《安全管理资料》之电力线路带电作业工作票.doc

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1、电力线路带电作业工作票单位           编号           1．工作负责人（监护人）                班组            2．工作班人员（不包括工作负责人）                                                               共      人3．工作任务 线路或设备名称工作地点、范围工作内容         4．计划工作时间 自    年  月 日 时 分至    年  月 日 时 分5．停用重合闸线路（应写双重名称）                  

2、                                                                                                                                          6．工作条件（等电位、中间电位或地电位作业，或邻近带电设备名称）                                                                                                         

3、                                                    7．注意事项（安全措施）                                                                                                                                                             工作票签发人签名              签发日期    年  月 日 时 分8．确认本工作票1～7项工作

4、负责人签名       9．工作许可调度许可人（联系人）        许可时间    年  月 日 时 分工作负责人签名                   年  月 日 时 分10．指定       为专责监护人专责监护人签名        11．补充安全措施                                                                                                                                               

5、                                                                                            12．确认工作负责人布置的工作任务和安全措施工作班人员签名：                                                                                                                                                         

6、    13．工作终结汇报调度许可人（联系人）工作负责人签名                    年  月 日 时 分14．备注