4工作许可证(PTW)-精品文档.docx

4工作许可证(PTW)PermittoWork/工作许可证Contractor施工单位CApplicant申请者Task任务描绘:DrawingNo.图纸号Electric/PowerWork电器/电源作业PressureTest/试压ScaffoldingErection/Dismantling脚手架搭建/拆除UseofHeavyEquipment/使用重型设备FloorOpening/楼板开孔作业Radiation/探伤作业WorkingatHeight/高空作业Others/其他HotWork/动火作业ConfinedSpaceEntry/受限空间作业Workimpactaccess占道施工AApplicationDate申请日期Area/Location工作区域/详细位置Typeofwork/工作类别施工单位勾选Lifting/起重吊装Fence/barricadesremove/围栏/防护栏杆移除Excavation/动土开挖Night/OTShift夜班/加班ApplicantsQuickReferenceofHazards/可能存在的危害因素施工单位勾选Liquidorgas液体或气体FallingObjects物体下落Toxicmaterial有毒物Confinedspace受限空间Poorlighting照明不好Adverseweather不利天气HardHat安全帽RespiratoryMask呼吸面罩ProtectiveSuit防护服Dailysafetytalkalreadysettled班前会能否已开Workplaceinspection/recordateachshiftstarting班前检查并记录ProvideSuitableAccessandEgress提供适宜的出入通道EnergyIsolation(LockOutandTagOut)能量隔离(挂锁/标签)ElectricalSystemtobecheckedandcertified电气系统的检查及鉴定Purging,Flushing,Depressurizing,吹扫,冲洗,卸压已确认地下无其它设施，确认人签字：总包单位：土建电仪WorkatHeight高处作业Corrosivematerials腐蚀物EarthCollapsed塌陷Electricity带电TieInWork管线连接Noise噪音SafetyGlasses安全眼镜ProtectionGloves防护手套FaceShield防护面罩Flammable易燃物Explosive易爆InertGas惰性气体RunningMachinery运转设备Traffic交通LiftingOperation起吊作业HearingProtection耳塞/耳罩SafetyHarness安全带OtherPPE(pleasedescribe)/其它防护用品请描绘：Flyingparticles/sparks飞尘/火花Nakedflamesorarcs明火或电弧Radioactivematerials放射性物质High/lowtemperature高/低温Other其它:ApplicantsPPEtoBeUsed/需要的个人防护用品施工单位勾选SafetyShoe/steeltoe钢包头安全鞋DoubleLanyards双系索ApplicantsMeasurestoBeTakenatTheWorkSite/现场需要采取的措施施工单位勾选Equipment/toolsalreadyinspected机具或工具已检查WorkPlaceBarricadeandIsolation现场围护或隔离PostingWarningSigns竖警示/警告牌,标志ReinforcingFieldLighting改善现场照明GasTestRequired气体测试MaterialSafetyDateSheet(MSDS)材料安全数据单工艺管线Nosoilstackbesideexcavationarea坑边不得堆土WorkplaceStandbyPerson/Watchman现场监护人/看护人FireProtection(Extinguisher/Sands)防火措施(灭火器/沙)ReinforcingVentilationCondition加强现场通风(强迫通风)Fall/FallingProtection(Nets,Canopy,Lifeline,Scaffolds)坠落物/坠落防护(安全网,蓬,平台,生命绳等)Methodstatementavailable,能否有作业方案YN现场其它条件备注：N/AApplicantsIsolationVerification(Electrical/Mechanical)/隔离绝缘验证(电气/机械)施工单位填写ElectricalIsolationsCompleted电气完全隔离是YES否NO不需要NALocations:位置SpecialInstructions:十分指令MechanicalIsolationsCompleted机械完全隔离是YES否NO不需要NALocations位置ProcessLineIsolationsCompleted工艺管线完全隔离是YES否NO不需要NALocations位置IhaveconfirmedthattheElectrical/MechanicalIsolationandValveCheckshavebeendoneasperVerifiedby(Signature)Date/TimetheneedoftheparticularoperationspecifiedinthisWorkPermit.负责人签名:日期/时间:我确认已经根据本许可证限定的操作安全要求进行了电气、机械隔离,阀门检查等措施。ApplicantAcknowledgementRiskAssessmentAttachedYESNOJobconditions(equipment/area)areinsafeconditionfortheproposedworkspecifiedinthispermit.附风险评估此工作许可证规定的工作条件(设备/区域)处于安全状况.MethodStatementAttachedIwillbethePTWRecipientandastheresponsiblepersonIwillensureallworkissupervisedbymyselfatalltimes.YESNO附施工方法讲明我作为本工作许可证的责任人/接受人,我将对本工作负责并确保总是监护本工作进行.DrawingsAttached附图纸YESNOApplicantSignature申请人签字:日期：联络Namelistoftheinvolvedworkers/工作人员名单标名特殊工种Watchman监护人：ContractorsOperationAuthorityIwillensuretheworkforceundermycontrolread,andcomplywithriskassessment(JSA),RequirementbythisPermittoWorkandsafetymethodstatement.Iwillguaranteethefieldmonitoringandsupervisionandensurethesafeexecutionofthiswork.IwillnotifytheSiteAuthorityoncompletionorinterruptionofthiswork.我保证我的下属阅读,理解和执行风险评估,许可证要求及安全施工方案.我将保证监护管理以确保安全施行,并且在这个工作完成或终止时通知项目区域负责人.Approvalbycontractor施工单位批准GC/ContractorConst.总包/分包施工主管GC/ContractorSafety总包/分包安全主管Date/Time:Date/Time:Authorization/批准现场十分指令：Ihavereviewedthisworkpermitandattacheddocumentandalsohavephysicallyinspectedtheworkareawithallparties.IherebyauthorizetocommencetheworkasthisPTW(PermittoWork).我已经审核过该许可证及附属文件并与相关所有方一起检查过现场.我批准工作能够按许可证要求开场作业.GCPerson总包施工主管CAFPEDept长安福特设备工程部Date日期GCPerson总包安全主管Date日期Date日期主管工程师技安工程师经理CAFSafetyDept.长安福特安全部CancellationofPermit/许可证关闭Applicant申请者Date日期Distribution:OriginalDisplayedatWorkSite,aftertheworkreturntoCAFsafetyDep.原件由申请人置于作业现场；工作完成后，工作许可证关闭后由申请人交CAF安全部处存档。AfterapprovedbyCAFsafetyDep,ApplicantwriteonthedisplayboardofCAFsafetyDep.工作许可证经CAF安全部批准后,由申请人在工作许可证一览表上登记；SafetyWorkPermit