Name of original design engineer(s):

Design drawing number(s):

I confirm that; the permanent works engineer has been consulted and has agreed that the permanent works supported by the falsework/temporary works detailed above are now self-supporting and I am satisfied that it is safe to strike/dismantle the falsework/temporary works detailed above.

Name of Senior Temp. Works Co-ordinator (please print):

I confirm that I have inspected the falsework/temporary works detailed above, I am satisfied that it can be safely struck/dismantled and I will comply with any special striking conditions

Name of Contractor Supervisor (please print):

I confirm that the permanent works engineer has been consulted and has agreed that the permanent works supported by the falsework/temporary works detailed above are now self-supporting I am satisfied that it is safe to strike/dismantle the falsework/temporary works detailed above.

Name of Project Leader (please print):