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Ehs PR 03.f01 Patos Form
Ehs PR 03.f01 Patos Form
Ehs PR 03.f01 Patos Form
F01
Activity/Task
Date Company Project Location
Complete the PATOS Questionnaire
If a hazardous substances / chemicals is to be used, do you have the MSDS available? NO YES
Equipment & Tools to be used: ___________________________________________________________________
Does the task require a permit or other document approval? NO YES Indicate which
Document Number – Title Owner Date Approved Revision Status Next Review Date
EHS-PR-03.F01 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy
Responsible Engineer /
Signature: Date:
Supervisors Name:
EHS Approver Name: Signature: Date:
Who is person responsible to Sign off by responsible person to state that
Control actions from PATOS implement this control? controls have been implemented prior to
commencing step in task
Yes No
If job is still in progress or incomplete: Have you discussed this PATOS with the oncoming Supervisor?
Document Number – Title Owner Date Approved Revision Status Next Review Date
EHS-PR-03.F01 PATOS Form EHS dd/mm/yyyy Rev 00 dd/mm/yyyy