PTW SPOT CHECK

Assessor Permit Number

Audit Date Site G Location
PTW AUDIT AT WORKSITE 2

N/A
Yes
No
1 Has The Correct Permit Type Been Selected For This Activity?
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2 Does The Job Description Correctly Describe The Work That Is Taking Place?
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3 Is The Work Party Working In The Location That Is Indicated On The Permit? (Permit Should Not Show Multiple Locations)
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4 Are All Required Supporting Documents At The Worksite (Eg: Lifting Plan, Rescue Plan, Fireguard Checklist, Etc.)
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5 Have All Of The Hazards Been Identified On The Permit And/Or Tbt Form? (Consider Wah/ Dropped Objects/ Energy Sources Etc).
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6 Are All Of The Control Measures In Place?

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7 Does The Work Party Clearly Understand The Task And The Associated Hazards & Necessary Control Measures?
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8 Have All Personnel Working In Adjacent Areas Been Made Aware Of Conflicting Jobs ?
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9 Is Everyone Wearing The Correct PPE Specified On The Permit?

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10 Is The Area Barriered Off Effectively And Have Clearly Visible Signs Been Erected To Restrict Access?
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11 Is Equipment On-Site Fit For Service/Switched On/Calibrated/Earthed/Certified As Required?

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12 Have Any Relevant DGS's Within The Vicinity Been Identified And Captured In The PTW?
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13 Do Members Of Work Party Know What To Do In Event Of An Emergency/GPA?

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14 Are Adequate Rest Periods Being Taken Where Appropriate?

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15 Is The Worksite Clean And Is The Work Party Using Correct Waste Disposal Methods?
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 PTW AUDIT AT WORKSITE

N/A
Yes
No
16 SDS: Was The Need For SDS Identified And Is It Readily Available For The Workparty?
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17 Hot Work: Is There A Portable Gas Detector On Site, Switched On And Within Calibration Date?
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18 Hot Work: Are Fire Extinguishers Available In The Vicinity?

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19 Hot Work: Has the PWE been adequately designed / built and maintaining positive pressure?
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20 Work at Height: Have All Tools & Equipment Been Properly Secured From Potential Drop?
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21 Work at Height: Are all work party wearing the correct harness and equipment for the activity?
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22 Rescue Plan: Is There A Rescue Plan Available And Have All Rescue Team Members Been Informed Of The Current Task?
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23 Confined Space: Is the entry sign in place?

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24 Confined Space: Is safety watch in place?

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25 Isolations: Are Identified Isolations In Place & Known/Proven To Work Party? (Follow Up With ICC Spot Check If Required)
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26 Isolations: Are The Personal Isolation Points Clearly Identified On The Personal Isolation Form
And Confirm They Are Have Not Been Left Unattended?
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27 Inhibits & Overrides: Has the Inhibit Certificate been authorized and signed by the correct person?
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28 Radiography: Have appropriate barriers been erected to minimize risk and at the correct distance?
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29 SimOps: Has the permit been countersigned by the HSE-SA (D) correctly?
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30 Is The Auditor Confident That The Worksite Is Well Managed And Safe For The Task To Proceed?
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I confirm that I have visited the worksite and these answers are true and correct. Page 2/2