35KV变电站停电工作票
山西介休倡源煤炭公司1、用户名称___________________________________________________________________________________________________2、工作负责人_____________全部工作人员共______人联系电话____________________________________________________3、工作任务_________________________________________________________________________________________________________________________________________________________________________________________________________________4、工作地点：__________________________________________________________________________________________________5、计划工作时间：自_____年_____月_____日_____时_____分至_____年_____月_____日_____时_____分6、应拉开的开关、刀闸或跌落保险：_____________________________________________________________________________________________________________________________________________________________________________________________应装设地线的地点______________________________________________________________________________________________________________________________________________________________________________________________________________7、补充安全措施_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________签发人_______________签发日期________月________日8、许可开始工作时间_____年_____月_____日_____时_____分工作许可人_______________工作负责人_______________9、每日上工和收工时间做好安全措施许可工作上工时间日时分工作许可人签名工作负责人签名工作人员退出、材料工具清理完毕、工作票交回收工时间日时分工作许可人签名工作负责人签名
f10、工作终结：现场已清理完毕，现场地线均已拆除，工作人员已全部撤离现场，全部工作已结束，工作票已于_____年_____月_____日_____时_____分交回，可以恢复送电。工作负责人_______________工作许可人_______________
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