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MGS3-00-0906-CNPS-063-00 - Stop Work Notice 01

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Farrukh Ijaz
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17 views2 pages

MGS3-00-0906-CNPS-063-00 - Stop Work Notice 01

Uploaded by

Farrukh Ijaz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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(St) Proj Unit Type Dev.

Serial Rev
(2) MGS3 00 0906 CNPS 0063 00

DOCUMENT
STOP WORK NOTICE
TITLE:

STOP WORK NOTICE

STOP WORK NUMBER: SW# 03

DATE & TIME: 08-Oct-24 08:15 am

LOCATION: Km 375+100

WORK PERMIT NUMBER: #000227

ACTIVITY SUPERVISOR: Antonio Cassali

WORK PERMIT ISSUER: Muhammad Sajid

WORK PERMIT RECEIVER: Ashraf Ahmed Khan


S T O P

ACTIVITY Grader
(write a description of the stopped activity)

RISK
(write down the potential risks and reason for
stoppage)

WORK STOPPED BY (ID, Name, Position) ACTIVITY SUPERVISOR (ID, Name)

Name: _____________________________
Name: _____________________________
ID#: _____________________________
ID#: _____________________________
Position: _____________________________
Signature: _____________________________
Signature: _____________________________

Note: Area Safety Officer shall support completing the “STOP” section.
(St) Proj Unit Type Dev. Serial Rev
(2) MGS3 00 0906 CNPS 0063 00

DOCUMENT
STOP WORK NOTICE
TITLE:

STOP WORK NOTICE


Immediate Causes: Root Causes:
☐Operating equipment without authority ☐Inadequate technical skills
☐Failure to warn ☐Lack of/inadequate training and/or information
☐Failure to secure ☐Inadequate personal skills (Stress management, communication skills,
☐Inadequate or missing guards/barriers poor motivation, inadequate leadership/coordinator)
☐Safety devices inoperable or removed ☐Inadequate risk perception/risk underestimated
☐Defective tools, equipment, or materials
☐No work planning or risk assessment performed
☐Using defective tools/equipment or materials
☐Risk assessment not effective/adequate
☐Using tools/equipment or materials improperly
☐Lack of supervision
☐Improper loading
☐Improper placement ☐Inadequate engineering
☐Improper lifting ☐Purchase or wrong tools/equipment
☐Improper position for the task ☐Inadequate maintenance
☐Servicing equipment in operation ☐Wrong or inappropriate tools/equipment
☐Failure to follow the procedure ☐Lack of/inadequate standards or work procedures
A N A L Y S E

☐Horseplay ☐Wear and tear


☐Under the influence of restricted substances ☐Abuse and/or misuse
☐Failure to use PPE or incorrect PPE ☐Required permit not obtained
☐Inadequate/missing warning system (i.e. signs) ☐Overwhelming work pressure
☐Inadequate protective equipment ☐Wrong or inappropriate change management
☐Congestion or restricted action
☐Wrong or inadequate security assessment/provisions
☐Fire and explosion
☐Hazardous atmosphere
Recommendations:
☐Poor housekeeping, disorder
☐Improper use of hazardous chemicals
☐Noise exposure
☐Radiation exposure
☐Difficult climate/weather situation
☐Inadequate or excess illumination
☐Inadequate ventilation
☐Failure to comply with laws and regulations
☐Operating at an improper speed
☐Activities in remote areas
☐Misunderstanding
☐Simultaneous operations/interferences

Safety Supervisor (ID, name & signature)

Note: Area Safety Supervisor shall identify immediate and root causes to identify recommendations.

DATE & TIME:

WORK PERMIT NUMBER:

ACTIVITY SUPERVISOR:
R E S U M E

WORK PERMIT ISSUER:

WORK PERMIT RECEIVER:


All recommended actions implemented and validated?
CORRECTIVE ACTIONS:
☐Yes ☐No
RESUMPTION VERIFIED BY (ID, name, position)

SAFETY SPV: ACTIVITY SPV:

Signature: Signature:

Note: Safety Supervisor and Activity Supervisor shall validate the implementation of recommended actions

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