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Work Authorization Permit.
Work Authorization Permit.
I hereby acknowledge receipt of this permit having inspected the above safety precautions. I am satisfied that the precautions taken are
adequate and I accept responsibility for undertaking the work specified above in a safe manner. I declare that neither myself, nor those
persons within my control, will not attempt any other task than that specified above.
Prepared by:
Approved by:
Printed Name: _____________________________________ Signed: _________________ Date: ____________
(Safety Officer)
MW-OPS-SP 3.6.13 F1