Get Form-0066 - After Hours & Weekend Work Request. Employer''s Report Of Injury Or Occupational

Filling out the Form-0066 is essential for requesting after hours and weekend work. This guide will provide clear and straightforward instructions on how to complete the form accurately and efficiently, ensuring all required sections are properly filled out.

Follow the steps to fill out the Form-0066 accurately.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Enter the date of the request in the designated field. This should reflect the date you are filling out the form.
3. Indicate the company requesting the after hours work in the appropriate section. Ensure the name is clear and accurate.
4. Provide the name of the foreman or supervisor overseeing the after hours work.
5. Specify the start date for the work detailed in question 12. This must be at least 24 hours from the time of form submission.
6. Fill in the start time for the work. Be sure to indicate whether the time is AM or PM.
7. State how many workers will be on site during the after hours work.
8. Describe the work to be done in detail, providing enough information for understanding the project requirements.
9. Enter the contact phone number where the supervising personnel can be reached.
10. Input the end date for the work, ensuring it aligns with the project schedule.
11. Fill in the end time for the work, and again specify whether the time is AM or PM.
12. Select the level of risk associated with the work by checking the appropriate box for Level 1, 2, or 3.
13. Complete the sections for first aid attendance and provide the ticket details if applicable.
14. List the locations where the work will be conducted, and if necessary, continue on the back of the form.
15. Detail the emergency plan, ensuring all steps are clearly outlined for safety.
16. Indicate any special equipment that will be used as part of the emergency plan, if applicable.
17. Respond to whether you have written procedures for the work by selecting 'Yes' or 'No'. If yes, attach the procedures for review.
18. Provide any additional comments as necessary to clarify the request.
19. Make sure to gather all signatures required from the safety coordinator and company representatives, verifying if items like SWP are okay.
20. Finally, review all information for accuracy before saving changes, downloading, printing, or sharing the form as needed.

Start completing your Form-0066 online today to ensure your after hours and weekend work request is submitted on time.