2024年4月11日发(作者：)

中 建 卡 塔 尔 多 哈 项 目 经 理 部

CSCEC DOHA HIGH RISE OFFICE BUILDING

.

PERMIT TO WORK/施工许可

(Confined space/强制条例)

Date/日期：

Time/时间：

Permit No./许可号：

This copy must be displayed at place of work & it only valued for a day.

本许可必须张贴在施工作业面，当天有效。

A） Details of Application (To be completed by Applicant)/

申请细节（申请人填写）

Name of Contractor/施工单位：

Location of Work/施工位置：

Nature of Work/工种：

Total Number of Workers/总工人数：

B）Safety Measures (Applicant MUST ensure the following safety measures are complied

accordingly prior to commencement of work )/

安全措施（申请人必须确保以下安全措施在施工前得以

有效落实）

Yes No N/A

a. Provide safe mean of access for entry & egrees.

安全通道

b. Workers are briefed on the safety requirement before starting works.

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施工前安全交底

c. Scaffold are erected safely with proper access,work platform

(min 2 planks with),adequate tie-back,guard rail & midrails.

脚手架、施工平台（至少两条跳板）、适当的高、中部护栏必须合理架设。

d. Fire estinguisher are placed within close proximity.

防火器具需放置在临近区域内。

e. All worker are fit for works.

所有工人适合从事此工作。

f. All worker are equipped with proper PPE,ie. safety helmet,safety boots,

safety hardress,glove,etc.

所有工人做好安全防护措施如：安全帽、安全鞋、手套等。

electrical energized equipment must be properly grownded.

所有电器设备工前检查。

of communication equipment/tools provided:

talkie,handphone,etc.

提供沟通用设备如：对讲机、手机等

signage like, “Men at work in cofined space” & “Danger keep out”

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are affixed on site.

现场树立安全警示牌如：“在限定区域内工作”“危险”。

route for emergency must be free from obstruction.

紧急逃生通道必须畅通。

Identify altenative escape route/逃生通道确认:

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C)Housekeeping/文明施工

Yes No N/A

debris / used materials are property disposed/discarded off.

工完场清

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中 建 卡 塔 尔 多 哈 项 目 经 理 部

CSCEC DOHA HIGH RISE OFFICE BUILDING

.

D）Completion of work./完工

Yes No N/A

entry to confined space are effectively closed up/barricade/guarded

with warning sign.

所有通道口必须有效关闭/隔离，并树有警示牌。

Note/说明:At least one co-worker/Fire watcher is to be present at all time to ensure that workers are aware of works

are performing in a confined co-worker/Fire watcher will also be responsible to notify the supervisor of

any emergency situation./在限定的施工区域内，必须有至少一名看火人以确保所有工人在施工中保持警觉。此

看火人同时负责在任何紧急情况下通知项目总安全员。

Name of co-worker/Fire watcher/看火人姓名:

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E）Verification & Applicant /确认及申请人

med that safety provisions are carried out with due diligent and had personally inspected the area that was

safe for operation./确认执行安全条例且已检查并确保施工区域安全

Applicant name/申请人姓名 :

Signature/Time /签名/时间:

F）Acknowledgment/批准

Name /姓名:

Signature/Time/签名/时间:

1

st

inspection 2

nd

inspection

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Approved

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Approved

Comment/批注:

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Rejected

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Rejected

Attachments/附件:

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Drawings/图纸

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Documents/文件

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Others/其它