Document No.

: IMS-QK-HSE-3-0013-1
Rev.00

Member Of The SNC-Lavalin Group

STARRT Card Closeout Sheet

I accept responsibility for safe behaviour and environmental issue for myself during the Task:
S/N (SIGN IN)
Employee (Print) I.D. NUMBER Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
I have taken responsibility for safe behaviour & environmental issues for myself while completing the
S/N above task : (SIGN OUT)
Employee (Print) I.D. NUMBER Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Date :
Safety Officer Signature:

Note: This form is reference in procedure number: IMS-QK-HSE-3-0013