Document Reference

INTEGRATED MANAGEMENT SYSTEM UCC-IMS-HSE-6009D

Rev. No. Rev. Date
HSE AWARENESS AND INCENTIVE SCHEME PROCEDURE
01 23-06-2016
Page
STOP WORK ORDER / NOTICE 1 of 1

This notice must be issued personally to the responsible Supervisor and a copy handed to the responsible Line
Manager (i.e. Contracts / Snr. Project / Plant Manager / Construction Manager).
Issued To: Company:
Signed
Position:
(Acceptance):
Name of Position of
Defaulter: Defaulter:
Issued By: Position:
Stop Work Order Notice No.: Date Issued:

In terms of the Suspension of Work provision of the approved ucc-sacyr Project Safety, Health and Environmental Plan and
Integrated Management System,

 All work related to __________________________, performed in the (area) ___________________,

under supervision of ___________________________, has been suspended with immediate affect

(date) _________________________, due to the following reasons (Circle A, B, C or D below):

A. Failure to correct identified risk conditions as per HSE Default Notice No. _____________________.

B. Poor workmanship that could adversely affect the quality of product or production

C. Failing to comply with HSE Management System and sacyr-ucc Operational Control requirements.

D. Immediate danger placing people's safety, health, and / or the environment at risk.

E. Identified At Risk Condition / Substandard Workmanship:

1.

2.

3.

4.

You must ensure that corrective measures are taken immediately to nullify and control the identified risk(s) to comply
with required and agreed standard.
Work may not resume until appropriate corrective measures have been taken and the
STOP WORK ORDER / NOTICE have been cleared / signed off by the initiator.
ZERO TOLERANCE FOR UNSAFE CONDITIONS AND UNSAFE ACTS
Initiator / HSE Manager / HSE Engineer / HSE Officer follow-up:
Corrective / preventative Action have been completed and work may resume

Date & Time: Name: Signature: