TN N V

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc
.., ngy thng.. nm

GIY NG K CNG TC
Knh gi: (Tn n v qun l vn hnh)
Cn c Bin bn kho st hin trng: ......................................., Cng ty (Chi
nhnh)..............................................................ng k tin hnh cng vic, c th nh sau:
1. Ni dung cng vic:.........................................................................................................
.............................................................................................................................................
2. a im (hoc thit b) thc hin cng vic:...................................................................
.............................................................................................................................................
3. iu kin v an ton in tin hnh cng vic:............................................................
.............................................................................................................................................
4. Thi gian tin hnh cng vic:.........................................................................................
5. S lng n v cng tc (nu c):...................................................................................
6. S lng nhn vin 01 n v cng tc: 6.1>....../ngi; 6.2>....../ngi; 6.3>...../ngi.
7. Ngi Lnh o cng vic (nu c):......................................................Bc AT......./5.
8. Ngi gim st an ton in (nu c): 8.1> ..........................................Bc AT......./5;
8.2>.............................. Bc AT......./5; 8.3>...........................................Bc AT......./5.
9. Ngi ch huy trc tip: 9.1> ................................................................Bc AT......./5;
9.2>.................................. Bc AT......./5; 9.3>.......................................Bc AT......./5.
10. Danh sch nhng ngi c c thc hin cng vic:
TT
H v tn
Bc Chc TT
H v tn
Bc Chc
AT danh
AT
danh
1

..../5

...../5

11. Cc n v qun l vn hnh c lin quan n cng vic phi cp Giy phi hp cho
php, bao gm:.....................................................................................................................
11.1............................................................11.2.................................................................
11.3............................................................11.4.................................................................
12. Nhng yu cu khc:......................................................................................................
.............................................................................................................................................
13. Ngi lin h: ......................................... chc v: ..................... T:............................
Ni nhn:
- Nh trn;
- Lu.

N V NG K CNG TC
(K tn, ng du)