交叉作业安全许可证.docx

SIMOPSPermit交叉作业许可证PermitNo.许可证号IOOoo(M)IApp1icationDate申请日期PartA(Genera1WorkInformation(Comp1etedbyPermitIssuer)A部分一般作业侑息由SIMPOS许可i£签发入完成)WorkDescriptionofGroupA/A蛆工作媾述WorkDescriptionofGroupB/B1>E作描述.WorkDescriptionofGroupC/CIf1X作描述Potentia1Hazard可能存在的危险因素，AbcAObcAbcChemica1Exposure化学品接触Hea1SgssZFros1biie中»/冻伤OVerheadHazards离空危险/ABCCuts-Abrasions划伤和挫伤ABcHotSurface热表面eabcabcAUfi1JCIJS1ips&Trips滑倒或绊倒ArcF1ash电弧OverheadHazards地下管她ABCQFa11s坠落aQbcWaterHazards水患abcabcWorkingSurfacejAccess匕问'通道InsufficientabcaObcChipsZS1ivere尖刺/碎图Nosie噪音ABCJghting照明不足Pressure压力abcPinchPoint夹点abcEnvironmcnb1Wcathcr环境/天气ABCMachinery&Equipnwm机械设备ABSPiHS溢漏AB(：IgnitionSources火源abcabcabCPitorHo1e坑洞FircyExp1osion火灾/爆炸InCrtAtmosphere情性环境abcStaticE1ectricity静电aQbcRadiationWork有箱射性的工作ABCABCABCPower1ines动力线1ining吊装InertAtmosphere电动手动工具abcHarmfu1gas有出气体其他Others:HazardMitigations危险H1防指*abcabcbCQRestrictedAccess限制通过Barricade.RoadC1osure道路对闭IEREquipment应急响应设备BCEvacuationRoutes逃生路线abcA1armSystem警报系统ABCABCABC看护人/SafetyWatchEnergyIso1ation能於隔离GasTesting气体检测AB(：EvacuateNon-Re1atedPersonne1疏散无关人员ABCFire-FightingEquipment火火器材其他Others:附属文件abcabcabc随工方案MethodState/WorkP1an工作安全分析JSA|应急计划ResponseP1anABCPID图/单城图P1&D/S1Dabc安全数据清单SDS尤他Others:承包商代表签字以确认11经完全执行了以上所要求的安全事项并对将进行的工作提供必要的安全防护设施。Contractorrepresentativestosignthepermitaftercertifyingthata11requiredprecautionshavebeentakenandnecessarysafetyprotectionfaci1itieswi11beprovided.许可证持有人(Ait1)PermitHo1der(GroupA)施工代表(Aa1)ConstnictionRep.(GroupA)EHS代表(AS1)EHSRcp.(G>upA)许可证持有人(BiiDPermitHo1der(GroupB)腌工代表(Bif1)ConsiniC1ionRep.(GroupB)EHS代表(B组)EHSRep.(GroupB):许可证持有人Cff1)PermitHo1der(GroupC)他工代表(Cff1)ConsiniccionRep.(GroupC)EHS代表(Cff1)EHSRep.(GroupC)PartB-AuthorizationforAPPrOVa1/B部分-授权批海Ihavereviewedthisworkpermitandattacheddocumentsanda1sohavephysica11yinspectedtheworkareawitha11par1ies.Iherebyauthorizetocommencetheworkasbeingapp1iedinthisPTW(PermittoWot).No<c:Thisdurationsha11bedecidedbyPCMCMorhisdesignee.我已经审核过该许可i及附文件并与相关所有方起检食过现场我批准工7乍可以按许可证要求开始作业.备注：该作业时段应由管理公司施:经理或其指派人决定C许可证有效期：ApprovedDurationforthispermitisFRQM自TQ¾IApprova1s很准入Signature签字DateZTimr日期时间ChicJian1iRep.总监代表PermitAuthority-PCMCMorHisDesignee许可证授权人-管理公司施工经理或其授权人PermitIssuer-PCMDiscip1ineEngineer许可证签发人-管理公司专业工程师PermitEHSAdvisor-PCMEHSEngineer许可证EHS顺问管理公司EHS工程师PartC-PermitCance11ation&C1osc-OutC部分-许可证的取消和关闭Safe1yComp1eted安全完成口ShutdownButUncomp1eted停止未完成口SafdyComp1eted安全完成口ShUtdoWnButUncomp1eted停止未完成口App1icant申请方AuthorizingParty批准方ConstructionRcp.(GroupA)俊工代表(Afft)>ate日期JianIJ监理Date日期ConS1nICiiOnRep.(GroupB)施工代表(Bff1)I>ate日期PCMConstructionRep.PCMMinaDate日期ConstructionRcp.(GroupC)施工代表(CaI)I>ate日期PCMEHSRep.PCMEHStDate日期PartD-WorkPartyResponsibIePersonne1andContacts1>M分作负贵ftJK方式Group但Ro1eAAName姓名ContactTE.联系电话APermi1Ho1der许可证持有人AConstnic1ionRcp.施工代表BPermitHO1dCr许可证持有人BConstructionReP,施工代表CPermitHo1der许可证持有人CConstructionReP.施工代表PartE-PermitWorkers'Names(Ifnotsufficient,additivepagecanbeattached)，E部分.参与该作业许可证作业人员名就(如空间不足，可附加页)B坦C蛆Distribution:Thewhiteone-tobcdisp1ayedatjobsite:TheYe11ow-Construction;ThCGreen-PCMEHS;TheB加C-Jian1i许可证分发：白色次于作业点；黄色-脆工部；绿色-PCMEHS；蓝色监理