Section 4 MWP –Activate (Work Coordinator to complete) All approvals obtained - Access Officer Y N/A _ _ _ _ _ _ _ _ _ Permit activation number confirmed work activity can proceed Access Officer name Date / time Y N/A Y N/A All risk controls implemented Isolations complete Permit Activated I have implemented all risk controls in accordance with the JSEA / SWMS and any associated high-risk work permits and isolation instructions. I authorise the permit receiver to conduct the work activity defined in Section 1 of this permit. Name: Signature: Work Coordinator Date: Time: Section 5 Receive MWP – (MWP Permit Recipient to complete) Permit Received I have discussed the specific hazards and controls with the work coordinator / project manager and agree that the work activity is safe to proceed in accordance with the requirements of this MWP and all supporting documentation. I understand and accept all of the conditions of this MWP and supporting documentation. Name: Signature: MWP Permit Recipient Date: Time: Change in Permit Recipient New Permit Recipient Sign On Old Permit Recipient Sign Off Date Time Name Sign Date Time Name Sign Section 6 Extended MWP – (MWP Permit Recipient to complete) New completion date New completion time Reason for MWP extension: Approved by Operations Coordinator Y N Operations Coordinator name Access Officer notified Y Access Officer name
Section 4 –Activate MWP (Work Coordinator to complete) All approvals obtained - Access Officer confirmed work activity can proceed Y N/A Permit activation number _ _ _ _ _ _ _ _ _ Access Officer name Date / time All risk controls implemented Y N/A Isolations complete Y N/A Permit Activated I have implemented all risk controls in accordance with the JSEA / SWMS and any associated high-risk work permits and isolation instructions. I authorise the permit receiver to conduct the work activity defined in Section 1 of this permit. Work Coordinator Name: Signature: Date: Time: Section 5 – Receive MWP (MWP Permit Recipient to complete) Permit Received I have discussed the specific hazards and controls with the work coordinator / project manager and agree that the work activity is safe to proceed in accordance with the requirements of this MWP and all supporting documentation. I understand and accept all of the conditions of this MWP and supporting documentation. MWP Permit Recipient Name: Signature: Date: Time: Change in Permit Recipient New Permit Recipient Sign On Old Permit Recipient Sign Off Date Time Name Sign Date Time Name Sign Section 6 – Extended MWP (MWP Permit Recipient to complete) New completion date New completion time Reason for MWP extension: Approved by Operations Coordinator Y N Operations Coordinator name Access Officer notified Y Access Officer name
FRM-00778%20Corporate%20Safety%20-%20Major%20Works%20Permit%20Form.docx