Information
Completed On
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Conducted on
Completed By:
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Signature:
Important Information
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Permit must be completed and signed off by all field personnel conducting the work AND an on-site supervisor prior to the work commencing.
Permit must be present in the field and available for review upon request.
A duplicate copy of the permit must be available to the on-site supervisor for the duration of the work.
Permit shall only be issued for 1 shift; extensions (if required) must be approved by the on-site supervisor.
Field Crew Partipicants
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Dwight G.
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Kristin M.
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Darcy B.
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Dianne D.
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Justin G.
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David W.
Work Description & Location
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UTM Easting:
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UTM Northing:
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Use notebook plus to show location on topo map
Mode of Transportation
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Light Vehicle
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Unit #:
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Boat
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Hewscraft
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Lund
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Helicopter
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Helicopter Call Sign
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Pilot
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Snowmobile
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ZZZ090
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ZZZ010
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ZZZ011
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ZZZ012
Communication
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Responsible Check-in Person:
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Channel 6
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Other
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GSH
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Winter Road
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Specify Other:
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Onsite Supervisor Phone #:
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Field Crew Sat Phone #:
Required Training
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Personnel Trained and Fit for Task
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Personnel Correctly Equipped (PPE)
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Personnel Correctly Equipped (Deterrents)
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Personnel Correctly Equipped (Personal Gear)
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Take 5
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Bear Awareness
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Cold Water Bootcamp
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Winter Survival
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Equipment Operators are Correctly Trained
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If all of the above are not checked, please describe mitigations below:
Additional Requirements
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SOP's Reviewed with Supervisor
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Field Equipment Checklists Completed
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Vehicles Maintained & Loaded
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Climate Conditions Reviewed
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Temperature
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Wind
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Windchill
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Precipitation
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Hours of Daylight
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Time of Darkness
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Forecast
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First Aid & Emergency Survival Equipment
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Other:
Permit Review & Signoff
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Print Name and Sign
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Print Name and Sign
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Print Name and Sign
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Print Name and Sign
Permit Acceptance (Supervisor)
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Print Name and Sign
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Permit Expires:
