WORK BEING PERFORMED

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Location Name:

Attraction / Venue Name:

Scope of Work:

Is This a Major Modification? If so, Explain. *

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Start Date / Time

Date

Time

End Date / Time

Date

Time

Responsible Party:

Responsible Party Phone:

On-Site Contact:

On-Site Contact Phone:

Testing & Acceptance Procedure:

Will You Be Turning off any Electrical Panels or Disconnecting / Interrupting Electrical Power in Any Way?

If Yes, List Panel ID and / or Affected Electrical Panel Information, Connected Technology Equipmengt or Description:

Answer YES / NO / or N/A

Is Attraction Operation Required?

Will any Field Software be Modified?

Do You Need to Enter the Ride Path

Are Restricted Area Access and RMP Procedures Required?

Is Downtime Required?

Will Ride/ Show Equipment Need to be in Motion with Work Being Performed?

Will Maintenance Be Required to Prevent Motion of Vehicles, Animation, or Other Equipment?

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Will You Be Using a Crane?

Will You Be Using an Aerial Lift Platform?

Will You Be Welding or Working With a Flame?

Is Lockout / Tagout (LOTO) Required?

Is Confined Space Entry Required?

Is Roof Access Required?

Use of Chemicals or Required SDS?

Will Work Involve Boring, Trenching, or Digging?

Is Fall Protection Required?

Is Overhead Interference Check Required?

Will You Be Using Scaffolding?

Will There be Work that Requires NESHAPS?

Will Work be Done on or Near the Monorail?

If Yes, Enter Pylon Number Closest to Where Work is Being Performed

If Yes, Will You Need a Key Assist?

Add Any Additional Information Needed for WBP: