附录B 变电站（发电厂）第一种工作票格式变电站（发电厂）第一种工作票单位______________ 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_______________________________________________________________________________自_____年_____月_____日_____时_____分至_____年_____月_____日_____时_____分7.收到工作票时间_____年_____月_____日_____时_____分运行值班人员签名___________ 工作负责人签名__________8.确认本工作票1～7项工作负责人签名____________ 工作许可人签名___________许可开始工作时间：_____年_____月_____日_____时_____分9.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组人员签名_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 10.工作负责人变动情况原工作负责人__________离去，变更___________为工作负责人工作票签发____________ _____年_____月_____日_____时_____分工作人员变动情况（增添人员姓名、变动日期及时间）：_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________工作负责人签名____________ 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_____分全部工作于_____年_____月_____日_____时_____分结束，设备及安全措施已恢复至开工前状态，工作人员已全部撤离，材料工具已清理完毕，工作已终结。

工作负责人签名__________ 工作许可人签名__________14.工作票终结临时遮栏、标示牌已拆除，常设遮栏已恢复。

未拆除或未拉开的接地线编号等共_____组、接地刀闸（小车）共_____副（台），已汇报调度值班员。

工作许可人签名__________ _____年_____月_____日_____时_____分15.备注（1）指定专责监护人__________负责监护___________________________________________________（地点及具体工作）（2）其他事项_______________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________附录C 电力电缆第一种工作票格式电力电缆第一种工作票单位______________ 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.电力电缆双重名称___________________________________________ 自_____年_____月_____日_____时_____分 至_____年_____月_____日_____时_____分7.确认本工作票1～5项工作负责人签名__________8.补充安全措施_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 工作负责人签名__________9.工作许可（1）在线路上的电缆工作：工作许可人__________用________方式许可自_____年_____月_____日_____时_____分起开始工作。