________________ __________________
DATE / TIME PERMIT HOLDER
I am satisfied that all precautions have been taken and safety arrangements will be maintained for the duration of the work.
________________ _____________________
DATE / TIME SENIOR OFFICER (sign/rank)
WORK PERMIT REVALIDATION: (Permit Holder And Senior Officer To Countersign)
Permit Cancellation
I confirm that the work has been completed and that all the associated equipment, tools and materials have been withdrawn.
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