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Electrical Maintenance Work Order. Work Order Number: XDDQ. Person in charge of the work at this factory (or supervisor): Maintenance (or supervision) team: Number of isolation key boxes: Outsourced work – Person in charge: Construction unit: Schematic diagram of safety isolation. Number of workers: Total of __ persons. 1. Work details: Location or scope of work: Is there an application for hot work? □ No, □ Yes (Location for hot work and name of equipment: ). 2. Planned working time: Starting from __/__/20 at __:__, ending on __/__/20 at __:__. 3. Isolation and safety measures that must be taken: Implementation status of the measures 3.1 Electrical equipment section Key numbers 3.1.1 3.1.2 3.1.3 3.1.4 3.1.5 3.1.6 3.1.7 3.1.8 3.1.9 3.1.10 3.2 Grounding and safety section 3.2.1 3.2.2 3.2.3 3.2.4 3.2.5 3.2.6 3.3 Mechanical equipment section 3.3.1 3.3.2 3.3.3 3.4 Barriers and signboards that should be installed: 3.4.1 3.4.2 3.4.3 3.4.4 3.4.5 3.5 Keeping live parts at the work site and additional safety measures 3.5.1 3.5.2 3.5.3 3.5.4 3.5.5 Person who approved the work order: Date, time: 20 year, month, day Hour, minute Person in charge of the external company’s project: Date, time: 20 year, month, day Hour, minute Person who issued the work order: Date, time: 20 year, month, day Hour, minute 4. Work permit: Risk assessment: □ High temperature □ High voltage □ Electric shock □ Rotating machinery □ Fall from height □ Radiation □ Water damage □ Fire □ Explosion □ Poisoning □ Asphyxiation Other: I assure that all the measures listed above have been properly and thoroughly implemented. Work permit time: Date, Month, Year, Hour, Minute. Work permit issuer: Person in charge of the work: 5. Work extension: Work is extended until Date, Month, Year, Hour, Minute. Work permit issuer: Person in charge of the work: Date, Month, Year, Hour, Minute; Date, Month, Year, Hour, Minute. 6. Change in person in charge of the work: The original person in charge hands over the documents; the work permit issuer takes them back and issues a new permit; the new person in charge receives it. Signatures: Signature, Signature, Signature, Signature. Date, Month, Year, Hour, Minute; Date, Month, Year, Hour, Minute. 7. Work interruption: Start time of interruption: Date, Month, Year, Hour, Minute. Work permit issuer: Person in charge of the work:. Time to resume work: Date, Month, Year, Hour, Minute. Work permit issuer: Person in charge of the work:. 8. Completion of work: I ensure that all workers have left the site and have been informed not to work on the equipment listed in Project 1; all temporary installations, tools, barriers, and miscellaneous items have been removed, and the work site has been cleaned up. Work completion time: Date, Month, Year, Hour, Minute. Person in charge of the work: Person who granted the work permit: 9. Work completion: I confirm that all work has been completed, the keys to the isolation lock box have been retrieved, and the safety isolation measures on the equipment have been removed. A total of groups of ground wires (blades) have been removed. Signature of the on-duty shift supervisor: Date, month, year, hour, minute – 20. Attachments: 11. Remarks: