China Construction (South Pacific) Development Co Pte Ltd

PTW Serial No（ 序列号）: ______________________________

PERMIT TO WORK 施工准许证 - ____LIFTING OPERATION 吊举工作__________

Form No（文件号 ）: HSEMS - 02 – 09B
(THIS COPY SHALL BE DISPLAYED AT PLACE OF WORK, AS APPROPRIATE)
(将此复印并贴示在施工作业区内)
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（施工历时 ）: From（从 ）______ to（至 ）______ (time) Total（共计 ）:______ hours
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throughout the duration of the work, otherwise, this PTW can be withdrawn at any time.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.
这份施工许可证只在以上说明的期限内有效。施工期间必须满足规定的安全工作条件，否则许可证可以随时撤销。申请者负责保
留一份副本并严格按照安全工作程序和要求施工。
SAFETY CONDITIONS TO BE COMPLIED WITH PRIOR TO PERMIT APPROVAL
在施工许可证批准之前必须符合下列安全条件
SAFETY CONDITONS 安全条件 √ / X / *NA
1. Valid LM certificate for crane 有效的吊举机械证书
2. Valid periodic maintenance report 有效的吊举机械维修或检查表
3. Crane operator’s daily check completed 操作员每日对吊举机械检查
4. Lifting supervisor’s daily check completed 吊举督工每日进行检查
5. Crane has been set up on firm ground with its access being in accordance with PE design
吊车通道地面坚固结实，并经过专业工程师设计
6. Crane is at a safe distance from excavations / trenches 吊车及外伸支架与沟坑保持安全的距离
7. Lifting gears are in good condition with number tags, and traceable to valid LG certificates
吊索等吊举配件处于良好状态并有编码和合格证书
8. Overhead dangers checked 高架上等高空危险经过检查
9. Warning signs and barriers provided for lifting zone 施工区域提供警示牌，并设置障碍
10. Crane operation is strictly outside the LTA railway safety zone
吊举作业严格施工在铁路以外的陆路交通管理局安全区
11. Lifting Plan 吊举计划
12. Any toolboxes on the crane are locked and controlled by the operator only. 吊举机上的任何工具箱仅
由操作员锁定和控制
13. Any loose materials or tools under or on the chassis of crane. 吊车底部和机身没有零碎的材料或工具
14. Others(please specify) 其他（请注明）
*Indicate “NA” against conditions that are not required
S/N Name of lifting personnel 姓名 Designation 职位 Signature 签名 Remarks
Day Night
1 Lifting Supervisor 吊举督工
2 Crane Operator 吊车操作员
3 Rigger / Signalman 捆绑员 /
信号员
4 Rigger / Signalman 捆绑员 /
信号员
5 Rigger / Signalman 捆绑员 /
信号员
6 Rigger / Signalman 捆绑员 /
信号员
Crane LM No 吊举机械编号: _________________________ Expiry Date 有效期至: _________________________

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Day work Night work
Permit Application By Foreman / Supervisor / Engineer Permit Application By Foreman / Supervisor / Engineer
of Workgroup of Workgroup
工作小组内的工长/ 督工 /工程师申请施工许可证 工作小组内的工长/ 督工 /工程师申请施工许可证

I fully understand the nature of the work and safety conditions that I fully understand the nature of the work and safety conditions that
must be met. I have inspected the safety conditions relating to the must be met. I have inspected the safety conditions relating to the
work to be performed. work to be performed.
我完全理解了工作的性质和需要满足的安全条件。我已经检查了与 我完全理解了工作的性质和需要满足的安全条件。我已经检查了与
工作相关的安全条件。 工作相关的安全条件。

Name 姓名 : ________________________________ Name 姓名 : ________________________________

Signature 签名 : ________________________________ Signature 签名 : ________________________________
Date 日期 : ________________________________ Date 日期 : ________________________________
Time 时间 : ________________________________ Time 时间 : ________________________________
Permit Verification By WSHO / WSHC / WSHS/ Permit Verification By Night Duty Personnel :
Competent Engineer 现场夜间值班员确认许可证 :
安全评估员/委任的技能人员确认许可证 :

Name 姓名 : ________________________________ Name 姓名 : ________________________________

Signature 签名 : ________________________________ Signature 签名 : ________________________________
Date 日期 : ________________________________ Date 日期: ________________________________
Time 时间 : ________________________________ Time 时间: ________________________________
Permit Approval By Project Manager / Construction Permit Approval By Project Manager / Construction
Manager Manager
项目经理/现场经理批准许可证: 项目经理/现场经理批准许可证:

Name 姓名 : ________________________________ Name 姓名 : ________________________________

Signature 签名 : ________________________________
Date 日期 : ________________________________
Time 时间 : ________________________________
Notification of Works Completion (to be reported by permit applicant)
工作完成的通知(由施工许可申请人报告):
Signature 签名 : ________________________________
Date 日期 : ________________________________
Time 时间 : ________________________________

The above mentioned work was completed on 上述施工完成于 : _______________________ (Date 日期/ Time 时间 )

Name 姓名 : __________________________ Signature 签名 : ________________________

Revocation of Permit (if any) By Project Manager /Authorized Work at height Manager/ WSHO / Work at height Assessor
取消施工许可证

Name 姓名 : ___________________________ Signature 签名 : _________________________

Date/Time 日期/时间 :_______________________ Reasons 原因 :_________________________

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 China Construction (South Pacific) Development Co Pte Ltd

CHECKLIST FOR LIFTING SUPERVISOR ( 吊举督工检查表 )

NAME OF CONTRACTOR (承包商名称):

LOCATION (地点):

TYPE OF CRANE / CAPACITY LM NO LM CERTIFICATE EXPIRY DATE:

(塔吊 / 吊车类型 / 性能) (吊车号码) (吊车执照截止日期)

S/NO ITEM TO CHECK (检查项目) YES(是) NO (否) N.A (无) REMARK

(备注)
1. Valid Approved Person’s Certificate
有效的资格证书
2. Crane access fully laid with steel plate
吊车通道全部铺满铁板
3. Is the crane level and station on firm ground
吊车是否在坚固的地板上
4. Outrigger of crane fully extended
吊车的支架是否全部都有
5. Outrigger of crane rested on steel plate or
timer block
吊车是否支撑在铁板上或木板上
6. Outrigger of crane not rested on edge of
slope
吊车没有支撑在斜坡边缘
7. Lifting gears & appliances in good condition
吊车齿轮和电动工具处于正常工作状态
8. Lifting hook provided with latches
吊钩用门外线路形式
9. Load to be lifted within the safe working load
吊举的重物在安全工作范围之内
10. Is the lift a critical lift
是极限吊举情况吗
11. Others 其他

DATE OF INSPECTION (验收日期) :

NAME OF LIFTING SUPERVISOR (吊举督工姓名) :

SIGNATURE OF LIFTING SUPERVISOR (吊举督工签名) :

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