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siemens - Public Service Commission

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ATTACHMENT 7<br />

Sheet 1 of 1<br />

Pneumatic Tool Safety Device Exemption<br />

1) Specifically Identify Tool:<br />

Verified By:<br />

Date:<br />

2) The proper operating condition of the tool has been verified.<br />

Verified By:<br />

Date:<br />

3) The proper air hose size has been verified.<br />

Verified By:<br />

Date:<br />

4) The proper safety device size and operational condition has been verified.<br />

Verified By:<br />

Date:<br />

5) No other usable tool is available on site.<br />

Verified By:<br />

Date:<br />

6) Exemption Granted.<br />

Supervisor:<br />

Date:<br />

NOTES:<br />

SAF-NGGC-2172. REV. 8<br />

Page 51 of 55

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