6 0 Cpa personnel involved in tsk, ncluding the PA shall sign this permit work party decisation — that they = have taken part in the pre-jab ToolBox Talk or Fisk Review + Cary out only the work detailed inthe pert ask description ‘ents ‘Shall be indicated by pacing a P by their own name. ‘+ understand te contols require tobe in pace to carr out the task saety and efficiently {awe an obligation to continually assess worksite hazards and stop the ob if sk can be reduced further or new hazards are understand the task described on this permit and the responsibilies associated wih carrying out his task safely and eficienty + ferifethod 3 anergy isolation (14.112), the Designated Work shall ital next o each worker's name. The Designated Worker Fainame Sonus Tarain | Tine Oa | Waid 3 Energy esaton me ny Designated Worker Tani [eb ow Bouse (PT lou | 14-70 : 9704723 | 22/r4/rz| 7 Wor Feah 14-05 | 14.90 2 au 14.65 | EUTYAT /SID IE ges. 14.30 | 5 z is | le | 7 ie | ® 7 7 fa ~ [The AA or et delegate sha: + review the parmit or TRA a periods which the TRA species and after any werk intertuptor 1 very tat only the work deere on the permis lng performed and that work can continue safely and ficiently. Fullname Roe Sensis Tine Comments "The AA, PA oF dologate shall early sign their name and the time ater each worksite inspection. BRORINGREAIT? SOOO 1B Toe 4