PTW AUDIT CHECKLIST

DEPT.: Total no. of PTW Audited:

PROJECT / LOCATION: Ref No.:
INSPECTOR: (write name/ designation) DATE:
OBSERVATION REMARKS / PTW No.
NO. ITEM S RECOMMENDATIONS / WITH
NOT CORRECTIVE ACTIONS VIOLATIO
OK
OK
N
A
1 Correct type of PTW issued
2 PTW issuer have valid certification
3 PTW receiver have valid certification
4 Joint site inspection conducted
5 JSA attached with the PTW
6 PTW heading filled up correctly
7 “Exact work location” identified
8 “Tools & Equipment to be used” complete
9 “Additional Precautions complete”
10 Gas testing information complete and proper
11 Gas testing conducted prior to and during the work
12 Issuer and Receiver signatures proper
13 If PTW is extended, is signatures and time proper
14 PTW properly closed out at end of job?
15 PTW available at site
16 Receiver/delegate available at site
17 Work scope defined properly
18 Equipment properly identified
19 Hazard properly identified
20 Pre-cautions properly defined
22 Pre-cautions properly defined
23 Receiver following PTW instructions
24 Barricade/warning signs adequate
25 PPE adequate
26 Issuer’s lockout/hold tag adequate
27 Receiver’s lockout/hold tag adequate
28 Standby man available
29 Tools in acceptable condition
30 Scaffolding acceptable
31 Acceptable excavation procedures
Others
General Comments:
B

Permit to Work Audit Checklist

Details of Action taken
# Check Points YES NO Score
noncompliance If "NO"
Are the permit issuers and
1 receivers are authorized to issue
and receive the work permit?
Are the hazard assessment is
done as per required of the
2
permit system with respect to
site condition?
Are all columns are filled
properly in the permit book and
register both e.g. job
description, names of persons
3
involved, isolation, tools and
PPE required, date and time of
issue and expected date and
time of finish of work.
Is the isolation officer is trained
4
and authorized?
Are all sort of energies are
5 isolated as per LOTOV
procedure?
Are the lock numbers of all
6
affected persons mentioned?
Is the housekeeping is done and
ensured that the equipment and
the area is rendered safe for
7
operation before surrendering
the work permit by receiver and
cross checked by issuer?
Are the persons involved in the
work at height and confined
8
space are trained and
authorized for such jobs?
Is the PEP Talk related to the job
9
is given before start of the job
 and signature taken from the
working personnel on the work
permit?
Is the JSA made for critical jobs
like roof repair, confined space,
10 work above 9 meter height, and
jobs involving more than two
departments.
Is the second copy of the permit
11 is available with the
employee/contractor at the site.
All the precautions mentioned
12 in the permit are actually taken
at the site. (Verify at the site).
Is the work permit is
13 surrendered immediately after
completion of the job?
Total Compliance %

Place score of 0 to 1 in status column for compliance in the relevant box against each point.
Permit to Work Audit Checklist
Work Permit Audit Done By : Sign : Date:
Department Audited : Sign of HOD :