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Run: Stop Work Authority Documentation Form

Stop Work Authority Documentation Form captures the hazard, the stop-work decision, notifications, corrective actions, and the approval to resume. Use it to ...

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Submission Notice

Read this before submitting

I understand this form records a safety event and may be used for audit trail and corrective action tracking. (required)

Yes No N/A

Event Details

Date of stop work event (required)

Time of stop work event (required)

Site / area / unit (required)

Reported by (required)

Reporter role (required)

Work activity in progress (required)

Was contractor work involved? (required)

Hazard Observed

Primary hazard type (required)

Describe the hazard observed (required)

Immediate risk if work continued (required)

Did the event involve injury, near miss, or damage? (required)

Describe injury, near miss, or damage

Work Stopped and Controls

What work was stopped? (required)

Stop action taken (required)

Interim controls implemented (required)

Can work resume immediately? (required)

What must happen before work can resume?

Notifications and Escalation

Supervisor notified? (required)

Supervisor name

Safety team notified? (required)

Other notifications made

Notification details

Resolution and Approval to Resume

Corrective actions completed (required)

How was the hazard verified controlled? (required)

Authorized by

Date work resumed

Time work resumed

Is follow-up action required after resumption? (required)

Follow-up actions

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