LSR-Work Permits Audit

Life Saving Rules - Safe Work Authorization & Permit Verification

📋 WORK PERMITS AUDIT

👤 Auditor Information

Name of Auditor *

Date *

Company *

Location *

🎯 Hazard Identification & Scope

Life Saving Rule: Work Permits ensure hazards are identified and controlled before work begins. All permits must be properly completed, signed, and understood by all workers.

Hazards Adequately Identified? *

YesNoNeeds ImprovementN/A

Scope of Work Adequately Defined? *

YesNoNeeds ImprovementN/A

Crew prepared for scope changes? *

YesNoNeeds ImprovementN/A

Training adequate for scope of work? *

YesNoNeeds ImprovementN/A

⚠️ SIMOPS & Hazard Mitigation

SIMOPS coordination noted on permit & adequate? *

YesNoNeeds ImprovementN/A

Hazard Mitigation Sufficient? *

YesNoNeeds ImprovementN/A

Hazards of Change or Combined Risk Addressed? *

YesNoNeeds ImprovementN/A

✅ Work Controls & Authorization

Stop the Job Criteria Established & Understood? *

YesNoNeeds ImprovementN/A

Permits Signed by All Authorized Parties? *

YesNoNeeds ImprovementN/A

Were permits signed BEFORE work began? *

YesNoNeeds ImprovementN/A

All applicable permit sections completed? *

YesNoNeeds ImprovementN/A

🔌 Energy Isolation & Testing

EIP Appropriate for scope and zero energy verified? *

YesNoNeeds ImprovementN/A

Atmospheric testing properly documented? *

YesNoNeeds ImprovementN/A

💡 Opportunities for Improvement

Identify any opportunities for improvement

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