Permit To Work System Review Checklist (User Sheet)

Score Adequacy Scoring Criteria Adequacy Score 0.00

System is mature - one or more feedback, review, and 5.00
Not Adequate but Effective Adequate and Ef-
>3.0 – 4.0 improvement cycles are complete; required revisions to
System documentation have been made. fective
System is deployed; procedures are fully documented;
>2.0 – 3.0 users trained, ongoing verification and measurement 4.00
occurring.
System charactristics are documented, approved and
resourced; procedures for key System tasks are
>1.0 – 2.0 identified and under development; deployment is in
3.00

EFFECTIVENESS
progress.
≤1.0 System is being developed to address hazard/risk.
(Documented, Planned and Practiced)
2.00
Scope Effectiveness Scoring Criteria. Effectiveness Score 0.00
Implementation consistently conforms to all System
requirements; quality of implementation is excellent; all
>3.0 – 4.0 objectives are being achieved. Practices are effective
1.00
and proven to be sustainable.
Implementation conforms to the important System and Adequate but Not Ef-
most other requirements; quality of implementation is fective
>2.0 – 3.0 good; main objectives are being achieved.
0.00
0.00 1.00 2.00 3.00 4.00 5.00
Implementation conforms to the important System
ADEQUATE
>1.0 – 2.0 requirements; quality of implementation is acceptable;
some objectives are being achieved.
Implementation does not always conform to System
≤1.0 requirements; quality of implementation need
improvement; none of the objective achieved.
(Effective and Sustained)

Department OEMS Assurance

OEMS System Assurance Checklist Actual Score
Quarterly Assurance Status Update
Requirement Reference Requirements Expectations (Documented, Planned, Leave blank Yes / No / Not Adequacy Effectiveness Summary of Assessment Evidences Agreed Priority (Action to be closed within P1 - 3 Due Date Action Party Department Q1 (%) Q2 (%) Q3 (%) Q4 (%) Status of closure Actual Closed Date
No. Practiced, Effective, Sustained) Applicable (Good Observation and Gaps) Corrective months, P2 - 6 months, P3 - 12 months) (Close/Open)
Actions

02.02.06 L2 Permit To Work

4.1 PTS 18.00.02 Establish, implement, maintain and control documented All requirements incorporated in L3 procedure 0
Section 4.1 information covering the following: are approved and contents are comprehensive in
and • Identification of the authorized personnel e.g. PTW reference to PETRONAS, Downstream, external
PTS 18.51.01 AA, RA, work leader and other signatories of the and OPU specific requirements.
supporting certificates, for execution of the PTW
procedure. 0
• The roles and responsibilities of the authorized 0
personnel and the competency requirements. 0
• The competence assurance process.
0
• The work process for managing PTW.
• Arrangement on PTW application for brown field
projects or activities in or adjacent to the existing
facility.
• The assurance process including monitoring and
tracking closure of action items.
• Retention and safe-keeping of records.
• Monitoring the status of handback and closure of all
PTWs and certificates.

4.2 PTS 18.00.02 Define roles and responsibilities for the following 0
Section 4.1, authorized personnel: 1) Plan: 0
PTS 18.51.01 • Line management. Training Plan
Section 4 • Contractor management. 2) Tools:
and • PTW Approving Authority (AA). a) RACI Chart
PTS 18.51.03 • Approving Authority Representative (AAR). b) Training modules
Section 3 • Approving Authority for Certificates (AAC). c) Attendance sheet
• Authorized Gas Tester (AGT). 3) Communication on plan and tools undertaken
• Entry Supervisor (ES). 4) Staff is trained and competent.
• Receiving Authority (RA).
• Receiving Authority Representative (RAR).
• Work Leader (WL). 1) Evidence of activities and processes are 0
• Fire watch. implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) Approved RACI Chart
b) Filled in attendance sheet
c) Approved training module

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
c) number of training actual vs plan
d) number of personnel overdue for refresher
training
e) Adequate number of competent personnel
based on business requirement
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.3 PTS 18.00.02 Ensure competence of the appointed authorized 0
Section 4.1 personnel through training and assessment. 1) Plan: 0
and • The list of appointed authorized personnel shall be PTW assessment plan
PTS 18.51.01 approved by the appropriate level of authority defined 2) Tools:
Sections 2 by the OPU/HCU/JV. a) Assessment / questionnaire record
and 5 3) Communication on plan and tools undertaken
4) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) Results of PTW Assessment / questionnaire
(achieving more than 85%)

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.4 PTS 18.51.01 Ensure the work process for managing PTW includes the 0
Sections 3, 6, following: 1) Tools: 0
7, 8 and 9 • Planning and risk assessment. a) PTW
• Permit application and site preparation. b) JHA (Job Hazard Analysis)
• Joint site visit, Permit approval and work execution. c) JMS (Job Method System)
• Work completion and sign-off. 2) Communication on plan and tools executed
• Handover. 3) Staff is trained and competent.
• Permit control and removal.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) Completed and Approved JHA
b) Completed and Approved JMS
c) Completed and Approved PTW

Open
 4.4 PTS 18.51.01 Ensure the work process for managing PTW includes the
Sections 3, 6, following:
7, 8 and 9 • Planning and risk assessment.
• Permit application and site preparation.
• Joint site visit, Permit approval and work execution.
• Work completion and sign-off.
• Handover.
• Permit control and removal.

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.5 PTS 18.51.01 Define the PTW categories, permit contents and permit 0
Section 7 validity for the safe execution of the work. 1) Tools: 0
a) Work Procedure
b) PTW
2) Communication on plan and tools undertaken
3) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) PTW category and validity as per requirement

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.6 PTS 18.51.01 Identify the types of and issue certificates required i.e. 0
Section 8 normal and special certificates including the approving 1) Tools / forms: 0
authority and validity period. a) Lifting Certificate
b) Electrical Isolation certificate
c) Vehicle Entry Certificate
d) SCE Bypass Certificate
e) Excavation Certificate
f) Road Closure Certificate
g) Radiation Certificate
h) Limit of Electrical Access Certificate
i) Confined space entry checklist
j) Physical Isolation Certificate
k) Diving Certificate
2) Communication on plan and tools undertaken
3) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
latest PTW procedure which include latest
revision of certificate as below:
a) Lifting Certificate
b) Electrical Isolation certificate
c) Vehicle Entry Certificate
d) SCE Bypass Certificate
e) Excavation Certificate
f) Approved Road Closure Certificate
g) Approved Radiation Certificate
h) Approved Limit of Electrical Access Certificate
i) Approved Confined space entry checklist
j) Approved Physical Isolation Certificate
k) Approved Diving Certificate
3) Certificate within validity period

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.7 PTS 18.51.01 Ensure PTW is applied when performing activities 0
Section 1 related to the following: 1) Tools: 0
• Construction. a) Non-routine / Routine Hazardous Operation
• Maintenance. Matrix
• Non-routine hazardous operation. b) Risk Assessment
c) Briefing notes for non-routine hazardous
operations
2) Communication on plan and tools undertaken
3) Staff is trained and competent.
1) Evidence of activities and processes are 0
implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) Approved Non-routine / Routine Hazardous
Operation Matrix
b) Approved Risk Assessment based on HER
(Hazard Effect Register)

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
c) non routine hazardous checklist actual vs plan
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.8 PTS 18.51.01 Track and record status of all PTWs and certificates on 0
Section 10 daily basis until they are closed.

Open
 4.8 PTS 18.51.01 Track and record status of all PTWs and certificates on
Section 10 daily basis until they are closed. 1) Tools: 0
a) Tracking tool (e.g. PTW logbook, PTW
Database, ePTW Database)
2) Communication on plan and tools undertaken
3) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) Updated tracking tool with the following data:
-Date Open
-Equipment Number
-PTW number
-Work Description
-Date Closed
-Signature

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Evidences which reflect the effectiveness of
the PTW system:
a) Tier 1 PTW Compliance Audit Actual vs plan
b) No PTW related incidents
3) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance and
investigation findings.

0
4.9 PTS 18.07.02 Conduct assurance activities at planned interval to 0
provide information whether the system: 1) Plan: 0
• Conform to the above requirements. a) Assurance plan
• Effectively implemented and maintained. b) Tier 1 Auditor training plan
2) Tools:
a) Tracking closure sheet.
b) Tier 1 checklist
3) Communication on plan and tools executed
4) Staff is trained and competent.

1) Evidence of activities and processes are 0

implemented as per requirements, planned and
specified tools.
2) Evidences for implementing, maintaining and
controling documented information in relation to
PTW system:
a) Completed tier 1 PTW checklist
b) Findings presented in the Leadership Meeting
(e.g. PLT)
c) Analytics on the common PTW findings
d) Tier 1 auditor training attendance

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.
3) Recommendations fully implemented.

0
Management DBE-01.14- Conduct annual Management System Review to ensure 0
System Review L2-625 the system suitability, adequacy and effectiveness 1) Communication on plan and tools conducted. 0
which aligned with the strategic directions of the 2) Staff is trained and competent._x000D_
Business.
1) Data gathering & analysis conducted 0
2) MSR result pack completed & uploaded in
ECM_x000D_
3) Provide update to element directions/policies
after MSR_x000D_
4) Tracking of gap closure after MSR._x000D_

1) All evidences of implemented practices are 0

consistently complied with requirements and
meet element's target.
a) Communications and training on all
requirements to the targetted stakeholders are
met
b) Documents and records are secured and
easily retrievable.
c) Zero outstanding NCR recorded during audit
due to incompliance to the requirements
(documented, planned and practiced).
d) Continual training, communication and efforts
are done to enhance user capability and other
staff awareness.
e) Updated element directions/policies.
f) 100% completed gap closure from MSR
review.
g) Achieved or exceed the target KPIs.
2) Showing continuous improvement by
updating relevant documents based on current
requirements, feedback, lessons learned and
recommendation from assurance etc.

Practices are effective and sustainable for 0

minimum 3 years.
a) All the record of practices are consistently
complied to the requirements and OPU target
from for the last 3 consecutive years.
b) No high findings or repetitive medium
findings from external or corporate assurance.

Performance Measurement - Number of incidents caused by PTW non-compliance.

- Number of ZeTo violations with regards to PTW.
- Number of safety inspection or audit for PTW every 6-
monthly.
- Number of non-compliance from safety inspection or
audits during or prior to PTW activities.
- Closure of PTW audit findings.
- Number of unsafe observations (conditions or
behaviours) during or prior to PTW activities.

Adequacy & Effectiveness 0.00 0.00

Score

Department OEMS Assurance

Assessor
Name:
HCU/OPU/Department/Section:
Date of Assessment:

Head of Department (HOD)

Name:
HCU/OPU/Department/Section:
Date:

Open