RIG NAME

NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

HERITAGE
CHECKLIST

YOUR SCORE

0%
YES NO

Date( )

WEEKLY PERMIT TO WORK ASSESSMENT SCORE SHEET

N/A

is permit to work system available on rig Is a designated ptw board available is ptw board in prominent place for all to see is ptw correctly filled in does permit have permit number and rig name is the work area checklist filled in is nature of work checklist filled out correctly has all safety precautions be checked out have isolation procedures been specified are persons performing the work aware of the permit has a toolbox meeting been conducted is the area for the work permit in a safe condition is the work permit displayed or present at work area was the work area checked by the supervisor before work are all safety procedures being followed if required have all lock out procedures been followed are tags in place is the main breaker isolated in PCR/SCR has the permit been entered into register has the permit been closed out correctly and on time does the ptw board have old permits still in place is permit consistant with job being undertaken

TOTAL

0 0%