RIG NAMEHERITAGE 0% Date( )

WEEKLY PERMIT TO WORK ASSESSMENT SCORE SHEETNUMBER CHECKLIST YES NO N/A

1 is permit to work system available on rig

2 Is a designated ptw board available

3 is ptw board in prominent place for all to see

4 is ptw correctly filled in

5 does permit have permit number and rig name

6 is the work area checklist filled in

7 is nature of work checklist filled out correctly

8 has all safety precautions be checked out

9 have isolation procedures been specified

10 are persons performing the work aware of the permit

11 has a toolbox meeting been conducted

12 is the area for the work permit in a safe condition

13 is the work permit displayed or present at work area

14 was the work area checked by the supervisor before work

15 are all safety procedures being followed

16 if required have all lock out procedures been followed

17 are tags in place

18 is the main breaker isolated in PCR/SCR

19 has the permit been entered into register

20 has the permit been closed out correctly and on time

21 does the ptw board have old permits still in place

22 is permit consistant with job being undertaken

0 0 0TOTAL 0%

YOUR SCORE