Permit for Excavation Work，Depth of excavation (m)，挖掘深度(米)

Permit for Excavation Work

Image

Please use mobile phone to attach photo

Location of work 施工位置

Permit validity Period 准证有效期(From)

Description of work 工作性质叙述

Permit validity Period 准证有效期 (Till)

Depth of excavation (m) 挖掘深度(米)

This permit is valid only for the period stated above. The conditions of issue must be complied with throughout the duration of work. This permit may be revoked at any time. You are responsible for the copy of this permit to display at work location till completion of the above work or expiry or revocation of permit and must produce it on request. 此准证以上述准证期为限。在工作期严格遵守所有工作条件与规格否则此准证将以作废论。你须承担此准证所述的责任，保存此准证并随时出示以供检验之用。

STAGE 1 – Application for Permit to Work (PTW) by the permit requester (STRAITS Engineer/Site Supervisor or Sub contractor Supervisor) 阶段 1–准证申请者 (海峡工程师/工地管工或二手承包商管工)

I have checked and confirmed that the following WSH measures have been taken to ensure safety and health of persons at work and fully understand the nature of work and the WSH compliances. 本人已检查与确认以下所列项目皆遵照相关安全条规，并充分明瞭上述工作性质与所需遵照的安全条规。I will supervise & continuously monitor the excavation works and undertake to stop/cease the operation should there be any unsafe condition or potentially hazardous situation arose during the course of work. I undertake to report immediately if there is any incompatible work found in /around the vicinity. 本人将监督所有工作程序并担保一旦发现任何导致工地意外的危险性举动或环境将即刻停工。

Power grid license No ,编号

Proper draining system in place 提供良好排水系统

Yes

Over head protection for the excavation cabin 挖掘机操纵舱须有上方防护板

Yes

Slopes are properly protected to avoid erosion 挖掘沟槽斜坡须保护以防冲蚀

Yes

Slopes are maintained as per PE design 挖掘沟槽斜坡角度须遵照专业工程师的设计与指示

Yes

Power grid licensed excavator operators are employed ,须有高压电力网合格挖掘机操纵员

Yes

The excavator are maintained periodically with records 挖掘机须定期维修，保留相关纪录

Yes

Adequate warning signboards placed at strategic locations 提供警示牌于显要的位置

Yes

All control measures are in place as per risk assessment 一切的意外防护措施须遵照风险评估所列

Yes

Personal protective equipment worn by all workers / site staff 所有工人与员工须穿戴备

Yes

Shoring to excavated trenches if exceed 1.5 meter depth 如挖掘深度大于1.5米，提供支撑或斜撑系统于挖掘沟槽

Yes

Materials are kept from the edge of excavation edges (min. 600mm) 不可存放任何物件于挖掘沟槽边缘600毫米之内

Yes

Dewatering system and pumps are available ，Accumulation of water is taken care of 提供抽水机及时将积水抽离

Yes

Excavation with more than 4 meter deep are provided with PE design 如挖掘深度大于4米, 须遵照专业工程师的设计示

Yes

Proper safe access to and egress from excavation provided e.g. ladders, steps, etc 提供良好的通行道，梯阶及扶手等

Yes

Open sides of excavation are guarded by effective barriers (min. 1.1 meter high) 提供至少1.1米高的围栏于所有挖掘槽

Yes

PE design available for sheet piling, underpinning, shoring or other means of shoring and PE arranged for Certificate of Supervision

Yes

Operators, workers and other trade workers working around the vicinity are briefed on the hazards associated 挖掘机操纵员及挖掘范围附近活动的员工都被训示相关意外风险

Yes

The excavators are provided with necessary safety components such rear side mirror, blinker lights, warning system, 挖掘机配有望后镜，警示系统及闪光讯号灯等

Yes

name

Signature

designation

Date & Time

Permit for Excavation Work

Construction Management System

Knowledge Based

For more information

Product

Company

Support

Product

Company

Support