FORMAT FOR ROAD CLOSURE
1A. Exact Location of road
…………………………………………………….…………
blockade
……………………(Attach marked up drawing)
1B. Purpose :………………………………………………………………………………………….
1C. Commencing Date. ………………………. Date of completion……………………………….
1D. Executing Dept……………………………….. Contractor…………………………………….
1E. Permit for the job to be executed has been obtained: Yes No
1F Name of executor ……………………………. Signature ………………………….T. No……..
2. Permitted with following precautions:
2A. Name of Issuer (GSI)……………………………. Signature …………………….T.No…………
3. Permission is granted as described above with following safety precautions: