ESR App C SFT Rev C-Jan 2002

SANCTION FOR TEST
WORK PERMIT No: SERIAL No:

1. ISSUE LOCATION...............................................
To:.......................................................................(SAEP/AEP)*
The following Electrical Equipment has been made safe in accordance with the AFPC Electrical Safety Rules for
the testing detailed in this Sanction forTest to proceed:
.................................................................................................................................................................................
.................................................................................................................................................................................
TESTING TO BE CARRIED
OUT:..........................................................................................................................
.................................................................................................................................................................................
POINTS AT WHICH THE ELECTRICAL EQUIPMENT HAS BEEN ISOLATED AND CAUTION
NOTICES ATTACHED:.......................................…..............................................................................................
...............................................................................................................................................................................
……DANGER NOTICES ATTACHED
AT:.................................................................................................................
...............................................................................................................................................................................
……CIRCUIT MAIN EARTH APPLIED
AT:...............................................................................................................
.................................................................................................................................................................................
(These may be removed and replaced under this Sanction for Test)
NUMBERS OF ADDITIONAL EARTHS ISSUED:...............................................................................................

KEY SAFES/SAFETY LOCK NOS:......................................................................................................................
OTHER PRECAUTIONS:........................................................................................................................................
DATE:..........................................................................TIME:.................................................................................
NAME :........................................................................SIGNATURE.....................................................................
(IN BLOCK LETTERS) (SAEP)
2. RECEIPT
I have checked the precautions taken and accept responsibility for carrying out the testing on the Electrical
Equipment detailed on this Sanction for Test and for taking precautions to prevent Danger.
DATE:..........................................................................TIME:.................................................................................
NAME :........................................................................SIGNATURE.....................................................................
(IN BLOCK LETTERS) (SAEP/AEP)*
3. HAND BACK OF WORK

The testing stated in Part 1 has been terminated and all persons under my charge have now been withdrawn and
warned that it is no longer safe to carry out testing on the Electrical Equipment detailed in this Sanction for
Test. All tools, test equipment and Additional Earths have been removed.
The testing is Complete/Incomplete*
Earths removed for testing purposes have been re-applied.
Exceptions (if none, state NONE).............................................................................................................................
.................................................................................................................................................................................
DATE:..........................................................................TIME:.................................................................................
NAME :........................................................................SIGNATURE.....................................................................
(IN BLOCK LETTERS) (SAEP/AEP)*
4. CANCELLATION
All Earths specified in Part 1 have been removed. This Sanction for Test is cancelled.
DATE:..........................................................................TIME:.................................................................................
* Delete whatever is not applicable REV C:- Jan 2001 MESC 93-55-81-035-9
White Copy- Permit Holder, Pink Copy – Senior Authorised Electrical Person , Blue Copy- Retained by Permit Co-ordinator
SANCTION FOR TEST
NAME :........................................................................SIGNATURE.....................................................................
(IN BLOCK LETTERS) (SAEP)
5. CROSS REFERENCES:....................................../................................................/............................................
* Delete whatever is not applicable REV C:- Jan 2001 MESC 93-55-81-035-9
White Copy- Permit Holder, Pink Copy – Senior Authorised Electrical Person , Blue Copy- Retained by Permit Co-ordinator

ESR App C SFT Rev C-Jan 2002

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SANCTION FOR TEST

WORK PERMIT No: SERIAL No:

NUMBERS OF ADDITIONAL EARTHS ISSUED:...............................................................................................

3. HAND BACK OF WORK

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