adherence to work scope?<br>Observing conditions of clearance?<br>Safe working practices?<br>Equipment condition?

  Yes

  No

  N/A

• 5.3 Is the authorised person physically checking the contractor's job performance :<br>Adherence to work scope?<br>Observing conditions of clearance?<br>Safe working practices?<br>Equipment condition?

  Yes

  No

  N/A

6 Authorisation

• 6.1 Has the clearance been authorised with time, date and correct validity period?<br>Was it issued at the job location?

  Yes

  No

  N/A

• 6.2 Has the JRA been signed on by all recipients with date and time?

  Yes

  No

  N/A

• 6.3 If the work being carried out is part of a plant modification, has the authoriser ensured the modification has been approved before signing the clearance certificate?

  Yes

  No

  N/A

• 6.4 Has the clearance been returned and signed by the recipient with the date, time and comments applicable?

  Yes

  No

  N/A

• 6.5 Has the clearance authoriser inspected the job to satisfy himself that the equipment has been left in a safe and workable state?

  Yes

  No

  N/A

• 6.6 If the work is confirmed to be physically complete, has the authorised person:<br><br>De-isolated the equipment by removing the locks and tags and signing off the SIS?<br>Signed off the clearance as complete by completing the clearance status section of the job copy?<br>Signed and dated the clearance correctly?

  Yes

  No

  N/A

• 6.7 If the job was not completed, has the authorised person:<br>Ensured that isolations remain correctly tagged and locked and that there are no open ends on process equioment?<br>Signed off the clearance as incomplete by completing the clearance status section of the job copy?

  Yes

  No

  N/A

7 General

• 7.1 Has the clearance been properly completed and clearly presented?

  Yes

  No

  N/A

• 7.2 Have the incomplete and complete clearances been filed correctly?

  Yes

  No

  N/A

• 7.3 General comments?

  Yes

  No

  N/A