Template

240-43921804 Rev 6
Identifier
Matla Power Station Visitors Document
16340 Rev 0
Permit Request Identifier
Effective Date January 2018
Review Date January 2021

DETAILS OF SUBMITTER

Name
Surname

Company/Department

Designation

Contact Number

Authorising Manager’s Initials & Surname

Date Signature

DETAILS OF VISITOR/S

SURNAME & INITIALS ID NO/”U” NO COMPANY/DEPARTMENT

DETAILS OF VISIT
Controlled Disclosure
When downloaded from the document management system, this document is uncontrolled and the responsibility
rests with the user to ensure it is in line with the authorised version on the system.
No part of this document may be reproduced without the expressed consent of the copyright holder, Eskom
Holdings SOC Ltd, Reg No 2002/015527/30.
 Template
240-43921804 Rev 6
Identifier
Matla Power Station Visitors Document
16340 Rev 0
Permit Request Identifier
Effective Date January 2018
Review Date January 2021

Date of Arrival Time of Arrival Length of Stay

Approved by Manager? Yes No Induction Required? Yes No

Host Name & Surname

Venue

Purpose of visit (Be specific and supply as much detail as possible):

*Note
 No one is allowed to amend or make changes to this form
 Only to be used by Matla Power Station Employees
 Must be completed in full before access will be given
 To be submitted to Security at least 24 hours in advance
 Ensure that induction is completed for people that will be working on site before making arrangements
on this form

Controlled Disclosure
When downloaded from the document management system, this document is uncontrolled and the responsibility
rests with the user to ensure it is in line with the authorised version on the system.
No part of this document may be reproduced without the expressed consent of the copyright holder, Eskom
Holdings SOC Ltd, Reg No 2002/015527/30.