APX-HSE-CoP-01.

1-03

EXCAVATION PERMIT 开挖许可证

1. DETAILS 说明 (to be completed by subcontractor 由分包商填写)

COMPANY NAME 公司名称 : _______________________________

LOCATION OF WORK *工作位置 : _______________________________

TO WORK 工作时间 FROM 从 : DATE 日期: ______________ TIME 时间 : ____________

UNTIL 至 : DATE 日期 : ______________ TIME 时间: ____________

SUPERVISOR 现场技术员/主管: EXCAVATOR OPERATOR 挖掘机操作人员 ELECTRICIAN 电工：

* Attach method statements, drawings and Plot Plans 附施工方案（开挖技术说明）、图纸和平面图

2. EXCAVATION DETAILS 开挖描述 (to be completed by subcontractor 由分包商填写)

AREA OF EXCAVATION 开挖面积 : ____________ meters 米 x : ____________ meters 米

DEPTH OF EXCAVATION 开挖深度 : ____________ meters 米 (maximum 最大值)

TYPE OF EXCAVATOR 开挖方式 : HAND 人工 [ ] MACHINE 机械 [ ]

REASON FOR EXCAVATION 开挖原因 : __________________________________________________________________________

__

Permission is granted to excavate under the following conditions 开挖要满足下列条件:

Exact location of underground facilities are clearly marked and will be exposed by hand in advance 地下设施的准确位置清晰标识，人工开挖至其暴露 [ ]

Protection shall be made for exposed facilities 已挖出的地下设施应采取保护措施。 [ ]

Machine excavation is not permitted within 2 meters of known underground facilities 已知的 2 米内有地下设施不得进行机械开挖 [ ]

A supervisor will be in attendance at all times during excavation work 整个开挖期间应有监督人员在场 [ ]

Any damage to underground facilities must be reported to CHEC immediately 地下设施的任何损坏必须立即向 CHEC 报告。 [ ]

All cable markers and tiles shall be reinstalled after work is complete and before back-filling 所有电缆标识和盖砖防护工作应在管道施工完成后、回填前重新制作 [ ]

Excavation layout must conform to recognized industry practices (benching, sloping & shoring) 开挖程序必须遵循施工标准和惯例（阶梯、坡度、支撑） [ ]

Safety barriers must be installed around the excavation if deeper than 1.2M 深度超过 1.2 米开挖区域四周必须设置安全防护栏 [ ]

The distance between the barrier and the excavation edge no less than 2M 围护距离开挖边缘不得小于 2 米 [ ]

Safe and adequate access and egress must be provided 提供足够的安全通道和出入口。 [ ]

Emergency Telephone Numbers for this excavation:此次开挖紧急事件联系电话：

Subcontractor 分包商：Tony 0816473631 CHEC 中港：Zou Quansheng 0816755872

Other safety requirements not previously listed :

其它安全要求：

PERMIT IS APPROVED 许可证被批准 [ ] NOT APPROVED 未被批准 [ ]

3. ACCEPTANCE 接收 (to be completed by subcontractors Authorized Person 分包商授权人员填写)

I confirm that I understand all conditions attached to this Permit and also understand that a separate work permit could be required before starting work. I understand that if conditioned

change all work must stop and the permit must be returned.

我确认已完全理解该许可证所列各项内容并了解施工前是否需要办理其他许可证。我保证如果施工条件变化，所有工作必须停止并且该许可证必须收回。

CM 施工经理： HSE manager HSE 经理

5. CANCELLATION 注销 (to be completed by subcontractors Authorized Person 分包商授权代表填写)

I confirm that all work as described is complete and that all tools and equipment have been removed from the job site and the area has been left in a safe, clean and tidy condition.

我确认所有工作已完成，并做到工完料尽场地清。

SUPERVISOR 现场技术员/主管 : SIGNATURE 签名 :

DATE 日期 : TIME 时间 : .