电工作业许可证格式

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):负责人检查现场：Signature签名:Time时间:Anyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.对于特殊的要求和设备，如果需要则打击“√”，不需要则留空。oPre-JobSafetyMeetingHeld(JSAReviewed)召开班前安全会(审核作业安全分析)oNon-EssentialPersonnelClearedFromArea无关人员是否离开现场oLockout/TagoutRequired:BreakerSwitch锁定和标识:断路开关oManRiderJSACompleted/Communicated是否进行了载人装置的作业安全分析,通知相关人员?o PoweroffVerifiedBy电源切断检验者:o AllToolsSecuredToWork所有工具固定到位o WillLockoutRemainPastyourShift?Lock锁定延至下一班?锁定o Ladders/ScaffoldingRequired所需的梯子和脚手架o Bus-barand/orcableshutterslockedat?母线和/或电缆闸门锁定？o SignalsDiscussed(Verbal&HandorRescueLine)是否讨论过信号(语言,手势或逃生路线)o Visolatorslockedopenat?V型隔离器锁定开启？o FullBodyHarness/Lanyard/RopeRequired是否需要全身式安全绳/系索或绳索o Vsupplyfusesremovedat?V供电保险丝移除？o FireExtinguisherReadyToUse灭火器是否随时待用o Voltagetransformerlowvoltagefudesremoved变压器低压保险丝移除o IntrinsicallySafeToolRequired是否需要基本的安全工具o Remotecotroldevicesinoperativeat?远程控制装置无法工作？o ExplosionProofExectricalCordsRequired是否需要使用防爆电缆o Vessels/LinesPurged/WithWhat？容器和管线用何物清洗?o ExectricalToolsGroundedType电动工具是否接地o Rack-out拆下保险丝？？？o Fire&GasDetectorsIsolated火灾和气体检测仪隔开o Equipmentcooled/Ventilated/Isolated设备冷却、通风和隔离o AreaBarriers/SignsPlaced放置区域隔离屏障和信号o CombustibleMaterialRemoved可燃材料是否移走o Water/SteamHouseReadyToUse水房和蒸气房随时可用o Vessels/LinesToBeVented容器和管线被通风o FaceShield/GogglesRequired(CircleOne)是否需要面罩/护目镜(圆形)o PhysicalSeparationReqiured是否需要物理隔离o HearingProtectionRequired是否需要听力保护装置o Grounding/BondingCablesRequired是否需要接地和搭接电缆o FireBlanketRequired是否需要防火毯o ExplosiveOrToxicGasMonitoring是否监测爆炸或有毒气体o Non-StandardPPEClothing(Type)?是否有不规范的劳保服(类型)?o OxygenDeficiencyTestRequired是否需要进行缺氧测试o RubberSafetyBootsRequired是否需要橡胶安全靴o StandbyManRequired是否需要人员待命o ParticalDustMaskRequired是否需要防尘口罩o IntrinsicallySafeLightsRequired是否需要基本的安全灯o ChemicalCartridgeRespiratorRequired是否需要化学药品呼吸器o IntrinsicallySafeRadioRequired是否需要基本的无线电通讯装置o OxygenVentilatorRequired是否需要氧气呼吸器o NoTransmittingDevices(Radios,Mobiles,Paper)是否无发射装置(收音机,手机和呼机)o SCBARequired是否需要正压式呼吸器o SafeEscapeRoutesFromWorkAreaIdentified是否确定了工作区的安全逃生路线o SABARequired是否需要供气式呼吸器o RestrictedWorkBelowRequirement限制性工作低于要求o Install,Inspect&Operatethe3rdPartyContractorEquipment是否安装、检查和操作第三方公司设备o StandbyVesselNotified是否指定了备用容器o PAAnnouncementPriorToStartingJob在开始工作前时间PA通知o FallProtectionEquipmentRequired&Inspected是否需要防坠落保护装置,检查过了吗?o MSDSReviewedWithAppropriatePersonnel相关人员是否检查了材料安全数据表TakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!根据上述内容采取有效 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 ！！CommentsandAdditionalRequirements:说明和其它要求：称GasTestingRecords气体测式 记录 混凝土 养护记录下载土方回填监理旁站记录免费下载集备记录下载集备记录下载集备记录下载 GasTestPerformedBy(Name)气体测试人: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﹤10ppmPTWSignature工作许可证签名PTWIssuer(sign)工作许可证签发人（签字）:PTWReceiver(sign)工作许可证接受人（签字）:StopWork&CancelPermits停止工作和取消许可证Reason原因:Signature签字:Time时间:PTWClosed工作许可证关闭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.:LWP-RigNo.:WellNo.:Date:Timestarts:Timepermitexpire:AreatoBeWorkedOn:SpecificWorktoBeDone:Permitapplicant&CrewMenbers:DescriptionofWork(s):SpotCheck(ConductedbyPIC):Signature:Time:ThispermitisrequiredforanyofthefllowingliftoMultiplecraneliftoWindvelocityexceeding30km/hroLiftingloadover10tonsoVisibilitylessthan30meterso Removalorinstallationofwellheadgrating.o Greaterthanfourleglifto Liftingoverunprotectedprocessequipmento Liftsinsideofconfinedspaceo Liftingwithwebbingorsyntheticsling/ropeo FailuretofullyilluminateloadandpathofloadAnyspecialrequirementsandequipmentsplacean"√"ifrequiredorleaveblankifnotrequired.oPre-JobSafetyMeetingHeld(JSAReviewed)oExplosiveOrToxicGasMonitoringoLockout/TagoutRequired:BreakerSwitch#oStandbyManRequiredo PoweroffVerifiedBy:o IntrinsicallySafeLightsRequiredo WillLockoutRemainPastyourShift?Lock#o SafeEscapeRoutesFromWorkAreaIdentifiedo EquipmentDepressurizedo RestrictedWorkBelowRequiredo EquipmentDrainedo FallProtectionEquipmentRequired&Inspectedo Slingfreeofdefectso Non-EssentialPersonnelClearedFromAreao Currentcertification/colorcodedo ManRiderJSACompleted/Communicatedo Slinglubricatedo AllToolsSecuredToWorkso LoadweightAscertained?o Ladders/ScaffoldingRequiredo Padeyesidentifiedo SignalsDiscussed(Verbal&HandorRescueline)o CombustibleMaterialRemovedo FullBodyHamess/Lanyard/RopeRequiredo Padeyesidentifiedo AreaBarriers/SignsPlacedo Areacheckedanddebrisfreeo FaceShield/GogglesRequired(CircleOne)o Experiencedsignalmano HearingProtectionRequiredo Rigginggearingoodconditiono Non-StandardPPEClothing(Type)?o Workrelatedproceduresonlocationo RuberSafetyBootsRequiredo Overheadwiring/Lineidentifiedo ParticalDustMaskRequiredo Vessels/LinesToBeVentedo Install,Inspect&Operate3rdPartyContractorEquipmento PhysicalSeparationReqiuredo PAAnnouncementPriorToStartingJobTakeAppropriateActionsBasedOnThePrecautionsNotedAbove!!!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.: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):