XXX construction co pte ltd PTW Serial

No（ 序列号）: ______________________________

PERMIT TO WORK 施工准许证 - ____LIFTING OPERATION ___________

Form No（文件号 ）: EHS 2 – F8 Rev 2
(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 Otherwise, this PTW can be withdrawn at any time.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. Valid LM certificate for crane.
3. Valid periodic maintenance report.
4. Crane operator has valid license and has conducted daily check on crane.
5. Lifting Plan and pre-lifting operation checklist done as in attachment.
6. Crane has been set up on firm ground with its access being in accordance with PE design.
7. Crane is at a safe distance from excavations / trenches.
8. Lifting gears are in good condition with number tags, and traceable to valid LG certificates.
9. Overhead dangers checked.
10. Warning signs and barriers provided
11. Crane operation is strictly outside the LTA railway safety zone.
12. Others: a)
b)

Permit Application By Supervisor / Person Responsible for Lifting Operation:

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 Checked By Lifting Supervisor:

Name : ______________________________ Signature : _____________________________
Date : ______________________________ Time : _____________________________

Permit Approval By Project Manager:

Name : ______________________________ Signature : _____________________________
Date : ______________________________ Time : _____________________________

Notifition of work completion by applicant ; the work area has been cheeked and cleared if equipment
tools waste materials etc.

Name : _____________________________ Signature : _________________________

Date : _____________________________ Time : ________________________

List of Workmen involved in Lifting Operation

Page 1 of 2
S/N Name of Worker Designation Signature
1

10

11

12

13

14

15

16

17

18

19

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