Quadunion Builders Pte Ltd

PTW Serial No（ 序列号 ）: ______________________________

PERMIT TO WORK 施工准许证 - ____EXCAVATION WORKS _________

Form No（文件号 ）: EHS 2 – F7 Rev 1
(THIS COPY SHALL BE DISPLAYED AT PLACE OF WORK, AS APPROPRIATE)

PROJECT TITLE（项目名称 ）: _____________________________________________________________________

APPLICANT COMPANY（申请公司名称 ）: ___________________________________________________________
NAME OF APPLICANT（申请人姓名 ）: Mr / Ms（先生/小姐 ）_________________________(Delete as appropriate 删除相应的)
WORK TO BE PERFORMED ( 所申请的施工类型 ）:____________________________________________________
DURATION OF WORK / DATE & TIME（施工历时/日期与时间）: From（从 ）___________ to（至 ）___________
LOCATION OF WORK（施工地点 ）: _________________________________________________________________

This Permit-To-Work (PTW) is valid only for the duration stated above. The conditions of issue must be
complied with throughout the duration of the work. Otherwise, this PTW can be withdrawn at any time. The
applicant of this PTW shall be responsible for maintaining a copy of this permit and must produce it upon
request.

SAFETY CONDITIONS TO BE COMPLIED WITH PRIOR TO PERMIT APPROVAL .

SAFETY CONDITONS  /  / NA
1. Workers briefed on safe work procedures & risk assessments.
2. Site checked by licensed cable detection worker (LCDW) before excavation.
3. Excavator operator has valid license and has conducted daily check of excavator.
4. Trial holes carried out where there are underground services near excavation works.
5. Safe means of access provided for excavation depth >1.2 m.
6. Open sides of excavation barricaded for excavation depth > 2 m and warning sign provided.
7. Shoring and bracing or PE-designed cut slope provided for excavation depth > 1.5 m up to 4 m.
8. Shoring and bracing in-accordance with PE-design for excavation depth > 4 m & COS issued.
9. Excavated material or other loads not placed near the edge of the excavation.
10. Others: a)
b)
c)

Permit Application By Supervisor / Person Responsible for Excavation Work:

I fully understand the nature of the work and safety conditions that must be met. I have inspected the
safety conditions relating to the work to be performed.
Name & Signature : __________________________ Company : ________________________
Date / Time : __________________________ Position : ________________________

Permit Verification By WSHO / Safety Assessor:

Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________

Permit Approval By Project Manager:

Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________

Notification of Work Completion by Applicant: The work area has been checked and cleared if
equipment, tools, waste materials, etc.
Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________

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List of Workmen involved in Excavation Works
S/N Name of Worker Designation Signature
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17
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