FIELD REVIEW
Permit Number :
Location :
Sketch of the Area with hazards marked
Date :
Check the condition. ( OK/ Not OK/ Not Required )
Hard Hats?
Safety shoes?
Safety glasses?
Gloves?
………………
……...………
………………
………………
Face Shield?
………………
Full Body Harness
with Lanyard
………………
H2S personal Monitor ? ……….
Multi gas monitor ?
…………
Barricades?
……………
Fire Extinguisher? ……………
Lock Out/Tag Out? ……………
Weather condition ?..................
Others ?
……………
Identification the Energy Sources at the field and its Mitigation
Sl. No.
Uncontrolled energy source identified
Mitigation
Name & Signature :
of Permit User
Work flow for PTW
JSA/
JHA
Asset owner
checks the area
Permit
Approval
Field
Review
Mitigation in place
Start work
Mitigation not in place
Stop work
Hazard Identification Tool
Chemical
Gravity
The energy present in
chemicals that inherently,
or through reaction, has the
potential to create a physical or health
hazards to people, environment or
equipment.
Examples: flammable vapors,
reactive hazards, toxic compounds,
corrosives, combustibles, oxygendeficient atmospheres, welding
fumes, and dusts
The force caused by
the attraction of all other
masses to the mass of the
earth.
Examples: falling object, collapsing
roof, and a body tripping or falling
Motion
The change in position
of objects or substances.
Examples: vehicle, vessel or
equipment movement; flowing water;
wind; and body positioning: lifting,
straining, or bending
Electrical
Mechanical
The energy of the components
of a mechanical system,
i.e. rotation, vibration, motion,
etc. within otherwise stationary piece of
equipment/machinery.
Examples: rotating equipment,
compressed springs, drive belts,
conveyors, and motors
Temperature
The measurement of differences
in the thermal energy of objects or
the environment, which the human
body senses as either heat or cold.
Examples: open flame; ignition sources;
hot or cold surfaces, liquids or gases;
steam; friction; and general
environmental and weather conditions
Pressure
Energy applied by
a liquid or gas which
has been compressed
or is under a vacuum.
Examples: pressure piping,
compressed cylinders, control lines,
vessels, tanks, hoses, and pneumatic
and hydraulic equipment
Radiation
The energy emitted from radioactive
elements or sources and naturally
occurring radioactive materials (NORM).
Examples: lighting issues, welding arcs,
solar rays, microwaves, lasers, X-Rays,
and NORM scale
The presence and
flow of an electric charge.
Examples: power lines,
batteries transformers, static
charges, lightning, energized
equipment.
Biological
Living organisms that
can present a hazard.
Examples: animals, bacteria,
viruses, insects, blood-borne
pathogens, improperly handled
food, and contaminated water
Sound
Sound is produced when
a force causes an object or
substance to vibrate––the energy is
transferred thru the substance in waves.
Examples: equipment noise,
vibration, high-pressure release.
Planning
Training
1. Do I understand the
task and how to
perform it ?
2. Have I identified the
hazards associated
with the task ?
3. How will I eliminate
the hazards
associated with the
task ?
4. Have I planned all
job task ?
1. Have I been trained to
do this work ?
2. Have I been trained to
use the tools or
equipment required ?
3. Have I been trained
on the procedures of
this work ?
Proper tools &
Equipment
State of mind
1. Will I give full attention
to this task ?
2. Will I stop and redo my
plan if something
unforeseen happens ?
3. Am I meeting or
exceeding the safety
requirements for this
task ?
1. Do I have the PPE, I
need ?
2. Do I have the right
tools and equipment ?
3. Have I checked if the
tools and equipment
are in good working
condition ?
In case of Emergency, Call
Land line: 23984444, Mobile: 66471717