Daily Excavator Inspection Checklist

APPOINTMENT RECORD FORM

Acknowledg e Project 工程名: 

Photo of Appointed Person 委任人照片

Name of Appointed Person 委任人姓名: Low –

Identification Nos of Appointed Person 委任人⾝份证: SXXXX298F Type of Appointment(s) 委任类型

☐ Confined Space Assessor密闭空间评估员

☐ Occupational First Aider职业急救员

☐ Dumper Operator⾃卸⻋操作员

☐ Confined Space Supervisor密闭空间主管

☐ Confined Space Worker密闭空间工作者

☐ Excavator Operator挖掘机操作员

☐ Formwork Supervisor模板主管

☐ Powered Tool Operator动⼒工具操作员

☐ Forklift Operator叉⻋操作员

☐ Lifting Supervisor起重监督

☐ Rigger / Signalman索具 /信号⼿

☐ Crawler Crane Operator履带起重机操作员

☑ Risk Management Team Leader风险管理组⻓

☐ Risk Management Member风险管理成员

☐ Mobile Crane Operator移动式起重机操作员

☐ Scaffold Supervisor脚⼿架主管

☐ Scaffold Erector脚⼿架安装工

☐ Tower Crane Operator塔式起重机操作员

☐ Work-At-Height Supervisor高空作业主管 ☐ Working-At-Height Worker高空作业工作者

☐ MEWP Operator (Boom Lift) 移动式高架工作 平台操作员(动臂升降机)

☑ WSH Professional / Safety Assessor WSH专业/ 安全评估师

☑ WSH Committee Member WSH委员会成员

☐ MEWP Operator (Scissor Lift) 移动式高架工 作平台操作员(剪叉式升降机)

☐ Emergency Response Team (Please specify) 紧急反应 小组（请注明）

☑ Others (Please specify) 其他，请注明

ECO & ECMO

List of attached document / photo eg qualification and training certifications附加⽂件/照片列表例如资格和培训证书: 1.WSHO, ECO, ECM, RISK MANAGEMENT CERTIFICATES

I understand that I have been appointed for the above appointment(s) and it is my duty and responsibility to ensure that the provisions in the WSH Act, its subsidiary legislations and all environmental, health and safety requirements are complied.

I fully understand that I shall be held responsible if I fail to discharge my duty and responsibility diligently.

The above appointment(s) shall ceased at the end of the project or upon my notification to TPS EHS Department, whichever come earlier.

我知道我已被委任上述任命，我的职责是确保遵守WSH法案，其附属立法以及所有环境，健康和安全要求的规定。

我完全理解，如果我不努⼒履⾏我的责任和义务，我将承担责任。

上述委任将在工程结束时或在我通知TPS EHS部⻔时（以先到者为准）停止。

Signature of Appointed Person委任人签名:

I have reviewed the above appointment and is satisfied the appointed person is competent and/or qualified to perform the appointed role(s).

The above appointment(s) shall take immediate effect.

我已经审查了上述委任，并且满意被委任的人员具备胜任和/或有资格担任指定的⻆⾊。上述委任应立即生效。

Name of Authorised Manager授权经理姓名: –

Designation 职称: – Signature签名: –

Date & Time ⽇期时间: –

DOC / REV DATE :

Appointment Record Form / 28/03/2018

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