№ lp_1_2_62760
Completed form must be maintained on file.
Note: Campus
Work cannot proceed until a completed JSA and/or a risk assessment is available: Yes/No
Locks and/or tags have been affixed to isolation points: Yes/No
The atmosphere in the confined space has been tested: Yes/No
Warning notices/barricades: Yes/No
Smoking forbidden: Yes/No
All persons have been trained: Yes/No
Communication equipment: Yes/No
Emergency Rescue Procedures in place and communicated to staff: Yes/No
Area clear of all combustibles including combustible atmosphere: Yes/No
Hot work is permitted: Yes/No
Complete Hot Work Permit WHS38 if required and attach: Yes/No
Signed: (Authorised Competent Person in direct control)
All persons and equipment, plant, and materials accounted for: Yes/No
Equipment checked and restored correctly: Yes/No
Work has been completed: Yes/No
Access to the space has been secured: Yes/No
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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