【文章內(nèi)容簡介】 應(yīng)裝接地線(注明地點)已裝接地線(注明接地線編號和裝設(shè)地點)應(yīng)設(shè)遮欄、應(yīng)掛標(biāo)示牌已設(shè)遮欄、已掛標(biāo)示牌(注明地點)工作地點保留帶電部分和補(bǔ)充安全措施附件1：__________________電氣第一種工作票 №：__________：_____________班組：_______________工作負(fù)責(zé)人(監(jiān)護(hù)人)：_________________：_______________________________________________共_____人：____________________________________________工作地點：____________________________________________： 自_______年______月______日______時______分至_______年______月______日______時______分：下列由工作票簽發(fā)人填寫 下列由工作許可人(值班員)填寫19工作票簽發(fā)人簽名：_____________收到工作票時間：_____年__月__日__時__分值班負(fù)責(zé)人簽名：______________工作許可人簽名：值班負(fù)責(zé)人簽名：____________________值長簽名：__________________危險點危險因素控制措施措施落實人：7.許可開始工作時間：____________年______月______日_______時______分工作許可人簽名：___________工作負(fù)責(zé)人簽名：_____________________8.工作負(fù)責(zé)人變動：原工作負(fù)責(zé)人____________離去，變更______________為工作負(fù)責(zé)人。變動時間：_____________年_______月______日_______時________分。工作票簽發(fā)人簽名：___________________20，有效期延長到：__________年____月____日______時____分工作負(fù)責(zé)人簽名：__________值長或值班負(fù)責(zé)人簽名：________________：工作班人員已全部撤離，現(xiàn)場已清理完畢。全部工作于____________年______月_____日______時_______分結(jié)束。工作負(fù)責(zé)人簽名：___________________ 工作許可人簽名：___________________臨時遮攔，標(biāo)示牌，常設(shè)安全措施已恢復(fù)，接地線共_________組，已拆除______組，因另有工作保留______組。（保留原因和地線位置填寫在備注欄內(nèi)）值班負(fù)責(zé)人簽名：____________11.工作組成員安全交底簽名：：_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________21危險點危險因素控制措施措施落實人______________電氣第二種工作票 №：_________(監(jiān)護(hù)人)：_________________________班組___________部門____________工作班人員：_________________________________________________共_____人：__________________________________________________________________工作地點：__________________________________________________________________：自__________年_______月______日______時______分至__________年_______月______日______時______分(停電或不停電)：_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________(安全措施)：______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________：工作票簽發(fā)人簽名：__________________7.工作組成員安全交底簽名：228．許可開始工作時間：___________年________月_____日______時________分工作許可人(值班員)簽名：________________工作負(fù)責(zé)人簽名：_______________：_______________年________月_____日_______時________分工作負(fù)責(zé)人簽名：_____________工作許可人(值班員)簽名：_______________：___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________23危險點危險因素控制措施措施落實人線路名稱及桿號接地線編號___________________電氣線路第一種工作票 №：_______、所(工段)、班組名稱：_________________________________________________：_________________________________________________________：____________________________________________________共_______人(雙回線路應(yīng)注明雙重稱號)：_________________________________________________________________________________________________(注明分、支路名稱，線路的起止桿號)：________________________________________________________________________________________________________________________________________________________________________________：__________________________________________________________________________________________________________________________________________________________________________________________________________________________(包括拉開的隔離開關(guān)、斷路器、應(yīng)停電的范圍)：___________