F32. Environmental Management Plan Task Options:Can the work be performed without the need for this high-risk activity? Yes No Indicate if there are environmental risks to each factor listed below:(Required) Air Noise Surface Water Foul Water Waste Disposal Land Ground Water Briefly describe the risks identified and how they can be mitigatedList below the accident / emergency equipment available for use: Add RemoveOutline the related emergency procedures below:List each of the pieces of equipment used to monitor environment quality and note the last date of service/calibration:Details of Monitoring EquipmentService / Calibration Date Add RemoveIs the contractor insured for Environmental damage? Yes No Has any Regulatory Authority been notified of the works? Yes No Conditions imposed upon the works to be done:Has a Risk Assessment been completed? Yes No Control measures installed? Yes No Has SWMS been completed? Yes No Has the Safety Advisor on site been notified? Yes No All staff have been Instructed? Yes No Has non-essential staff left the work area? Yes No Other Permits to Work to be considered:Confined space Yes No Heights Yes No Service Isolation Yes No Hot Work Yes No Excavation Yes No Live Electric Yes No General Works Yes No Plant Isolation Yes No Hazardous Chemicals Yes No Restricted Area Access Yes No The following workers have been involved in the Risk Assessment. Each worker has been trained and assessed as competent for the task. Each worker is aware of the PPE and control measures required to safely perform this task. Each worker acknowledges the work must be performed live and they understand the procedures that have been described to them.Participating and accredited WorkersWorker's NameWorker's Signature Add RemoveThis written authority is valid until:Date:Time:Approval I declare that the above is correct and work may commence.Supervisor's Name:Supervisor's Signature:All persons and equipment accounted for? Yes No Equipment checked and restored correctly? Yes No Completion of WorkAny changes to work methods or comments about the work:Sign to close out PermitDate:Time:
