J-6_Work_Authorization_Form.pdf

COMUSFLTFORCOMINST 4790.3 REV C

IV-10A-1

APPENDIX A

WORK AUTHORIZATION FORM

1. USS 2. SYSTEM 3. WAF NO.

4. JSN 5. DIVISION/LWC/RA

7. JOB DESCRIPTION 6. TECHNICAL WORK DOCUMENT

PREPARATION FOR WORK

8. POST WORK TESTING AS SPECIFIED: BELOW IN THE TWD NO TEST REQD FORMAL TEST PROGRAM

9. RESTRICTIONS/PRECAUTIONS/REMARKS

10. DIVISION/REPAIR ACTIVITY READY TO COMMENCE WORK.

LPO/DIV OFF /RA __________________________________________________________________________ DATE___________________

AUTHORIZATION TO WORK

11. SAFETY OF SHIP (Submarine Only): YES NO

RA SSO (if SPOD used) or QUALIFIED WATCH/DUTY OFFICER (if SOSMIL used)

____________ ________________________________________ DATE ____________________

12. CONCURRENCES:

_______________________ DATE _______ _________________________ DATE _______ _________________________ DATE _______

13. TAGOUT REQUIRED: YES NO

SYSTEM/COMPONENT IS LINED UP FOR WORK, A TAGOUT IS HUNG,

VERIFIED AND SIGNED BY THE REPAIR ACTIVITY (IF REQUIRED) AND SHIP.

TAGOUT NO.____________________________

WATCH/DUTY OFFICER DATE

14. PLANT/SHIP CONDITIONS (E.G., DRAINED, DE-PRESSURIZED,

DE-ENERGIZED) SET. DIVISION/RA IS AUTHORIZED TO START WORK.

WATCH/DUTY OFFICER DATE

REPAIR ACTIVITY DATE

NOTIFICATION OF WORK COMPLETION

15. RESTRICTIONS/PRECAUTIONS/REMARKS

16. WORK IS COMPLETE

LPO/DIV OFF or RA _________________________DATE __________

17. TESTING IS COMPLETE

WATCH/DUTY OFF or RA _________________DATE__________

18. WAF CLOSED OUT

RA_____________________________DATE___________ WATCH/DUTY OFF __________________________________DATE_______________

CHECK IF CONTINUED ON ANOTHER SHEET

Sheet _____

IV-10A-2

INSTRUCTIONS FOR COMPLETING WORK AUTHORIZATION FORM

Block 1. USS: Enter name or the hull number.

Block 2. SYSTEM: Enter the system noun name, abbreviation or identification number.

Block 3. WAF NO.: Enter the WAF serial number.

Block 4. JSN: Enter the Job Sequence Number or job order.

Block 5. DIVISION/Lead Work Center (LWC)/REPAIR ACTIVITY (RA): Enter ship’s Division, LWC or repair activity Point of Contact responsible for conducting the maintenance.

Block 6. TECHNICAL WORK DOCUMENT: Enter the TWD (e.g., Controlled Work Package (CWP)/Formal Work Package (FWP), Task Group Instruction (TGI)) number(s) or enter “see attached TWD Record Sheet”. If a TWD Record Sheet is used, it shall be referenced in Block 6.

Block 7. JOB DESCRIPTION: Enter a description of work to be performed detailed enough for the Authorizing Officer and/or RAR to understand the scope of the work boundary and prepare/concur in the isolation established for this work. If necessary, use of an additional Continuation Sheet per Appendix C is authorized. Description of work can contain either a description of work boundaries or a description of components (see paragraph 10.4.3a of this chapter).

Block 8. POST WORK TESTING IS AS SPECIFIED: Check BELOW and identify test requirements when retest is not contained in a TWD or formal test program. Check FORMAL TEST PROGRAM if retesting will be tracked or completed in a program administered by the repair activity. If FORMAL TEST PROGRAM or NO TEST REQUIRED is checked, Block 17 is N/A.

Block 9. RESTRICTIONS/PRECAUTIONS/REMARKS (OPENING): Enter any restrictions or precautions associated with the work item. If any information is entered in this block, the person making the entry must enter name, organization and date. If necessary, use of an additional Continuation Sheet per Appendix C is authorized.

Block 10. DIVISION/REPAIR ACTIVITY READY TO COMMENCE WORK: Signature by Leading Petty Officer/Division Officer for Ship’s Force work or repair activity indicates that sufficient prerequisites are met to commence isolation for production work.

NOTE: SHIPYARDS IMPLEMENTING SAFETY OF SHIP REQUIREMENTS FOR SURFACE

FORCE SHIPS PER LOCAL MOAS MAY MODIFY AND USE BLOCK 11 TO DOCUMENT

SHIP SAFETY DETERMINATIONS.

Block 11. SAFETY OF SHIP: For submarines, when required by paragraph 10.4.8 of this chapter and/or reference (a), check YES or NO. If the SPOD is used, the Repair Activity’s Ship Safety Officer will sign concurrence. During times when safety of ship qualified RA work control personnel process the WAF, they may sign concurrence for non-Safety of Ship maintenance. If the SOSMIL is used, the qualified Watch/Duty Officer will verify that work is listed on the SOSMIL for that day and sign the block.

Block 12. CONCURRENCES: Concurrence signatures may be entered as necessary (e.g., nuclear/non-nuclear interface, assist work center(s), two cognizant department heads). The Authorizing Officer or RAR should define any needed concurrences by noting the concurring organization beneath the signature line in Block 12 and obtain the concurrences. Enter N/A if no concurrences are required.

Block 13. TAGOUT REQUIRED: If tagout is required, mark YES. When tagout is hung, enter tagout number(s) (Log Serial Number/Shift Operations Management System line item number) and Watch/Duty Officer will sign block. If no tagout is required, mark NO. Enter N/A in TAGOUT NO., and Watch/Duty Officer will sign block.

Block 14. PLANT/SHIP CONDITIONS (e.g., drained, de-pressurized, de-energized) SET, FMA/DIVISION/REPAIR ACTIVITY ARE AUTHORIZED TO START WORK: The Watch/Duty Officer signs in all cases for authorizing the start of all work. Note any restrictions and/or precautions in Block 9. If Block 11 is checked YES, the Watch/Duty Officer shall ensure the work of the WAF is listed on the SOSMIL/Ship’s Plan of the Day prior to authorization of the WAF. RAR signs for authorizing the start of work when the WAF is for repair activity work.

IV-10A-3

Block 15. RESTRICTIONS/PRECAUTIONS/REMARKS: Enter any general conditions (e.g., outstanding work) that may affect system restoration. If any information is entered in this block, the person making the entry must enter name, organization and date. If necessary, use of an additional Continuation Sheet per Appendix C is authorized.

Block 16. WORK IS COMPLETE: A signature by Ship’s Force or the repair activity is entered when the work described in Block 7 is verified complete and tags may be cleared with any exceptions listed in Block 15.

Block 17. TESTING IS COMPLETE: A signature by the activity performing the retest is entered when testing of Block 8 is completed. Block 17 is marked N/A if Formal Test Program is in effect or no test required.

Block 18. WAF CLOSED OUT: When work specified in Block 7 and testing as specified in Block 8 is completed, including all exceptions listed in Block 15, repair activity signature is entered to indicate the WAF is closed out. Ship’s Force signature indicates acceptance of the work and testing and that appropriate system status has been set (e.g., clear tags and perform valve lineups as appropriate for the situation). Block 18 may be signed prior to completion of testing covered by a formal test program. A copy of the closed out WAF shall be provided to Ship’s Force if the repair activity is maintaining the original WAF.