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  • C822444-COR-HS-FRM-0001 Stop Work Authority (SWA) Form Rev 2 (Jan 16)

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    Andrianto Bakri
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    This document is a Stop Work Authority form used to report safety issues observed during engineering and construction projects. The form collects information about the observer who initiated the SWA, the observee the SWA applies to, details of the observation such as location and nature of work, reason for issuing the SWA, and how the issue was responded to and resolved. Feedback is also captured on whether work resumed, if the problem was real or perceived, and if outside resources were involved to address the safety concern.

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    This document is a Stop Work Authority form used to report safety issues observed during engineering and construction projects. The form collects information about the observer who initiated the SWA, the observee the SWA applies to, details of the observation such as location and nature of work, reason for issuing the SWA, and how the issue was responded to and resolved. Feedback is also captured on whether work resumed, if the problem was real or perceived, and if outside resources were involved to address the safety concern.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    44 views1 page

    C822444-COR-HS-FRM-0001 Stop Work Authority (SWA) Form Rev 2 (Jan 16)

    Uploaded by

    Andrianto Bakri
    This document is a Stop Work Authority form used to report safety issues observed during engineering and construction projects. The form collects information about the observer who initiated the SWA, the observee the SWA applies to, details of the observation such as location and nature of work, reason for issuing the SWA, and how the issue was responded to and resolved. Feedback is also captured on whether work resumed, if the problem was real or perceived, and if outside resources were involved to address the safety concern.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 1

    ENGINEERING & CONSTRUCTION MANAGEMENT PROJECT

    STOP WORK AUTHORITY FORM


    A.     Observer Data (SWA is initiated/reported by)/Data Observer (SWA digagas/dilapor oleh):

    Name/Nama: Badge./Badge no: Signature:


    Dept./Dept: Job Title/Jabatan:

    Company/Perusahaan:
    Date:

    B.      Observee Data (SWA is implemented to)/Data Observee (SWA diterapkan kepada):

    Name/Nama: Badge/Badge no: Signature:


    Dept./Dept: Job Title/Jabatan:

    Company/Perusahaan:
    Date:

    C.     Detail SWA Observation/Observasi Detail SWA:


    Location/Lokasi: OU:
    Date/Tanggal
    Human Lifting
    Motor &
    Nature Of Job: Earthwork Serious Injuries & Confined
    Civil Fatality (SIF): Performance Rigging
    Vehicle
    Mechanical/ Space Work at
    Electrical & Electrical Safety
    Process
    Piping Excavation Height
    Instrument
    Other Hotwork Safety
    Non SIF
    *Probable Severity Level: (tick the box) Hum Physi Syst
    3b Category:
    an cal em
    Description/Deskripsi:

    Reason for doing SWA/Alasan melakukan SWA:

    Response & Resolution/ Respon & Resolusi:

    Feedbacks/ Umpan balik:


    No/
    Was work activity resumed? / Yes/
    Tida
    Apakah aktivitas kerja dilanjutkan kembali? Hrs/jam: …….. hrs Ya
    k
    No/
    Was real problem? / Yes/
    Tida
    Apakah isu SWA disepakati kedua pihak? Ya
    No/
    k
    Was perceived problem? / Yes/
    Tida
    Apakah isu SWA hanya dirasakan satu pihak? Ya No/
    Was issue resolved? / Yes/ k
    Tida
    Apakah isu yang dibahas terselesaikan? Ya
    No/
    k
    Were outside resources involved to mitigate? / Yes/
    Tida
    Apakah melibatkan pihak lain untuk mitigasi? Ya
    C822444-COR-HS-FRM-0001 rev02 k
    Distribution SWA files:
    White - Contractor Pink - CPI Yellow - RW Issuer Green - HES File
    C822444-COR-HS-FRM-0001 rev02

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