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Permit To Work Self Assesment Checklist

The document is a permit to work self-assessment checklist for the Train 3 of Wara Pressure Maintenance Project in Nigeria. It contains 10 sections evaluating aspects of work planning, task description, hazards and controls, cross-referenced certificates, authorization and distribution, site gas testing, permit registry, re-issue and return, worksite audit and job execution, and closing. The checklist is used to assess compliance with permit to work procedures and ensure all necessary safety measures are addressed before hazardous work begins.

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320 views3 pages

Permit To Work Self Assesment Checklist

The document is a permit to work self-assessment checklist for the Train 3 of Wara Pressure Maintenance Project in Nigeria. It contains 10 sections evaluating aspects of work planning, task description, hazards and controls, cross-referenced certificates, authorization and distribution, site gas testing, permit registry, re-issue and return, worksite audit and job execution, and closing. The checklist is used to assess compliance with permit to work procedures and ensure all necessary safety measures are addressed before hazardous work begins.

Uploaded by

ஹரிஹரசுதன்
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CHINA PETROLEUM ENGINEERING & CONSTRUCTION

CORPORATION
TRAIN 3 OF WARA PRESSURE MAINTENANCE
PROJECT (NSK) Project-EF/1945
COMPANY EPC CONTRACTOR
Check List Number Check List Title Page 1 of 2
Rev 0
Permit to Work Self-Assessment Checklist
Date

Element 1 - Integrated Safe System of Work (ISSOW)


Permit To Work Self-Assessment Checklist
Project No/
Area / Location:
Project Title
Associated
PTW Number:
Certificates
Task Description

Date of Audit: Name of Auditor:

Section 1 - Work Planning Yes No N/A


Has a Work Permit meeting involving Permit Applicant, Permit Issuer and Work
1.1 Site supervisor as a minimum been held, and for critical works the HSE
Representative is involved?
Section 2 - Task Description
2.1 Has the correct type of permit been used?
2.2 Has the Equipment to be worked on been properly identified?
2.3 Has the correct Worksite / location and area been identified?
2.4 Is the task description full and clear with exact nature & scope of work?
Have special tools or equipment that may impact on safety at the worksite been
2.5
mentioned, if applicable?
Section 3 - Hazards and Controls Yes No N/A
3.1 Job Safety Analysis been carried out for the job?
In the view of the Auditor have all the hazards been identified and correctly filled
3.2
in respective sections of the permit?
In the view of the Auditor have all the appropriate controls been correctly
3.3
identified in respective sections of the permit?
Is approved Method Statement attached with Work Permit for all critical
3.4
activities?
3.5 If heavy lifting is involved is the JSA supported by Rigging and Lifting plan?
Have specific worksite preparation requirements identified in sub-clause 5.13 of
3.6
KOC.SA.004 procedure been complied with?
Section 4 - Cross-Referenced Certificates Yes No N/A
4.1 Are all other associated permits correctly cross-referenced?
In case of jobs involving Excavation, is a duly filled and approved Excavation
4.2
Notification available?
4.3 Are Electrical Isolations supported by Electrical Work Certificate?
4.4 Are Instrumentation isolations recorded in Override Record Register?
CHINA PETROLEUM ENGINEERING & CONSTRUCTION
CORPORATION
TRAIN 3 OF WARA PRESSURE MAINTENANCE
PROJECT (NSK) Project-EF/1945
COMPANY EPC CONTRACTOR
Check List Number Check List Title Page 2 of 2
Rev 0
Permit to Work Self-Assessment Checklist
Date

4.5 Have all isolations been entered and endorsed in relevant section of the Permit?
Have isolations been carried out by nominated & authorized personnel only
4.6
(from KOC or Service Contractor)?
Section 5 - Authorization & Distribution Yes No N/A
Has the permit been duly signed by Permit Applicant, Permit Issuer and
5.1
Worksite Supervisor?
5.2 Have copies of Work Permit been distributed as per requirement?
Section 6 - Site Gas Test Yes No N/A
Has the gas test been carried out in line with requirements of sub-clause 5.15 of
6.1
KOC.SA.004 procedure and relevant section in the Permit duly filled-up?
Section 7 - Permit Registry Yes No N/A

7.1 Has the permit been registered in the system?

Section 8 - Re-Issue, Transfer and Return Yes No N/A


Has the validity requirements been met for each type of Permit, namely,
8.1
Hot/Cold/Radiography, Confined Space Entry and Vehicle / Mobile Plant Entry?
Has the permit been renewed / re-endorsed, as a minimum, in case of shift
8.2 change, transfer of responsibility, work suspension, crew change (in case of
Confined Space Entry Permit)?
8.3 Have all the authorizations been obtained for Re-Issue?
Have section for transfer /share of responsibilities been duly filled, where
8.4
applicable?
Section 9 - Worksite Audit/ Job Execution Yes No N/A
9.1 Is there a copy of the permit at the worksite?
9.2 Has the Worksite Supervisor conducted a pre-job toolbox talk?
Do the workers demonstrate a good understanding of the task including the
9.3
hazards and controls stated in the JSA?
9.4 Are all the controls identified in the Permit being complied with?
Do the workers understand what action they need to take in the event of a
9.5
General Alarm?
Is the PPE / special equipment specified in the Permit and associated
9.6
documents (Method Statement etc.) available and in use?
9.7 Has the Standby Man been briefed on his duties?
Have Fire Protection requirements during work been implemented as per
9.8
requirements of sub-clause 5.16 of KOC.SA.004 procedure?
Section 10 – Closing Yes No N/A
10.1 Has relevant section (s) pertaining to Permit Closure been duly filled?
In case of work continuation on another permit, is this detail clearly identified in
10.2
the relevant section and new Permit raised with the existing Permit number?
CHINA PETROLEUM ENGINEERING & CONSTRUCTION
CORPORATION
TRAIN 3 OF WARA PRESSURE MAINTENANCE
PROJECT (NSK) Project-EF/1945
COMPANY EPC CONTRACTOR
Check List Number Check List Title Page 3 of 2
Rev 0
Permit to Work Self-Assessment Checklist
Date

Has the Permit Issuer inspected the worksite and ensured that area is
10.3
acceptable prior to signing to accept the hand-over of the area & equipment?
10.4 Have all supplementary certificates been collected?
10.5 Have all control measures been removed?
If the isolations at worksite continue beyond work completion or validity of
10.6 permit, are such long term isolations indicated in the permit and recorded in
Override Record Register?
Note: N/A means ‘Not Applicable’
Critical Findings

Auditors’ Immediate Actions

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