Closure form

This form should be used by anyone who has been granted a permit to work to undertake work near our infrastructure.

The aim of the form is to enable onsite workers to inform us when all works are finished. 

First name* Last name* Email address* Mobile*

Please state your VicTrack reference number. You will find this reference number in your PTW approval email from VicTrack* Location of work* Was the permit to work successful or unsuccessful?* Successful Unsuccessful Was the permit to work implemented as per your design / plan?* Yes No Was the permit to work completed within the documented time period?* Yes No Were there any issues encountered during the Implementation?* Yes No Please describe the issues*