“ Whatever you do , Do it in safe way ”

LIFTING PERMIT
This permit can be obtained from AK SAFETY DEPARTMENT Permit no.:

Part 1: Application – To Be Completed By Sub-Contractor / By Technician

Work Performed by : ကုမၸဏီ အမည္ (name of Sub-Contractor)

Name of Lifting Supervisor in Signature: လက္မွတ္

Charge: ၀န္ခ်ီ
‘မ’တင္ေဆာင္ရြက္ျခင္းလုပ္ငန္း
ႀကီးၾကပ္သူ အမည္
Name of Riggers: ‘မ’တင္ေဆာင္ရြက္ Name of Signalmen:
မည့၀
္ န္ကို ခ်ည္ေႏွာင္သူ အမည္ ခန္.အပ္ အခ်က္ျပမည္သ
့ ူ၏အမည္

Location / Description of work:

တည္ေနရာ / အလုပ္ေဖၚျပခ်က္

Date & Time of Lifting Work: From No. of

To:
ေဆာင္ရြက္မည့္ ရက္စြ ဲ/ အခ်ိန္ : Personnel:

Safety Requirements to be complied with Prior Application of Lifting Permit: (ပါမစ္မေလွ်ာက္မီေအာက္ပါအခ်က္မ်ားကိုႀကိဳတင္ေဆာင္ရြက္ထားရမည္။)

□ LM is approved to be used by mechanical
engineer.
(၀န္ခ်ီစက္ (သိ.ု )ကရိန္းသည္ စက္မႈအင္ဂ်င္နီယာမွ
အသုံးျပဳရန္အတည္ျပဳၿပီး ဟုတ?္ မဟုတ?္ )
□ Appointed Lifting supervisor present. □ Crane access in good condition
(ခန္.အပ္ထားေသာ ၀န္ခ်ီ ‘မ’တင္ေဆာင္ရြက္ (၀န္ခ်ီစက္ (သိ.ု )ကရိန္း
ျခင္းလုပ္ငန္းႀကီးၾကပ္သူ ရွိ? မရွိ?) ၀င္ထြက္ရာႏွင့္ရပ္တည္ရာ
ေျမျပင္အေျခအေနသည္ ေဘးကင္းျခင္း
□ Appointed Riggers and Signalman ရွိ? မရွ?ိ )
(မတင္မည့္၀န္ကို ကရိယာမ်ားျဖင့္ခ်ီေႏွာင္ျခင္း၊

□ Provision of Signage and Barriers စနစ္က်စြာအခ်က္ျပျခင္းလုပ္ငန္းေဆာင္ရြက္သူ

သီးျခားခန္.အပ္ထားမႈ ရွိ? မရွိ?

(လုံေလာက္ေသာသတိေပးဆုိင္းဘုတ္ႏွင့္

အကာအရံမ်ားစီမံထားမႈ) □ Appointed Competent Crane Operator

(ကၽြမ္းက်င္ရင့္က်က္ေသာ ၀န္ခ်ီစက္ေမာင္းသူ
□ LG are inspected properly by user before lifting. (
သီးျခားခန္.အပ္ထားမႈ ရွိ? မရွိ?)
၀န္ခ်ီရာတြင္ တပ္ဆင္အသုံးျပဳေသာ ခ်ည္ေႏွာင္ျခင္း

ကရိယာမ်ားကို အသံုးျပဳသူမွ လုပ္ငန္းမေဆာင္ရြက္မီ

ေသခ်ာစြာစစ္ေဆးျခင္း ရွိ? မရွ?ိ )

Part 2: Check & Endorse – By AK SAFETY DEPARTMENT / Contractor Safety Assessor (On Site) / By Team Leader

□ Work area is safe. Environment aspects eliminated.

□ Reasonably practicable steps have been taken to safeguard the safety and health of the working personnel, and preservation of the environment
(အလုပ္သမားမ်ား၏အႏၱရာယ္ႏွင့္က်န္းမာေရးအတြက္သင့္ေလ်ာ္ေကာင္းမြန္ေသာ ႀကိဳတင္ကာကြယ္စီမံထားရွိမႈမ်ား စီမံထားၿပီးေၾကာင္းမွန္ကန္ပါသည္။)

Name/Signature: Date/Time:
 “ Whatever you do , Do it in safe way ”

Part 3: Approval – By Project Manager (Issuance of Permit to Work) / By Area Manager

□ I’m satisfied that all reasonably practicable measures have been implemented and enforced, and the working personnel are informed of the
hazards and protection counter measures to be taken. (အလုပ္သမားမ်ား၏ အႏၱရာယ္ႏွင့္က်န္းမာေရးအတြက္ သင့္ေလ်ာ္ေကာင္းမြန္ေသာ
ႀကိဳတင္ကာကြယ္စီမံထားရွိမႈမ်ား၊ အသိေပးထားေသာအႏၱရာယ္မ်ား ႏွင္.လုပ္ေဆာင္ထားေသာတန္ျပန္ထိန္းခ်ဳပ္မႈကို ေက်နပ္မႈရွိပါသည္။) The above mentioned work
is: Approved / Not Approved
Name/Signature: Date/Time: Witness By:

Part 4: Notification Of Completion Of Work By Sub-Contractor / By Technician

□ Housekeeping has been carried □ Work area is safe for other personnel.
□ Work has completed. အလုပ္(လံုး၀) out.
အလုပ္ေနရာသည္ တစ္ျခားသူမ်ားအတြက္
စနစ္တက်သန္. သိုၿပီးစီးမႈ
ၿပီးစီးမႈ
ရွင္းသပ္ရပ္စြာထား ေဘးကင္းလံုျခံဳမႈ
Name/Signature: Date/Time:

Note: Original Copy – to be displayed at lifting location

Legends: = OK/Good X = Not OK/Bad NA = Not Applicable