Company Name
*
Project Name
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time Issue
*
Hour Minutes
AM
PM
AM/PM Option
Expiry Time
*
Hour Minutes
AM
PM
AM/PM Option
Describe in detail the work to be performed and the location/area where the task will be done
*
Reasons the work can't be done other than by using a cutting disc: (band saw, reciprocating saw, plasma cutter, chop saw, or other)
*
1. Does the RPM rating of the disc match the grinder being used?
Yes
No
2. How will the material be cut and secured?
*
3. Has the competency of the worker using the grinder been verified?
*
Yes
No
Years of experience
*
Trade level
*
4. Has the worker seen "The Grind" training video?
*
Yes
No
Submitted by:
*
Approved by: PCL Project Superintendent
*
Signature
*
Approved by: PCL Project HSE
Signature
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
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