SAFETY STOP WORK ORDER

CONTRACTOR :

LOCATION : DATE : TIME :

NAME OF PERSON IN CHARGE :

DESCRIPTION OF WORK IN PROGRESS

-

You are hereby instructed to stop work on the above mentioned activities with immediate effect
in view of the breach in safety standards as described below: -

Please ensure all procedures must adhere before commence any work and please submit your
completed checklist to us.

Note:

NOTICE SERVED BY: ACKNOWLEDGE BY:

NAME: NAME:

SIGNATURE: SIGNATURE:

The following corrective action has been completed and you are REQUESTED TO INSPECT the
work on: _______________ at _________________ hours.

NAME & SIGNED:

The subject works have been inspected.

THIS STOP WORK ORDERS IS LIFTED
COMMENTS:
DATE: NAME:

TIME: SIGNATURE:
* Delete as appropriate