QAC Job Safety Analysis & Authority to Work Permits

Authority to Work Permit (ATWP)

Welcome to Queenstown & Wanaka Airports, Authority to Work System, the JSA portion is to be completed by the contractor proposing the work prior to an Authority to Work Permit being assessed
JSA Section (Job Safety Assessment) To be completed by the contractor
Date of Request *

Day Month Year
Date
Primary Contact Name *

First Name Last Name
Email *
[email protected]
Mobile Number *
Name of Company *
Do you have a current QAC Site Induction? *

Yes No
Are you using any other staff ? *

Yes No
Other Staff Details *
Are you using sub contractors? *

Yes No
Sub Contractor Details *
Part A: Work Details
Site *
Location of Work/Access Required? *
Description of Work *
Work Date/Time Start *
Work Date/Time End *

Liability Acceptance (Contractor)

I, {primaryContact} understand the above safe work requirements and agree to comply with this authority to work.

This document must be displayed or available on request by QAC staff at the location and time of work and is only valid for the period authorised in the ATW.

Audits or inspections may be conducted at anytime during the work.

I warrant that all persons under my control are trained in the safe work procedures submitted for the job, and hold the necessary licences and competency to perform their work.

I hereby agree to complete the work as described to the highest standards and agree that QAC may engage a third party without my agreement to rectify any items and that I am liable for the cost of this rectification work.
Work Authorisation (ATW Issuer)

I, {permitIssuer} hereby authorise the persons nominated above to perform the work specified within this authority to work.

I have also validated all contractors licenses / certificates of competency required for the relevant activities they have been engaged for
Status *
Comments
ATW Extension
Extension Required
Extension Start Date
Extension End Date
Date Extension Approved

Day Month Year
Extension Approved By
Confined Space Permit Checklist
Working at Heights Permit Checklist
Excavation Permit Checklist
Hot Work Permit Checklist
Isolation Permit Checklist
Completion Checklist
Should be Empty:

Authority to Work Permit (ATWP)