Information
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Document No.
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Name of Document:
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Prepared by:
- Mark A. Davis
- Mark D. Davis
- Richard Dickinson
- James Brown
- Jason Corbin
- Hugh French
- Anthony Beverly
- Scott Taylor
- Michael Wright
- Lee Ratliff
- James Shifflett
- Chuck Ayers
- Joe Bailey
- Michael Wright
- Christopher Cole
- Doug Tait
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Issue Date
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Location (Drop Pin for GPS & Address):
STOP WORK DETAILS
Stop Work Order This form is to record action taken to stop work due to safety related activities or behaviors that do not comply with the regulations, policies, procedures or contractual stipulated items. In all cases, every effort must be made to make the area and or activity safe.
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Please take photos of the area and actions when possible causing the stop work order action:
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Describe with as much detail as possible, the actions, and behavior observed causing the stop work order action:
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Add Sketch here if required.
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Can the situation be made safe?
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Confirm that you are stopping the work, all activities shall cease and desist until the action is lifted by the issuer:
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Describe the actions to make the activity or behavior safe:
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Confirm that it is safe to continue work activities:
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Record details of corrective actions and get well plan to remediate the issue(s):
STOP Work Order Action Authorization:
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Person Stopping Work:
- Mark A. Davis
- Mark D. Davis
- Richard Dickinson
- James Brown
- Jason Corbin
- Hugh French
- Anthony Beverly
- Scott Taylor
- Michael Wright
- Lee Ratliff
- James Shifflett
- Chuck Ayers
- Joe Bailey
- Michael Wright
- Christopher Cole
- Doug Tait
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Signature:
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Date and time work shall cease:
Signatures:
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Foreman's Acceptance Signature:
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Superintendent Acceptance Signature:
RETURN to Work Authorization (STOP Work Order Has Been Lifted):
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Person authorizing RETURN to work must be the same person who initially stopped the work
- Mark A. Davis
- Mark D. Davis
- Richard Dickinson
- James Brown
- Jason Corbin
- Hugh French
- Anthony Beverly
- Scott Taylor
- Michael Wright
- Lee Ratliff
- James Shifflett
- Chuck Ayers
- Joe Bailey
- Michael Wright
- Christopher Cole
- Doug Tait
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Signature:
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Date and Tine Return to Work Shall Begin:
