WORKS AUTHORISATION FORM HWL_WAF001

• SUBCONTRACTOR COMPANY NAME

• WORK LOCATION

• DATE OF PLANNED WORKS

  Date

• Brief description of works

WORKS AUTHORISATION FORM - VALID FOR UP TO SIX MONTHS

PRELIMINARY SAFETY AND ENVIRONMENTAL DETAILS

• NAME OF HONEYWELL CONTACT SUPERVISING THE WORKS:

• NAME OF SUBCONTRACTOR REPRESENTATIVE SUPERVISING THE WORK:

• NAMES OF OTHER WORKERS:

• Will you be using subcontractors during the planned works? Please advise your Honeywell contact of all subcontractors coming to site.

  YES

  NO

• Are all workers engaged in the works site inducted and approved through the Avetta sysyem system to work for Honeywell?

  YES - ALL SITE INDUCTED AND AVETTA APPROVED

  NO - NOT ALL WORKERS SITE INDUCTED AND/OR AVETTA APPROVED

• Are all workers familiar with the work area and specific hazards of the area and associated works? Have all workers signed the SWMS for the planned task?

  YES, FAMILIAR WITH THE SITE, HAZARDS AND HAVE SIGNED THE SWMS.

  NO, NOT ALL WORKERS ARE FAMILIAR WITH THE SITE OR HAVE SIGNED THE SWMS.

• Has the SWMS been issued to Honeywell and approved?

  YES, APPROVED BY HWL.

  NOT APPROVED

• Are tools, plant and equipment in good order ? (plant maintained, electrical equipment tested and tagged etc.)

  YES - EQUIPMENT IN GOOD ORDER, PLANT MAINTAINED TO MANUFACTURER RECOMMENDATIONS AND ELECTRICAL EQUIPMENT IN TEST DATE/TAGGED

  NO - TOOLS, PLANT OR EQUIPMENT MAY BE DEFECTIVE, NOT MAINTAINED OR NOT HAVE TEST/TAG COMPLIANCE

  NOT APPLICABLE - NO TOOLS, PLANT OR ELECTRICAL EQUIPMENT WILL BE USED.

• Are workers aware of the safety requirements, environmental controls for the task?

  YES - WORKERS HAVE BEEN MADE AWARE OF THE SAFETY AND ENVIRONMENTAL CONTROL MEASURES

  NO - WORKERS HAVE NOT BEEN ADVISED OF SAFETY AND ENVIRONMENTAL CONTROL MEASURES FOR THE PLANNED TASKS

• Are workers trained and qualified for the planned works? E.G electrical, refrigeration, plumbing trade licenses. Elevating work platform licenses/Industry cards?

  YES, ALL WORKERS HAVE BEEN TRAINED AND/OR ARE HOLDERS OF TASK SPECIFIC TRADE CERTIFICATES , HIGH RISK WORK LICENSES

  NO, NOT ALL WORKERS HAVE BEEN TRAINED OR ARE IN POSSESSION OF TRADE LICENSES, HIGH RISK WORK LICENSES FOR WORKS THAT THEY WILL BE PERFORMING

  NOT APPLICABLE - PLANNED WORKS DO NOT REQUIRE TRADE LICENSES, HIGH RISK WORK LICENSES OR TASK SPECIFIC TRAINING.

• Have licenses been uploaded into the Avetta portal and approved by Honeywell?

  YES, ALL LICENSES AND COMPETENCIES UPLOADED TO THE AVETTA DATABASE

  NO, HIGH RISK WORK AND OTHER LICENSES/COMPETENCIES HAVE NOT BEEN RECORDED

  NOT APLLICABLE, NO LICENSES ARE REQUIRED FOR THE PLANNED TASKS

ENVIRONMENTAL IMPACTS, HAZARD IDENTIFICATION, RISK ASSESSMENT AND CONTROLS

• HAZARD IDENTIFICATION : The planned works involve:

  Select EXPOSURE TO ENERGISED ELECTRICAL SYSTEMS FALL FROM ONE LEVELTO A LOWER LEVEL LINE BREAKING (E.G. OPENING STEAM/GAS/ CHEMICAL LINES CONFINED SPACE ENTRY EXPOSURE TO ASBESTOS OR SYNTHETIC MINERAL FIBRES TRAFFIC AND/MOBILE PLANT CHEMICALS/FUMES/VAPOURS/DUSTS LOUD NOISE AND/VIBRATION PUBLIC/CLIENT EXPOSURE TO HAZARDS EG. FALLING OBJECTS, MOBILE PLANT SPILL OR RELEASE TO ENVIRONMENT OTHER

  • EXPOSURE TO ENERGISED ELECTRICAL SYSTEMS
  • FALL FROM ONE LEVELTO A LOWER LEVEL
  • LINE BREAKING (E.G. OPENING STEAM/GAS/ CHEMICAL LINES
  • CONFINED SPACE ENTRY
  • EXPOSURE TO ASBESTOS OR SYNTHETIC MINERAL FIBRES
  • TRAFFIC AND/MOBILE PLANT
  • CHEMICALS/FUMES/VAPOURS/DUSTS
  • LOUD NOISE AND/VIBRATION
  • PUBLIC/CLIENT EXPOSURE TO HAZARDS EG. FALLING OBJECTS, MOBILE PLANT
  • SPILL OR RELEASE TO ENVIRONMENT
  • OTHER

• Classify the overall risk of the planned works (After safety and environmental controls are implemented).

  HIGH RISK

  MEDIUM RISK

  LOW RISK

• Record additional safety and environmental controls to be used.

MANDATORY PERMITS AND SYSTEM ISOLATIONS:

• Will the planned works cause interruption or isolation of site utilities and services (e.g. security, access control, medical gases, communication, water, gas, power etc.)

  NO INTERUPTION OR ISOLATION OF SYSTEM OR UTILITIES

  YES, WORKS REQUIRE INTERUPTION/ISOLATION OF SYSTEMS/UTILITIES

• Permits must be obtained and approved before commencing the following activities : please select from list below.

  Select HOT WORKS LIVE ELECTRICAL WORK CONFINED SPACE ENTRY LINE BREAKING WORK AT HEIGHTS ESSENTIAL EQUIPMENT ISOLATION FIRE/SMOKE/EVAVUATION SYSTEM IMPAIRMENT PENETRATION OR DISRUPTION OF FIRE RATED MATERIAL WORK ON ROOFS

  • HOT WORKS
  • LIVE ELECTRICAL WORK
  • CONFINED SPACE ENTRY
  • LINE BREAKING
  • WORK AT HEIGHTS
  • ESSENTIAL EQUIPMENT ISOLATION
  • FIRE/SMOKE/EVAVUATION SYSTEM IMPAIRMENT
  • PENETRATION OR DISRUPTION OF FIRE RATED MATERIAL
  • WORK ON ROOFS

• If yes to isolation of services and utilities, record the extent and duration of the interuption.

SUBCONTRACTOR DECLARATION:

• I confirm that all necessary Work Health, Safety and Environmental measures and precautions documented in the work authority will be taken to ensure the health and safety of workers and others affected by the work. I also confirm that workers performing the planned works are competent and where appliable licensed or certified to carry out the task.

  CONFIRMED

• SUBCONTRACTOR NAME AND SIGNATURE:

  Sign

• WORK AUTHORISATION EXPIREY DATE:

  Date

• Name of Honeywell manager approving HIGH risk work.