Translated from German to English - www.onlinedoctranslator.

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SEA Sustainable Energy Aschaffenburg AE number:

Work permit (AE) AE-______-Los____

A) General
Contractor: Construction manager of the AN /AvO of the AN: Personnel strength:

Execution date:
Building (part): Level/work location:
Start: End (max. 1 week):
LOT1 - BE East 2 / BE East3 0 - 24,000

B) Emergency - who should be notified? (E.ON construction site DS Smith, Weichertstrasse 7, 63741 Aschaffenburg)

1. Fire Department Emergency

112
2. E.ON control room +49 6021 / 400470
C) Type and scope of activities to be carried out
Which work equipment (including vehicles),
Description:
hazardous substances?

E.ON HSE test

D) Activity-related risk assessment Site Manager takes place:

Risk assessments, operating instructions, proof of training and safety data

sheets presented, available on site.

The following activity(s) with increased risk potential should be carried out*:
AG Working with risk of falling (+ removing gratings) HB Working with aerial work platforms

No. No.
HA hot work PA Use of personnel lifting equipment in crane operation

No. No.
EB earthworks DP radiographic examinations

No. No.
BE Working in containers, silos, narrow spaces MK Erection and operation of mobile cranes

No. No.
* If increased risk potential is ticked, the corresponding additional form must be filled out, approved and attached to
this AE. An AE does not override the obligations according to DGUV V1 §8 Dangerous work (1)!
E) Relevant electrical and mechanical activations (attach activation lists): Necessary

F) Responsibilities Release
Step Surname: Tel. Date: Signature:
Issued by (Coordinator/BL of the contractor):
1

Checked by (E.ON HSE Site Manager):

2

Released by (E.ON construction manager / AE manager):

3

Acknowledgment and confirmation by (AvO of the AN)*:

4

* The contractor's AvO confirms with his signature that he will instruct his employees in this work permit and in
particular in the risks and protective measures that exist at work.
AE work permit certificate v0.doc Page1from2
 SEA Sustainable Energy Aschaffenburg AE number:

Work permit (AE) AE-______-Los____

G) Last-minute risk assessment (must be carried out before work begins)

01 Conditions at the place of work YES NO* Other problems:
a. Safe entry/exit; Are there enough escape routes and
first aid available?
b. Shared workspace is the right one?
c. Emergency numbers and, if necessary, fire
LMRA carried out:
extinguishers known/available?
02 Planning and coordination Date: Time:
a. Area clean, tidy and free of tripping hazards and
adequately lit?
b. Any necessary activations have been carried out
Name AvO of the contractor & abbreviation:
and documents are attached?
c. If necessary, have you discussed and coordinated with
surrounding trades about mutual threats?
03 PPE / work equipment Signature of the contractor:
a. Suitable and tested PPE?
b. Suitable and tested work equipment?

* For one-offNOor other problems, contact the contractor's construction manager!

New assessment per working day by the contractor's AvO

Date: Abbreviation: Date: Abbreviation: Date: Abbreviation:

2 day 3rd day 4th day

Conditions unchanged Conditions unchanged Conditions unchanged

1xNO= STOP 1xNO= STOP 1xNO= STOP

Date: Abbreviation: Date: Abbreviation: Date: Abbreviation:

5th day 6th day 7th day

Conditions unchanged Conditions unchanged Conditions unchanged

1xNO= STOP 1xNO= STOP 1xNO= STOP
H) Conclusion
Report of completion of the work by the
Yes No Known name E.ON construction manager / AE responsible:
contractor’s AvO:

New release certificate is

required on (date): Control result:
Work site was left safe and cleaned.
Date: Surname: Signature: Date: Surname: Signature:

Legend/Terms
AE Work permit
BL Construction management

AvO Person responsible for work on site

AT contractor
HSE Health, Safety and Environment
LMRA Last minute risk assessment / last on site check

1. AN-BL/AvO
Distributor:
2. E.ON HSE

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