Chapter 2: Work Planning and Control
Service Subcontractor Construction Site
Release Form
ENVIRONMENT, SAFETY, HEALTH, AND
QUALITY DIVISION
Product ID: 666 | Revision ID: 1676 | Date Published: 30 September 2014 | Date Effective: 30 September 2014
URL: http://www-group.slac.stanford.edu/esh/eshmanual/references/wpcFormServiceReleaseConstruct.pdf
This form is used to document release by the SLAC field construction manager (FCM) of service subcontractors requiring access to a construction
site. The form is to be completed by the FCM for the construction site and the workers involved; completed forms are maintained in the work
package. (See Work Planning and Control: Work Planning and Control Procedure [SLAC-I-720-0A21C-002].)
Required Permits / Plans (for service work being released)
None
Energy Isolation Plan (CoHE)
Penetration Permit
Confined Space Entry Permit
Excavation Permit
Radiological Work Permit
Construction Project Air Permit
Fire Protection Impairment
Stormwater BMP
Electrical Work Plan (EWP)
Hoisting and Rigging Plan
Other:
Elevated Surface Work Plan (ESWP)
Hot Work Permit-Fire (flame or sparks)
Other:
Worker and Releaser Acknowledgment
Today’s construction site work activities, general or unique hazards, and controls have been discussed, including the permits above. Releaser has
affirmed the worker’s JSA is adequate.
Date
Subcontractor Name
(print)
30 September 2014
Subcontractor
Signature
Subcontractor
Company
SLAC-I-730-0A21J-054-R000
SLAC Releaser Name
(print)
SLAC Releaser Signature
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