YES NO NA SEPARATE PERMITS REQUIRED YES NO NA Excavating/Barricade SIGNS AND BARRICADES Red tape warning signs attached Hot Work (Welding/cutting) – Hot Work (Electrical) Yellow tape Confined Space Warning signs with names of contractor and contact person & phone number Shutdown/Tie-In > 48 hours permanent barricades Roof/Floor/Wall Penetration – Lift Plan LOCKOUT / TAGOUT ID isolation points written procedure Unusual Job Plan – Locks for all authorized persons Tags available (name, date, company) Have there been any incidents and accidents today? Yes: No: If Yes, have they been reported to Samet? Yes: No: Comments / Additional Information and/or Instructions: Contractor: Supervisor: Date: Crew Names: Initials (AM Review) Initials (PM Review)
SEPARATE PERMITS REQUIRED YES NO NA Excavating/Barricade Hot Work (Welding/cutting) Hot Work (Electrical) Confined Space Shutdown/Tie-In Roof/Floor/Wall Penetration Lift Plan Unusual Job Plan YES NO NA SIGNS AND BARRICADES Red tape – warning signs attached Yellow tape Warning signs with names of contractor and contact person & phone number > 48 hours – permanent barricades LOCKOUT / TAGOUT ID isolation points – written procedure Locks for all authorized persons Tags available (name, date, company) Have there been any incidents and accidents today? Yes: No: If Yes, have they been reported to Samet? Yes: No: Comments / Additional Information and/or Instructions: Contractor: Supervisor: Date: Crew Names: Initials (AM Review) Initials (PM Review)