单位______________ 编号______________1.抢修工作负责人（监护人）______________班组______________2.抢修班人员（不包括抢修工作负责人）_____________________________________________________________共____________人。3.抢修任务（抢修地点和抢修内容）______________________________________________________________________________________________________________________________________________________________4.安全措施_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________5.抢修地点保留带电部分或注意事项______________________________________________________________________________________________________________________________________________________________6.上述1～5项由抢修工作负责人__________根据抢修任务布置人__________的布置填写。7.经现场勘察需补充下列安全措施______________________________________________________________________________________________________________________________________________________________经许可人（调度/运行人员）__________同意（_____年_____月_____日_____时_____分）后，已执行。8.许可抢修时间_____年_____月_____日_____时_____分许可人（调度/运行人员）__________9.抢修结束汇报本抢修工作于_____年_____月_____日_____时_____分结束。现场设备状况及保留安全措施：_____________________________________________________________________________________________________________________________________________________________________________________________________________抢修班人员已全部撤离，材料工具已清理完毕，事故应急抢修单已终结。抢修工作负责人__________ 许可人（调度/运行人员）__________填写时间_____年_____月_____日_____时_____分

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