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Permit to Work at Heights
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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)
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 二手承包商督工)
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 works at height 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 and around the vicinity.本人将监督所有工作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。
Safe means of access or egress provided 确保提供安全的出入通道
Yes
No
Good housekeeping maintained at working location工作地点保持良好的内务家政
Yes
No
Surrounding areas do not pose additional hazards 周边地区没有造成其他危险。
Yes
No
Daily Tool box meeting conducted and records are maintained每日进行工具箱会议和保持记录
Yes
No
Edge protection provided wherever there is falling risks确保提供边缘保护以便降低高处堕下的风险
Yes
No
Due consideration given to eliminate work at heights tasks确保并适当考虑到消除在高处工作的任务
Yes
No
Fall prevention equipment are adequate and in good condition高处堕下预防设备是足够的,并处于良好状态
Yes
No
Fall prevention equipment used to provide access or work platform高处堕下预防设备用来提供工作平台
Yes
No
All personnel are adequately trained to perform work at heights所有工人进行充分的培训,进行高处作业。
Yes
No
Anchorage/ lifeline installed and inspected by competent person 锚固点和生命线是 由合资格的人安装和检查
Yes
No
Travel restraint system used to exclude persons from falling risks旅游克制系统,用于排除高处堕下的风险
Yes
No
Risk Assessment / Safe Work Procedure are conducted and communicated风险评估/安全工作规程进行和沟通。
Yes
No
Standing supervision by supervisor for workers working at height available确保工头或主任在旁监督所有在高处施工的工作
Yes
No
All persons subjected to falling risks are equipped with Personal Fall Arrest System所有受到高处堕下风险的人都配备了个人防坠落系统
Yes
No
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