SST024
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Site conducted
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Conducted on
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Prepared by
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Location
Information Required
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Permit to Alter Design, Load, Unload, Strike Temporary Works
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Contract Name:
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Project Number:
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Contractor Supervisor in Charge of the Works (print name)
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Permit No
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Date Issued
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Start Time
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Finish Time
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RAMS Ref
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Rev Date
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Description and location of Works
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Permit required for (circle applicable)
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1. Alter Design
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2. Load / Unload
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3. Strike
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Applicable Drawings
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Applicable Method Statements
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If yes, identify the back propping requirements inc. drawing reference and sequence
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Back Propping Required? (circle applicable)
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Date until back propping is to remain in place until?
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Confirmation by Contractor's Supervisor:
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Name
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Position
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Signature
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Date
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Confirmation by Temporary Works Co-ordinator:
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- Name of Temporary Works Co-ordinator
