new-Excavation Permit (EnCh).docVIP

Unit 单位： Location of Excavation 开挖地点： Ref. drawing no. 参考图号： Start Date/Time起始日期/： End Date/Time 间: Description of work excavation sketch with detail of sloping/shoring/access/barricading to be attached separately 作业描述 -详细说明放坡/支护/通道/围护的具体方案 ： _________________________________________________________________________________________________ _________________________________________________________________________________________________ Excavation Dimension cm 厘米 ： 长L________ 宽W________ 深D________ Excavation Type 开挖方式： Mechanic 机械 Manual 人工 Underground Services Involved 涉及的地下设施 Piping 管道 Electric Cable 电 Equipment设备 Building/Equipment Foundation 建筑物/设备基础 Other specify 其它 ? _______________________ Any involved item here to be marked on the attached excavation sketch 此处涉及的设施要在开挖草图上标出。 Actions Required 采取措施 Trial holes required打 Cable Locator Required 电缆探测 Mark the Excavation Area Watchman 监护人员 Name___________________ Gas Test Required 要求进行气体测试 est Frequency 检测频率: _________ Gas to be tested : H2S硫化氢 CO一氧化碳 O2氧气 LEL可燃气体 Other specify 其它 注明 : ______________ If the excavation work meets the Confined Space nature, the confined space work permit will be applied and relevant measures will be taken as well. 如果开挖工作符合受限空间特征，要申请受限空间作业许可证并采取相应措施。 Additional measures to be taken 额外措施： ______________________________________________________________________________________________ ______________________________________________________________________________________________ Backfill/Compaction 回填/压实 Backfill Material Required 要求回填材料： Level of Compaction Required 压实等级要求 Contractor Supervisor Declaration 承包商主管人员声明 By signing hereby I undertake to supervise the excavation work and take all actions required by this permit. 我签我将管理并安全措施Name 姓名: _______________ Signature 签名: ________________ Date/Time日期/时间: _________________ Approval 批准 Contractor Construction Manager 承包商施工经理 ______________ _______________ _____________ 姓 名 签 名 日期/时间 Contractor HSE M