Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Area Concerned / Requiring Repair / Attention

  • Task Details

  • Request / Purchase order Number

  • Division Requesting Works

  • Specify

  • Person Requesting Work

  • Date Work Required

  • Item / Service to be Isolated /Terminated

  • Specify Item / Service

  • Type of Isolation / Termination

  • Specify

  • Location of Works

  • The Landscapes and Infrastructure Manager must be notified of any intended Scheduled Service and Utilities Shut downs prior to any works commencing. In the Event of Urgent or Emergency Work The Landscapes and Infrastructure Manager must be Updated as soon as Possible.

  • Peter Donaghue Has Been Notified

  • Method of Notification

  • Specify

  • Date Of Notification

  • NOTIFY PETER DONOGHUE IMMEDIATELY; MOBILE : 0410 220 927 Pdonoghue@zoo.nsw.gov.au

  • NOTIFICATION COMPLETE

  • Method of Notification

  • Specify

  • Area's Impacted by Work

  • Name of Area affected & Persons Notified.

  • Name of persons in Asset Operations Notified

  • Specify

  • Name of Person in Security Notified

  • Specify

  • Name of Persons in Guest Experience & Cleaning Notified.

  • Specify

  • Name of Persons Notified

  • Specify

  • Name of Persons Notified

  • Specify

  • Name of Persons Notified

  • Specify

  • Person Notified

  • Specify

  • Name of person Notified

  • Specify

  • Name of Person Notified

  • Specify

  • Name of Persons Notified

  • Specify

  • Name of Persons Notified

  • Specify

  • Name of persons Notified

  • Specify

  • Method of Notification

  • Specify

  • Date Of Notification

  • Time of works Commencement

  • Time of works Completion

  • Manager Notified

  • Specify

  • Approval to Isolate / Terminate / Interrupt / Shut Down Services

  • Details

  • Manager Name

  • Company Conducting Isolation / Termination

  • Company Authorised Persons Performing Work

  • Relevant trade License & Photo Identification of persons performing work

  • Qualified Zoo Reprasentative Present

  • Actual Work Start Time

  • Record / Photo of item Shut down / Isolation / Termination

  • Actual Work Completion Time

  • Record / Photo of Item on Reconnection / Restoration of Services, Or Completion of Termination

  • Zoo Representative Responsible

  • Date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.