Attachment2:

Section
7

GAS TESTER COMPLETED BY SAFETY CONTROLLER

GAS TESTER
NUMBER

GAS

RESULT %

NAME

DATE

TIME

Hot Main Work permit No:

GAS TESTER
NUMBER

VISA

HAND OVER OF WORK / REVALIDATION

SHIFT CONTROLLER

COMPLETION

NAME

TASK SUPERVISOR

VALID UNTIL

DATE / TIME

SHIFT CONTROLLER
(SC)
TASK SUPERVISOR
(TS)

11

RESULT %

NAME

DATE

P:
TIME

VISA

SHIFT CONTROLLER SIGNATURE CONFIRMS ABOVE CONDITIONS CHECKED AND ACCEPTED. WORK IS AUTORISED.
TASK SUPERVISOR SIGNATURE CONFIRMS PERMIT CONDITIONS READ, UNDERSTOOD AND WILL BE COMPLIED WITH.

DATE/TIME

10

GAS

DISTRIBUTION

HAND BACK OF WORK

EQUIPMENT
STATUS

VISA

DATE / TIME

REMARK:

SHIFT CONTROLLER

TASK SUPERVISOR

VALID UNTIL

EQUIPMENT
STATUS

To sign closed on main original work permit

BY SIGNING I DECLARE TO HAVE CHECKED AND AGREED WITH THE TASK SUPERVISOR
DECLARATION HERE UNDER AND THAT NORMAL OPERATIONS MAY BE SAFETY RESTART
BY SIGNING I DECLARE THAT THE WORK WHICH WE CARRY OUT HAS BEEN PROPERLY
PERFORMED AND COMPLETE AND THAT THE EQUIPMENT AFFECTED BY THE WORK LEFT IN A SAFE
AND TIDY CONDITION

WHITE (TS)

GREEN (SFT-A)

PINK (OA)

BLUE (PA)

TASK SUPERVISOR

SAFETY AUTORITY

OPERATING AUTHORITY

PERFORMING AUTHORITY