ARCHIRODON GROUP NV Integrated Management System

Health, Safety & Environment (HSE) Rev. Issued For General Use Reference No. HSE-PRO-06-F04 Serial No. Page 1 of 1 PTW No:

FORM PTW Re-Validation

0.1

SHIFT RE-VALIDATION DATE (DD/MM/YYYY) TIME( (HH:MM) PERMIT HOLDER (1st Shift) PERMIT HOLDER (2nd Shift)

SIGNATURE

SIGNATURE

Note: Presence and signature of Permit Holders of both shifts are mandatory during the PTW re-validation process (hand over) otherwise the PTW becomes invalid.

Completed by
Job Position Name Surname Signature Date

Approved by
Job Position Name Surname Signature Date

Distribution List
Job Position Name Surname

PTW Coordinator

PTW Authority

PTW Holder (2nd shift) PTW Authority HSE Manager Employer