Miele Store Permit - Request

To be completed by all Miele Personnel

"*" indicates required fields

Store*

Company Role*

Contractor

Other

Company Name*

Supervisor Name*

Supervisor email*

Store Emergency Contact Number

Description of Activities*

Has a RAMS and/or a Safe Plan of Action for the proposed work been prepared and approved. RAMS/SPA must be communicated to staff.*

Yes

Not Applicable

Number of employees?*

Start date of Permit

Permit Requested By

Store Manager Signature

Hidden

Date of cancellation or closing of the permit*

Hidden

Contractor Sign Off

Hidden

Store Manager Sign Off