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PTW Checklist (CSE Permit#000123)
PTW Checklist (CSE Permit#000123)
ANNEX F
PTW inspection checklist
The success of the PTW system largely depends on the care and competence of the personnel responsible for
authorizing the work, strict supervision and the professionalism in the way the work is undertaken.
As with any system it requires regular supervision and auditing to ensure it operates at peak effectiveness.
The attached sheets are given as guidance to persons involved with such an audit. To ensure this is a meaningful and
accurate assessment, straight yes/no answers may not be sufficient. Please therefore be thorough in your assessment
and expand your answers as necessary.
n. Item Answer
1 Permit n°: 000123
2 Date of issues: 29/5/2020
3 Valid until: 29/5/2020
4 Type of permit: CSE Permit
Have permit copies been properly distributed, and where necessary is a permit
5 Yes
prominently displayed?
Is the work description on the permit adequate, i.e. does it adequately describe the work
location, the equipment to be worked on, and the exact nature and scope of the work?
6 Yes
If not, explain deficiency:……………………………………………………………………………………
Validity
a) The permit should clearly state the time and dates between which it is valid. Yes
7 N/A
b) Is permit revalidation being signed and dated by Permit Issuer?
N/A
c) Are revalidations up to date?
8 Hazards
10 Gas Tests
a) Have gas tests been undertaken? Yes
b) Are tests valid for this period? Yes
c) Are portable gas monitors fully operable at worksite and calibrated? Yes
d) Are on-site personnel knowledgeable on how to operate equipment? Yes
e) Have they been properly trained in its use? Yes
f) Has periodic testing been carried out as appropriate? Yes
11 Precautions Taken by Task Supervisor
a) Has Task Supervisor briefed everyone in the Work Party? Yes
b) Have all the persons in the Work Party read the permit? Yes
c) Do all persons fully understand the safety requirements and the precautions stated on Yes
the PTW?
d) Are they in compliance e.g. using safety clothing as specified, isolating equipment at
Yes
breaks, etc.?
If not – specify ……………………
12 Isolation
a) Are isolation certificates attached to the permit? Yes
b) Are they cross referenced? Yes
c) Do certificates or attachments detail specific isolation points? Yes
d) Are all isolations secure? Yes
e) Are all isolations tagged? Yes
f) If more than one task on same isolation, has multiple lock/key system or other suitable Yes
control been used?
If so - give details (CWP#4088, 4100, HWP#0008, CSE Permit#0123, IC#0841)
…………………………………
13 Precaution by Permit Issuer
a) Has task been fully discussed with person carrying out the isolation? Yes
b) Has task been discussed with Task Supervisor? Yes
c) If more than one Permit on equipment/system, have all appropriate cross references been Yes
made and all necessary personnel been made aware?
d) Where tasks may impinge on other responsible persons/areas, have affected persons signed to N/A
acknowledge their awareness of the work?
14 Handover (Task completed within the Day shift)
Yes / No
a) Has handover of permit been done between Permit Issuers at shift change?
Yes / No
b) How is thing being documented?............................. Yes / No
c) Has a handover of jobs between Task Supervisors been done? Yes / No
16 Training
a) Have personnel who are currently associated with this permit received training in the Yes
company’s PTW system?
b) Is the type and frequency of training in accordance with company policy? Yes
c) Is evidence of their training and appointment readily available? Yes