HOLD/DANGER TAG:

                                   YES          NO 

CONTRACTOR:

LOCATION: _____________________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

INITIATED BY:   (PRINT NAME)   ____________________________________________________________________________

DATE: ____________________   TIME: _________________   SIGNATURE: ______________________________________

DEION OF NONCONFORMANCE:  _________________________________________________________________

CONTRACTORS AREA RESPONSIBLE SUPERVISOR:  ______________________________________________________________

DISPOSITION:  __________________________________________________________________________________________

ACTION VERIFIED AND STOP WORK ORDER CLOSED BY

FAL HSE MANAGER CONFIRMED CLOSED:

PRINT NAME: _____________________________________

SIGNATURE: ______________________________________

DATE: __________________________________

CONTRACTOR SUPERINTENDENT:

PRINT NAME: _____________________________________

SIGNATURE: ______________________________________

DATE: __________________________________

TIME WORK AUTHORIZED BY FAL ACM TO RESTART:

________________

FAL AREA CONSTRUCTION MANAGER

PRINT NAME: _____________________________________

SIGNATURE: ______________________________________

DATE: ___________________________________