吊装作业许可证格式

PermitNo.:HWP-RigNo.:WellNo.:Date:Timestarts:Timepermitexpire:AreatoBeWorkedOn:SpecificWorktoBeDone:Permitapplicant&CrewMenbers:DescriptionofWork(s):SpotCheck(ConductedbyPIC):Signature:Time:Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.oPre-JobSafetyMeetingHeld(JSAReviewed)oNon-EssentialPersonnelClearedFromAreaoLockout/TagoutRequired:BreakerSwitch#oManRiderJSACompleted/Communicatedo PoweroffVerifiedBy:o AllToolsSecuredToWorkso WillLockoutRemainPastyourShift?Lock#o Ladders/ScaffoldingRequiredo EquipmentDepressurizedo SignalsDiscussed(Verbal&HandorRescueline)o EquipmentDrainedo FullBodyHamess/Lanyard/RopeRequiredo FlushedWithWatero FireExtinguisherReadyTouseo SteamedOuto IntrinsicallySafeToolRequiredo Vessels/LinesPurged/WithWhat?o ExplosionProofExectricalCordsRequiredo Drains/SumpsCovered&Sealedo ExectricalToolsGroundedTypeo Equipmentcooled/Ventilated/Isolatedo Fire&GasDetectorsIsolatedo CombustibleMaterialRemovedo AreaBarriers/SignsPlacedo Blindsinstalled&BleedsOpeno Water/SteamHouseReadyToUseo Vessels/LinesToBeVentedo FaceShield/GogglesRequired(CircleOne)o PhysicalSeparationReqiuredo HearingProtectionRequiredo Grounding/BondingCablesRequiredo FireBlanketRequiredo ExplosiveOrToxicGasMonitoringo Non-StandardPPEClothing(Type)?o OxygenDeficiencyTestRequiredo RuberSafetyBootsRequiredo StandbyManRequiredo ParticalDustMaskRequiredo IntrinsicallySafeLightsRequiredo ChemicalCartridgeRespiratorRequiredo IntrinsicallySafeRadioRequiredo OxygenVentilatorRequiredo NoTransmittingDevices(Radios,Mobiles,Paper)o SCBARequiredo SafeEscapeRoutesFromWorkAreaIdentifiedo SABARequiredo RestrictedWorkBelowRequiredo Install,Inspect&Operate3rdPartyContractorEquipmento StandbyVesselNotifiedo PAAnnouncementPriorToStartingJobo FallProtectionEquipmentRequired&Inspectedo MSDSReviewedWithAppropriatePersonnelTakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!!CommentsandAdditionalRequireds:GasTestingRecordsAgentLimit(s)ResultTimeSignatureAgentLimit(s)ResultTimeSignatureOxygen19.5-23%Oxygen19.5-23%Flammable﹤10%LELFlammable﹤10%LELH2S﹤10ppmH2S﹤10ppmPTWSignaturePTWIssuer(sign):PTWReceiver(sign):StopWork&CancelPermitsReason:Signature:Time:PTWClosedo Completedo SuspendedPTWReceiver(sign):o TimeOuto PermitCancelledPTWIssuer(sign):PermitNo.:CWP-RigNo.:WellNo.:Date:Timestarts:Timepermitexpire:AreatoBeWorkedOn:SpecificWorktoBeDone:Permitapplicant&CrewMenbers:DescriptionofWork(s):SpotCheck(ConductedbyPIC):Signature:Time:Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.oPre-JobSafetyMeetingHeld(JSAReviewed)oNon-EssentialPersonnelClearedFromAreaoLockout/TagoutRequired:BreakerSwitch#oManRiderJSACompleted/Communicatedo PoweroffVerifiedBy:o AllToolsSecuredToWorkso WillLockoutRemainPastyourShift?Lock#o Ladders/ScaffoldingRequiredo EquipmentDepressurizedo SignalsDiscussed(Verbal&HandorRescueline)o EquipmentDrainedo FullBodyHamess/Lanyard/RopeRequiredo FlushedWithWatero FireExtinguisherReadyTouseo SteamedOuto IntrinsicallySafeToolRequiredo Vessels/LinesPurged/WithWhat?o ExplosionProofExectricalCordsRequiredo Drains/SumpsCovered&Sealedo ExectricalToolsGroundedTypeo Equipmentcooled/Ventilated/Isolatedo Fire&GasDetectorsIsolatedo CombustibleMaterialRemovedo AreaBarriers/SignsPlacedo Blindsinstalled&BleedsOpeno Water/SteamHouseReadyToUseo Vessels/LinesToBeVentedo FaceShield/GogglesRequired(CircleOne)o PhysicalSeparationReqiuredo HearingProtectionRequiredo Grounding/BondingCablesRequiredo FireBlanketRequiredo ExplosiveOrToxicGasMonitoringo Non-StandardPPEClothing(Type)?o OxygenDeficiencyTestRequiredo RuberSafetyBootsRequiredo StandbyManRequiredo ParticalDustMaskRequiredo IntrinsicallySafeLightsRequiredo ChemicalCartridgeRespiratorRequiredo IntrinsicallySafeRadioRequiredo OxygenVentilatorRequiredo NoTransmittingDevices(Radios,Mobiles,Paper)o SCBARequiredo SafeEscapeRoutesFromWorkAreaIdentifiedo SABARequiredo RestrictedWorkBelowRequiredo Install,Inspect&Operate3rdPartyContractorEquipmento StandbyVesselNotifiedo PAAnnouncementPriorToStartingJobo FallProtectionEquipmentRequired&Inspectedo MSDSReviewedWithAppropriatePersonnelTakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!!CommentsandAdditionalRequireds:GasTestingRecordsGasTestPerformedBy(Name):AgentLimit(s)ResultTimeSignatureAgentLimit(s)ResultTimeSignatureOxygen19.5-23%Oxygen19.5-23%Flammable﹤10%LELFlammable﹤10%LELH2S﹤10ppmH2S﹤10ppmPTWSignaturePTWIssuer(sign):PTWReceiver(sign):StopWork&CancelPermitsReason:Signature:Time:PTWClosedo Completedo SuspendedPTWReceiver(sign):o TimeOuto PermitCancelledPTWIssuer(sign):PermitNo.:CSE-RigNo.:WellNo.:Date:Timestarts:Timepermitexpire:AreatoBeWorkedOn:SpecificWorktoBeDone:Permitapplicant&CrewMenbers:DescriptionofWork(s):SpotCheck(ConductedbyPIC):Signature:Time:Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.oPre-JobSafetyMeetingHeld(JSAReviewed)oNon-EssentialPersonnelClearedFromAreaoLockout/TagoutRequired:BreakerSwitch#oManRiderJSACompleted/Communicatedo PoweroffVerifiedBy:o AllToolsSecuredToWorkso WillLockoutRemainPastyourShift?Lock#o Ladders/ScaffoldingRequiredo EquipmentDepressurizedo SignalsDiscussed(Verbal&HandorRescueline)o EquipmentDrainedo FullBodyHamess/Lanyard/RopeRequiredo FlushedWithWatero FireExtinguisherReadyTouseo SteamedOuto IntrinsicallySafeToolRequiredo Vessels/LinesPurged/WithWhat?o ExplosionProofExectricalCordsRequiredo Drains/SumpsCovered&Sealedo ExectricalToolsGroundedTypeo Equipmentcooled/Ventilated/Isolatedo Fire&GasDetectorsIsolatedo CombustibleMaterialRemovedo AreaBarriers/SignsPlacedo Blindsinstalled&BleedsOpeno Water/SteamHouseReadyToUseo Vessels/LinesToBeVentedo FaceShield/GogglesRequired(CircleOne)o PhysicalSeparationReqiuredo HearingProtectionRequiredo Grounding/BondingCablesRequiredo FireBlanketRequiredo ExplosiveOrToxicGasMonitoringo Non-StandardPPEClothing(Type)?o OxygenDeficiencyTestRequiredo RuberSafetyBootsRequiredo StandbyManRequiredo ParticalDustMaskRequiredo IntrinsicallySafeLightsRequiredo ChemicalCartridgeRespiratorRequiredo IntrinsicallySafeRadioRequiredo OxygenVentilatorRequiredo NoTransmittingDevices(Radios,Mobiles,Paper)o SCBARequiredo SafeEscapeRoutesFromWorkAreaIdentifiedo SABARequiredo RestrictedWorkBelowRequiredo Install,Inspect&Operate3rdPartyContractorEquipmento StandbyVesselNotifiedo PAAnnouncementPriorToStartingJobo FallProtectionEquipmentRequired&Inspectedo MSDSReviewedWithAppropriatePersonnelTakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!!CommentsandAdditionalRequireds:GasTestingRecordsAgentLimit(s)ResultTimeSignatureAgentLimit(s)ResultTimeSignatureOxygen19.5-23%Oxygen19.5-23%Flammable﹤10%LELFlammable﹤10%LELH2S﹤10ppmH2S﹤10ppmPTWSignaturePTWIssuer(sign):PTWReceiver(sign):StopWork&CancelPermitsReason:Signature:Time:PTWClosedo Completedo SuspendedPTWReceiver(sign):o TimeOuto PermitCancelledPTWIssuer(sign):PermitNo.:EWP-RigNo.:WellNo.:Date:Timestarts:Timepermitexpire:AreatoBeWorkedOn:SpecificWorktoBeDone:Permitapplicant&CrewMenbers:DescriptionofWork(s):SpotCheck(ConductedbyPIC):Signature:Time:Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.oPre-JobSafetyMeetingHeld(JSAReviewed)oNon-EssentialPersonnelClearedFromAreaoLockout/TagoutRequired:BreakerSwitch#oManRiderJSACompleted/Communicatedo PoweroffVerifiedBy:o AllToolsSecuredToWorkso WillLockoutRemainPastyourShift?Lock#o Ladders/ScaffoldingRequiredo Bus-barand/orcableshutterslockedat?o SignalsDiscussed(Verbal&HandorRescueline)o Visolatorslockedopenat?o FullBodyHamess/Lanyard/RopeRequiredo Vsupplyfusesremovedat?o FireExtinguisherReadyTouseo Voltagetransformerlowvoltagefudesremovedo IntrinsicallySafeToolRequiredo Remotecotroldevicesinoperativeat?o ExplosionProofExectricalCordsRequiredo Vessels/LinesPurged/WithWhat?o ExectricalToolsGroundedTypeo Rack-outo Fire&GasDetectorsIsolatedo Equipmentcooled/Ventilated/Isolatedo AreaBarriers/SignsPlacedo CombustibleMaterialRemovedo Water/SteamHouseReadyToUseo Vessels/LinesToBeVentedo FaceShield/GogglesRequired(CircleOne)o PhysicalSeparationReqiuredo HearingProtectionRequiredo Grounding/BondingCablesRequiredo FireBlanketRequiredo ExplosiveOrToxicGasMonitoringo Non-StandardPPEClothing(Type)?o OxygenDeficiencyTestRequiredo RuberSafetyBootsRequiredo StandbyManRequiredo ParticalDustMaskRequiredo IntrinsicallySafeLightsRequiredo ChemicalCartridgeRespiratorRequiredo IntrinsicallySafeRadioRequiredo OxygenVentilatorRequiredo NoTransmittingDevices(Radios,Mobiles,Paper)o SCBARequiredo SafeEscapeRoutesFromWorkAreaIdentifiedo SABARequiredo RestrictedWorkBelowRequiredo Install,Inspect&Operate3rdPartyContractorEquipmento StandbyVesselNotifiedo PAAnnouncementPriorToStartingJobo FallProtectionEquipmentRequired&Inspectedo MSDSReviewedWithAppropriatePersonnelTakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!!CommentsandAdditionalRequireds:GasTestingRecordsGasTestPerformedBy(Name):AgentLimit(s)ResultTimeSignatureAgentLimit(s)ResultTimeSignatureOxygen19.5-23%Oxygen19.5-23%Flammable﹤10%LELFlammable﹤10%LELH2S﹤10ppmH2S﹤10ppmPTWSignaturePTWIssuer(sign):PTWReceiver(sign):StopWork&CancelPermitsReason:Signature:Time:PTWClosedo Completedo SuspendedPTWReceiver(sign):o TimeOuto PermitCancelledPTWIssuer(sign):PermitNo.:LWP-RigNo钻机号:WellNo井号:Date日期:TimeStarts开始时间：TimeExpires结束时间：AreatoBeWorkedOn工作区域:SpecificWorktoBeDone具体工作:PermitApplicant&CrewMenber许可证申请人或班组人员:DescriptionofWork(s)工作描述:SpotCheck(ConductedbyPIC)检查现场的负责人:Signature签名:Time时间:Thispermitisrequiredforanyofthefllowinglift本许可证用于任何游动吊装oMultiplecranelift多个起重机吊装oWindvelocityexceeding30km/hr风速超过每小时30公里oLiftingloadover10tons吊装超过10吨的物件oVisibilitylessthan30meters能见度小于30米o Removalorinstallationofwellheadgrating井口（grating)的移除和安装o Greaterthanfourleglift重量大于四个支架的提升o Liftingoverunprotectedprocessequipment吊装未保护的设备o Liftsinsideofconfinedspace在限制空间中的提升o Liftingwithwebbingorsyntheticsling/rope用带子或合成纤维的绳索取吊装o Failuretofullyilluminateloadandpathofload未能充分阐明负载及负载路径Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.对于特殊的要求和设备，如果需要则打“√”，不需要则留空。oPre-JobSafetyMeetingHeld(JSAReviewed)召开班前安全会(审核作业安全 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 )oExplosiveOrToxicGasMonitoring是否需要监控爆炸和有毒气体oLockout/TagoutRequired:BreakerSwitch锁定和标识:断路开关oStandbyManRequired是否需要人员待命o PoweroffVerifiedBy电源切断检验者:o IntrinsicallySafeLightsRequired是否需要基本的安全灯o WillLockoutRemainPastyourShift?Lock锁定延至下一班?锁定o SafeEscapeRoutesFromWorkAreaIdentified工作区安全通道是否确定o EquipmentDepressurized设备压力被释放o RestrictedWorkBelowRequired限制性工作是否低于要求o EquipmentDrained设备排水o FallProtectionEquipmentRequired&Inspected是否需要防坠落设备，是否检查过o Slingfreeofdefects绳索无破损o Non-EssentialPersonnelClearedFromArea无关人员是否离开现场o Currentcertification/colorcoded目前的认证/色标o ManRiderJSACompleted/Communicated是否进行了载人装置的作业安全分析,通知相关人员?o Slinglubricated绳索是否润滑o AllToolsSecuredToWork所有工具固定到位o LoadweightAscertained?重量是否确定o Ladders/ScaffoldingRequired所需的梯子和脚手架o Padeyesidentified垫眼是否确定o SignalsDiscussed(Verbal&HandorRescueLine)是否讨论过信号(语言,手势或逃生路线)o CombustibleMaterialRemoved可燃材料是否移走o FullBodyHarness/Lanyard/RopeRequired是否需要全身式安全绳/系索或绳索o Padeyesidentified垫眼是否确定o AreaBarriers/SignsPlaced工作区放置隔离装置或警示标志o Areacheckedanddebrisfree工作区是否检查无碎屑o FaceShield/GogglesRequired(CircleOne)是否需要面罩/护目镜(圆形)o Experiencedsignalman信号指挥人员是否有经验o HearingProtectionRequired是否需要听力保护装置o Rigginggearingoodcondition索具装备处于良好状态o Non-StandardPPEClothing(Type)?是否有不 规范 编程规范下载gsp规范下载钢格栅规范下载警徽规范下载建设厅规范下载 的劳保服(类型)?o Workrelatedproceduresonlocation作业现场有相关程序o RubberSafetyBootsRequired是否需要橡胶安全靴o Overheadwiring/Lineidentified高架线是否确定o ParticalDustMaskRequired是否需要防尘口罩o Vessels/LinesToBeVented容器和管线是否通风o Install,Inspect&Operatethe3rdPartyContractorEquipment是否安装、检查和操作第三方的设备o PhysicalSeparationReqiured是否需要隔离o PAAnnouncementPriorToStartingJob在开始工作前时间PA通知TakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!根据上述内容采取有效措施!!CommentsandAdditionalRequirements:说明和其它要求：GasTestingRecords气体测试记录Agent介质Limit(s)极限Result结果Time时间Signature签名Agent介质Limit(s)极限Result结果Time时间Signature签名Oxygen氧气19.5-23%Oxygen氧气19.5-23%Flammable可燃物﹤10%LELFlammable可燃物﹤10%LELH2S﹤10ppmH2S﹤10ppmPTWSignaturePTW签字PTWIssuer(sign)工作许可证签发人（签字）:PTWReceiver(sign)工作许可证接收人（签字）:StopWork&CancelPermits停止工作和取消许可证Reason原因:Signature签字:Time时间:PTWClosed许可证关闭o Completed完成o Suspended中止PTWReceiver(sign)许可证接受人（签字）:o TimeOut时间到o PermitCancelled许可证取消PTWIssuer(sign)许可证签发人（签字）:PermitNo.:SWP-RigNo.:WellNo.:Date:Timestarts:Timepermitexpire:AreatoBeWorkedOn:SpecificWorktoBeDone:Permitapplicant&CrewMenbers:DescriptionofWork(s):SpotCheck(ConductedbyPIC):Signature:Time:Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.oPre-JobSafetyMeetingHeld(JSAReviewed)oNon-EssentialPersonnelClearedFromAreaoLockout/TagoutRequired:BreakerSwitch#oManRiderJSACompleted/Communicatedo PoweroffVerifiedBy:o AllToolsSecuredToWorkso WillLockoutRemainPastyourShift?Lock#o Ladders/ScaffoldingRequiredo EquipmentDepressurizedo SignalsDiscussed(Verbal&HandorRescueline)o EquipmentDrainedo FullBodyHamess/Lanyard/RopeRequiredo FlushedWithWatero FireExtinguisherReadyTouseo SteamedOuto IntrinsicallySafeToolRequiredo Vessels/LinesPurged/WithWhat?o ExplosionProofExectricalCordsRequiredo Drains/SumpsCovered&Sealedo ExectricalToolsGroundedTypeo Equipmentcooled/Ventilated/Isolatedo Fire&GasDetectorsIsolatedo CombustibleMaterialRemovedo AreaBarriers/SignsPlacedo Blindsinstalled&BleedsOpeno Water/SteamHouseReadyToUseo Vessels/LinesToBeVentedo FaceShield/GogglesRequired(CircleOne)o PhysicalSeparationReqiuredo HearingProtectionRequiredo Grounding/BondingCablesRequiredo FireBlanketRequiredo ExplosiveOrToxicGasMonitoringo Non-StandardPPEClothing(Type)?o OxygenDeficiencyTestRequiredo RuberSafetyBootsRequiredo StandbyManRequiredo ParticalDustMaskRequiredo IntrinsicallySafeLightsRequiredo ChemicalCartridgeRespiratorRequiredo IntrinsicallySafeRadioRequiredo OxygenVentilatorRequiredo NoTransmittingDevices(Radios,Mobiles,Paper)o SCBARequiredo SafeEscapeRoutesFromWorkAreaIdentifiedo SABARequiredo RestrictedWorkBelowRequiredo Install,Inspect&Operate3rdPartyContractorEquipmento StandbyVesselNotifiedo PAAnnouncementPriorToStartingJobo FallProtectionEquipmentRequired&Inspectedo MSDSReviewedWithAppropriatePersonnelTakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!!CommentsandAdditionalRequireds:GasTestingRecordsGasTestPerformedBy(Name):AgentLimit(s)ResultTimeSignatureAgentLimit(s)ResultTimeSignatureOxygen19.5-23%Oxygen19.5-23%Flammable﹤10%LELFlammable﹤10%LELH2S﹤10ppmH2S﹤10ppmPTWSignaturePTWIssuer(sign):PTWReceiver(sign):StopWork&CancelPermitsReason:Signature:Time:PTWClosedo Completedo SuspendedPTWReceiver(sign):o TimeOuto PermitCancelledPTWIssuer(sign):