Hot Work Permit Registration - CNLA

• Hotwork Permit No.

  Date

• Applicant: Tenant/Contractor Bên Đăng Ký: Tenant/Nhà Thầu

• Contact Work Supervisor (Lessee/Contractor) Tên Giám Sát (Khách Thuê/Nhà Thầu) - Yêu cầu có số điện thoại liên hệ khi cần

• Designated Work Area Vị trí khu vực thi công nóng
  Address

• Permit Validation Duration - Start Date

  Date

• Permit Validation Duration - End Date

  Date

• Work Brief Description

• Conducted on

  Date

• Prepared by

• 1. The operator is competent for the task (e.g. certificate, experience, ability etc.,)

  Yes

  No

  N/A

• 2. A fire watchman is assigned to supervise the whole work process, until 30 mins after the work is completed.

  Yes

  No

  N/A

• 3. The work safety (fire prevention) and emergency response training evidence are trackable.

  Yes

  No

  N/A

• 4. All equipment/tools involved in the task are free of obvious defects.

  Yes

  No

  N/A

• 5. The written fire risk analysis and mitigation measures are approved by the facility management team.

  Yes

  No

  N/A

• 6. The approved written work method statement/Job safety analysis has communicated with the worker

  Yes

  No

  N/A

• 7. Work area is clear and there is no flammable material within 10 meter of the hot work area. Otherwise, fire barriers or welding curtains or other acceptable measure must be in place to prevent the spark/slag contact with the flammable material.

  Yes

  No

  N/A

• Work area is clear and there is no flammable material within 10 meter of the hot work area. Otherwise, fire barriers or welding curtains or other acceptable measure must be in place to prevent the spark/slag contact with the flammable material.

  Yes

  No

  N/A

• 8. A fire extinguisher is kept at the work area for the whole work duration.

  Yes

  No

  N/A

• 9. Security center & security patrol team are informed.

  Yes

  No

  N/A

• 10. The equipment, electric cable and other devices nearby the hot work area are protected adequately (if any)

  Yes

  No

  N/A

• 11. Proper personal protection equipment is provided for the worker. E.g. insulating gloves, safety goggles etc.,

  Yes

  No

  N/A

• 12. All other safety measures described in Job safety analysis/work method statement are in place

  Yes

  No

  N/A

• 13 The following requirements must be 100% fulfilled If any compressed gas cylinder is involved:<br>- Cylinder are well secured; Regulators, hoses, flashback arrestors are functional well;<br>- Oxygen and acetylene cylinders are kept at least 6.0 meters apart, and 10 meters away from open flame;<br>

  Yes

  No

  N/A

• We have attended work safety training, understand fire and injury prevention and emergency treatment, confirmed that working conditions are as described in the work instruction, and promised to strictly follow the work instruction and PPE policy.

• After on-site inspection, it has been confirmed that all fire and injury risk mitigation measures (include but not limited to Item 1 to 13) are sufficient and effective, the risk is acceptable, and we promise to ensure that the risk will be under control by monitoring the work process. Therefore, we are formally requesting that the landlord can approve this task.

Worker (Signature):

• Name/signoff:

  Sign

• Date:

  Date

Fire Watchman (Signature):

• Name/signoff:

  Sign

• Date:

  Date

Supervisor of Applicant (Signature):

• Name/signoff:

  Sign

• Date:

  Date

Tenant’s Site Representative (Signature):

• Name/signoff:

  Sign

• Date:

  Date

• 1. The fire and critical injury prevention measures are in place as described in the JSA/WI, and acceptable.

  Yes

  No

  N/A

• 2. Sprinkler system and other fire prevention function are well; or <br>The fire system impairment permit is approved

  Yes

  No

  N/A

• 3. Periodical security patrol is arranged (hourly/bi-hourly).

  Yes

  No

  N/A

• 4. Special measures are in place to prevent any false alarm/mis-action of the fire system. (fire system impairment permit shall be approved if needed)

  Yes

  No

  N/A

• 5. CNSH (Cainiao Smart Hub) Fire Safety and/or Hot Work safety requirements are fully followed

  Yes

  No

  N/A

• 6. CNSH HQ (Cainiao Smart Hub HQ) Safety Team has been consulted prior to work commencement on:<br>- Hot work happens on warehouse roof<br>- Hot work happens inside of water tank, septic pit.<br>- Hot work happens on diesel supply system<br>- Any PU or similar material involved within the hot work process

  Yes

  No

  N/A

• After onsite checking the work safety condition, we confirmed that all asset protection and major injury prevention measures are in place and acceptable, and we officially approve this task.

Facility Management Leader (signature):

• Name/signoff: Sơn

  Sign

• Date:

  Date

Property Management Leader (CAINIAO):

• Name/signoff: Duy

  Sign

• Date:

  Date

Extension Gia Hạn Thêm

• Extended new Date

  Date

Supervisor of Applicant (Signature):

• Name/signoff:

  Sign

• Date:

  Date

Facility Management Leader (Signature):

• Name/signoff: Sơn

  Sign

• Date:

  Date

Close

• I confirmed that all hot work is completed, and the permit shall be closed.

Facility Management Leader (Signature):

• Name/signoff: Sơn

  Sign

• Date:

  Date