LIMITED Recess PERMIT STearseo 199834 NSELN, AM A.M: (Name of Competent Parson) secton Company .IMABENSA, \rcteatonrs MNISIS SG) oininanen Wi ~136 206 opieten Apwoaloue.2, S206 202¢ Locate SALINE: OPK Ks SP, lboteaton of Equipment cre entation hunwoangcante wrarovepem Ins tabla tan play lay. BER« fran...ranlsy. fe Conlyn. Te 0.6.€7) un AARON. Leagitg 9a IDLER Es fa, We Pep? at Sime. : : LIMITS OF WORK AND/OR WORK AREA MCLG 6ieB a9 GOD. NandveD em, E : Qecrclay Aires] QpS oe Tyas. pporimnene. ANG, ee sey naa pars ber eae td cael poesseaensed 2 : COI et Sherp.edges.o.Heavy.daty va Cues Trench. Live, Warley, Gawd. 6% 6 - rocoto be ken See St of Work ar at Sytem deved had ; , Cor. swiich, Dhuld be emul pe S/4n.darn Heels oI Use proper ppl all Wer. qyeae..dboing well, iff fa tic (Dy, GUUS. pore. cautiins uamecrgeuvess.£ Make iiaseureaning Mak, Gloves all Te.Times, Any wife, cartac welsh POT AAS RISSP No NB. Key Safe Key No E- tha Sate Docuent le vata up OG x2 Pon 2OLO. 1 Rona “as Renews FORE SIGNNG ISSUE, ATHORIZED PERSON MUST COMPLETE THE FOLLOMING (You RUB e able To anewor yes 6 all questions Before staring work (Vor yes", Tor No) ; ‘Are you andthe Competent Person Wained and you both hol Is the equipment safe to work on? ivy you mi ie compan Pe Lv 7 Do you Fave adequaie information and are you lear on he is there adequate working space for correct use of tooVequipment? Vv Palin tu tamer v Va expats Te Crpgank Ps The Haan TanSS | 7s he wrk te sale a clea he over Rares To To ahd inte Work acti? be done? v ave yu ensires Tht Be COnpaTeH POTENT RT Fag m7 aeady Do you hava ae oreo documents muding approved method |g pen safety document? statement? it you answer Noto any ofthe above, give detalle of what remedial action you have taken to allow work to proceed Saree eee ee eee ere | See ee soe ame. Moc Maasind.. Soe. Signature... Sonn Tine L260. date,.282 26528, mere ele hat nave sts my att sao wr win te ni work andr wrk ua enor tae and atv pnd precautions to achiove Safety ‘System as wall as General Safety (0 all < ofthe Working Party I futher accept responsibilty fr caryog Pep ageran Guin ei inasgl areata | noreby declare that al men have been withdrawn and warmed that sno longer safe to work within the iis of werk andlor work area dealed above and hata tools and gear have been remaved Name, Signature Time nnnnnence DA, | ome canes! | ‘rhe name ofthe Control Person agreeing othe cancellation ofthis document. [THis LIMITED ACCESS PERMIT IS HEREBY CANCELLED. Name, Signature Tine, se Dat