上锁挂牌作业许可permit for lockout and tagout.docVIP

上锁挂牌作业许可 PERMIT FOR LOCKOUT AND TAGOUT ZHJT-MR-09/R01 隔离点数量No. of isolation point: ； 作业人数No. of operator: 。 编号Serial No.：LT 项目PROJECT/厂房WORKSHOP: ；位置LOCATION: 。 作业描述DESCRIPTION OF WORK： 。 开始日期及时间COMMENCEMENT DATE TIME: 年Y 月M 日D ： 计划完成日期及时间COMPLETION DATE TIME: 年Y 月M 日D ： □ 是否已经完成工作安全分析并传达给所有作业人员？（请附上）Whether the related JSA has been approved and communicated to all worker members ? （Please attach it） 第一步STEP 1：领班/监督申请APPLICATION BY FOREMAN OR SUPERVISOR 我已采取措施使该区域适合上锁挂牌作业申请，在施工前我将确保落实以下措施，在施工过程中做好维持。I have taken measure to render the area safe and fit for lockout and tagout work application. I shall also ensure compliance with the under-mentioned prior to the commencement and during the work. □是Yes □不适用N/A 拉警戒线限定安全区域Cordon off areas for distance of safe limits. □是Yes □不适用N/A 在所有可能进入受影响区域入口处突出显示警示板Prominent display of warning signboards at all possible access to the affected work area. □是Yes □不适用N/A 清理受影响区域所有无关人员Clear all unauthorized personnel from the affected work area. □是Yes □不适用N/A 安排专人现场监控Assign responsible personnel to supervise the operation. □是Yes □不适用N/A 确认能量已隔离或去除Confirmed the energies have been isolated or removed. □是Yes □不适用N/A 个人挂锁对隔离点上锁，将标牌挂在个人锁上。Use the individual padlock and tagout on it. □是Yes □不适用N/A 集体挂锁对隔离点上锁，将标牌挂在集体锁上。Use the collective padlock and tagout on it. 监护人签名Signed by watchman： ； 申请人签名Signed by applicant： 。 第二步STEP 2：安全监管人员审核REVIEWED BY SAFETY PERSONNEL 我已检查确认所有安全要求已经遵照执行I have inspected and confirm that all safety measures have been implemented. 安全监管人员签字Signed by safety personnel： 第三步STEP 3：建造经理/生产经理审批APPROVED BY FABRICATION/ PRODUCTION MANAGER 1.我确认相关影响区域已执行了彻底的检查及合理评估，所有安全措施已经采取I confirm that a thorough inspection and proper assessmen