变电站第二种工作票单位______________编号______________1.工作负责人（监护人）______________班组______________2.工作班人员（不包括工作负责人）_______________________________________________________________________________________________________________________________________________________________共____________人。3.工作的变配电站名称及设备双重名称_______________________________________________________________________________4.工作任务工作地点或地段工作内容5.计划工作时间自_____年_____月_____日_____时_____分至_____年_____月_____日_____时_____分6.工作条件（停电或不停电，或邻近及保留带电设备名称）____________________________________________________________________________________________________________________________________________________________________________________________7.注意事项（安全措施）_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________工作票签发人签名__________签发日期_____年_____月_____日_____时_____分8.补充安全措施（工作许可人填写）9.确认本工作票1～8项许可工作时间：_____年_____月_____日_____时_____分工作负责人签名__________工作许可人签名__________10.确认工作负责人布置的任务和本施工项目安全措施工作班人员签名____________________________________________________________________________________________________________________________________________________________________________________________11.工作票延期有效期延长到_____年_____月_____日_____时_____分工作负责人签名_______________年_____月_____日_____时_____分工作许可人签名_______________年_____月_____日_____时_____分12.工作票终结全部工作于_____年_____月_____日_____时_____分结束，工作人员已全部撤离，材料工具已清理完毕。工作负责人签名_______________年_____月_____日_____时_____分工作许可人签名_______________年_____月_____日_____时_____分13.备注_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
