Permit to work (PTW) Audit Form

Type:

Attachment:

PERMIT TO WORK (PTW) Audit Form

Permit Number:
Task Description
Area / Location:
Date of Audit:

Section 1 - Specification of Work		Yes	No	N/A
1.1	Is the task description full and clear?
1.2	Has the correct location and area been identified?
1.3	Is it correct type of PTW for the work?
Section 2 – Planning and Risk Assessment		Yes	No	N/A
2.1	In the view of the Auditor(s), have all the potential hazards been identified?
2.2	Was the requirement for a Level 2 TRA correctly identified?
2.3	Was the need for a COSHH, Manual Handling and/or LOLER assessment correctly identified?
2.4	Is RTC included with the permit and relevant to the scope of work?
2.5	In the view of the Auditor(s), have all appropriate controls been identified?
Section 3 – Authorisation and Issue (Worksite Audit)		Yes	No	N/A
3.1	Has the performing authority held a pre job tool box talk?
3.2	Do the Work Party demonstrate an adequate level of awareness of the task?
3.3	Have all the correct authorisations been identified and given for this Permit? e.g. AA, SC and AAA and/or REP where applicable.
Section 4 – Job Execution (Worksite Audit)		Yes	No	N/A
4.1	Is there an up to date copy of the Permit at the worksite signed by all members of the work party
4.2	Have all the Controls been put in place?
4.3	Have the appropriate gas tests been carried out and recorded on the Permit?
4.4	If any PPE has been specified in a TRA, COSHH assessment or section 2 of the Permit, is it in use and in good condition?
4.5	Is safety equipment defined in the Risk Assessment available at the worksite?
4.6	If The answer to 4.5 is YES, are the necessary members of work party competent to use it?
Work Party Questions
4.7a	Did the Performing Authority tell you about your task?
4.7b	Can you tell me about your task?
4.7c	Do you know the type of things that could go wrong during your task?
4.7d	Did anyone tell you what safety controls are in place?
4.7e	Do you know the reason you had to sign onto the Permit?
4.7f	Are there appropriate controls in place, if not what they should be?
Section 5 – Supplementary Certificates		Yes	No	N/A
5.1	Have the conditions of the Entry Certificate been complied with?
5.2	Is there an ICC associated with this Permit?
5.3	If yes does ICC covers the work scope given in the task description of the PTW form?
5.4	Are the Entry Certificates and ICC’s cross-referenced on the Permit?

Compliance Failure Categories
Question Number	1.1	1.2	1.3	2.1	2.2	2.3	2.4	2.5	3.1	3.2	3.3	4.1	4.2
Score 1,0 or N/A
Question Number	4.3	4.4	4.5	4.6	4.7a	4.7b	4.7c	4.7d	4.7e	4.7f
Score 1, 0 or N/A
Question Number	5.1	5.2	5.3	5.4
Score 1, 0 or N/A

Total Actual:

Total Possible:

Percent Score:

Findings:

Immediate Actions:

Auditor’s Name:
Signature:
Auditor’s Name:
Signature:
Date:

Site Controller / Area Authorities Comments:

HSSE Managers Comments:

Notes:

All questions must be answered either “Yes”, “No” or Not Applicable “N/A”. The auditor will not be allowed to complete the audit until all questions are answered.
All “Yes” answers score one point. All “No” answers score zero.
The “Possible Score” is the total of “Yes” and “No” answers given.
The actual score is the total of “Yes” answers given.
Please ensure the date, time and signature is written at the top of the Permit Certificate

____________________________________________________________________________________