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I have participated in a review of the Permit Pack which includes the Permits, JSA(s), and relevant documents for safe work execution. I understand the
hazards that have been identified and the controls implemented and maintained to work safely.
Each person working on this permit must sign before commencing work for the first time. If any person working on this permit considers that conditions
are becoming unsafe to continue, they will immediately inform their co-workers, stop work, make the worksite safe, and then inform Permit Holder and the
Area Operator.
Date
Time In
Time Out
Name
Signature