Quadunion Builders Pte Ltd

PERMIT TO WORK 施工准许证 - ____DEMOLITION _________

(THIS COPY SHALL BE DISPLAYED AT PLACE OF WORK, AS APPROPRIATE)

PROJECT TITLE（项目名称 ）: _____________________________________________________________________

APPLICANT COMPANY（申请公司名称 ）: ___________________________________________________________
NAME OF APPLICANT（申请人姓名 ）: Mr / Ms（先生/小姐 ）_________________________(Delete as appropriate 删除相应的)
WORK TO BE PERFORMED ( 所申请的施工类型 ）:____________________________________________________
DURATION OF WORK / DATE & TIME（施工历时/日期与时间）: From（从 ）___________ to（至 ）___________
LOCATION OF WORK（施工地点 ）: _________________________________________________________________

This Permit-To-Work (PTW) is valid only for the duration stated above. The conditions of issue must be
complied with throughout the duration of the work. Otherwise, this PTW can be withdrawn at any time. The
applicant of this PTW shall be responsible for maintaining a copy of this permit and must produce it upon
request.
SAFETY CONDITIONS TO BE COMPLIED WITH PRIOR TO PERMIT APPROVAL .

SAFETY CONDITONS  /  / NA
1. Workers briefed on safe work procedures & risk assessments.
2. Safety barricades, safe working platforms, safe means of access and signage provided.
3. Fire extinguishers and other fire fighting equipment available.
4. Authorized operator provided.
5. Termination of affected services completed.
6. Area enclosed with hoarding / fencing / external scaffolds and netting
7. No flammable materials in the vicinity of works
8. Dust preventive measures
9. The shoring and method of demolition is in accordance to P.E. design / procedures
10. All uncollapsed structures are safe before any worker is allowed to enter for work
11. Others: a)
b)

Permit Application By Supervisor / Person Responsible for Demolition Work:

I fully understand the nature of the work and safety conditions that must be met. I have inspected the
safety conditions relating to the work to be performed.
Name & Signature : __________________________ Company : ________________________
Date / Time : __________________________ Position : ________________________
Permit Reviewed By Project Engineer for Engineering Aspects:
Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________
Permit Reviewed By M&E Engineer / Coordinator for M&E Aspects:
Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________
Permit Verification By WSHO / Safety Assessor:
Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________
Permit Approval By Project Manager:
Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________
Notification of Work Completion by Applicant: The work area has been checked and cleared if
equipment, tools, waste materials, etc.
Name : __________________________ Signature : _________________________
Date : __________________________ Time : _________________________

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List of Workmen involved in Demolition Works
S/N Name of Worker Designation Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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25
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