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CHECKLIST FOR PERMIT TO WORK

NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

Compliance
No Check List Y N
REMARK
1 Administration and Organization
1.1 Is the form properly filled-up and signed?
Is the list of PTW authorized signatories updated and
1.2
displayed at the PTW Office/Station?
Copies of PTW available : Original (Worksite), Copy 1
1.3
(Control Room/PTW Office/Station), Copy 2 (RA)
Are personnel involved in PTW trained, assessed and
1.4
appointed?
2 Implementation & Monitoring
Is the work description clear and specific (e.g. exact
2.1
location, equipment)?
Have all hazards associated with the work been
2.2
identified and necessary precautions specified ?
2.3 Are personnel using correct PPE specified in PTW?
Are the supporting certificates, JHA/JSA and relevant
2.4
drawings for the work attached with the PTW?
Has joint-site inspection been conducted by AAR and
2.5
RAR and WL
2.6 Has toolbox talk been conducted for the work?
Has revalidation been carried out during shift change or
2.7
if there is any change to the conditions of the permit?
Has the work been hand back and PTW signed off by RA
2.8
and AA upon completion of the job?
Has the housekeeping been done after completion of the
2.9
job?
3 Hot Work
Are incompatible activities e.g. atmospheric venting,
3.1 draining, line breaking, sampling been prohibited at
adjacent areas?
Are firefighting equipment e.g. fire extinguisher, fire
3.2
blanket available and working?
3.3 Is the assigned fire-watch present at site?
4 Gas Testing
4.1 Are the AGTs certified?
Is the gas testing frequency specified on the PTW and
4.2
carried out i.e. Continuous or at specified intervals?
4.3 Have the Gas testing meters been calibrated and valid?

Percentage Compliance (Total no complied/Total no of requirements) %

AA (Approving Authority), AAR (Approving Authority Representative), RA (Receiving, authority)


RAR (Receiving Authority Representative), WS (Work Supervisor), WL (Work Leader)

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