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  • Stop Work Autority Reporting Form

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    Abegail Bernabe
    24 views2 pages
    This form is used to document a stop work intervention at a customer site. It collects information about the supervisor, date, customer, project details, workers involved, description of the unsafe event or condition, corrective actions taken, remaining hazards, and a management evaluation of the intervention. Signatures are required from the person submitting and reviewing the form.

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    This form is used to document a stop work intervention at a customer site. It collects information about the supervisor, date, customer, project details, workers involved, description of the unsafe event or condition, corrective actions taken, remaining hazards, and a management evaluation of the intervention. Signatures are required from the person submitting and reviewing the form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    24 views2 pages

    Stop Work Autority Reporting Form

    Uploaded by

    Abegail Bernabe
    This form is used to document a stop work intervention at a customer site. It collects information about the supervisor, date, customer, project details, workers involved, description of the unsafe event or condition, corrective actions taken, remaining hazards, and a management evaluation of the intervention. Signatures are required from the person submitting and reviewing the form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    FORM

    Stop Work Authority


    Reporting
    [C_Officialname]

    STOP WORK INTERVENTION INFORMATION


    Supervisor Date of Stop Work Customer Name

    Project Name/Description:

    WORKERS INVOLVED
    First Name Last Name Job Title Contact Info

    DESCRIPTION OF THE EVENT OR PERCEIVED STOP WORK CONDITION


    CORRECTIVE ACTION TAKEN/HOW RECURRENCE WILL BE PREVENTED

    REMAINING UNSAFE CONDITIONS OR HAZARDS THAT MUST BE ADDRESSED

    MANAGEMENT EVALUATION (PREVENTION/QUALITY OF INTERVENTION/FOLLOW-UP/IMPROVEMENT)

    Submitted By:

    Reviewed By:

    Today’s Date:

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