TITT APP PSH工程安全健康申报表.pdfVIP

LandTransportAuthority

SafetyHealthDeclarationForm

ContractNo:

Tenderer’sName:

Address:

BusinessRegistrationNo.:

1.Hastherebeenanyfatalityinanyofyourworksiteduetoanindustrial

accidentforthepast2years?*

YesNopleaseprovidedetails

2.Hastherebeenanypermanenttotal/partialdisabilitycaseinanyofyour

worksiteduetoanindustrialaccidentforthepast2years?*

YesNopleaseprovidedetails

3.Hastherebeenanycranecollapseortopplinginanyofyourworksiteforthe

past2years*

YesNopleaseprovidedetails

4.Hastherebeenanyindustrialaccidentthatresultedin24hourhospitalisation

ormorethan3daysmedicalleaveforthepast2years?*

YesNopleaseprovidedetails

5.Hastherebeenanyindustrialaccidentthatissthan4daysmedicalleavefor

thepast2years?*

YesNopleaseprovidedetails

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