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ÓÐЧÆÚ´Ó_______________                          ÖÁ______________

1. Work requestÊ©¹¤ÒªÇó

Name of supervisor¹ÜÀíÈËÔ±: _______________           DateÈÕÆÚ: ______________

Company¹«Ë¾Ãû³Æ: _______________                     Tel.µç»°: _______________

2. Work descriptionÊ©¹¤ÃèÊö

Location×÷ҵλÖÃ: _______              ___

No. of workersÈËÊý: __________    Name/Tel of job coordinator

Start timeÈ볡ʱ¼ä: __________              Ð­µ÷Ô±ÐÕÃû/µç»°:_______________________________

End timeÍ˳¡Ê±¼ä: __________

Description of workÊ©¹¤ÃèÊö: ___________________________________________________

_____________________________________________________________________________

3. Workers¡¯ names and Badge numbers need to be attached

Ð踽¹¤ÈËÐÕÃû¼°ÐØ¿¨ºÅÂë_______________________________________________

4. Dust generating work»Ò³¾ÎÛȾ

Does work generate dust? Yes _____     No _____

²úÉú»Ò³¾Óë·ñ£¿                ÊÇ_____    ·ñ_____

If yes, state cause ______________________________________________________________

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Method to contain dust _________________________________________________________

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5. Hot work permit¶¯»ð×÷Òµ

Is hot work involved?ÓÐÎÞ¶¯»ð×÷Òµ__________

If yes, specify date / time / duration ×¢Ã÷ÈÕÆÚ¡¢Ê±¼ä¼°Ê±³¤__________________________

All safety precautions taken and cleanroom procedures to be complied by vendor / contractor / safety officer/ supervisor to supervise work and ensure the above precautions are carried out.

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       ______________________                                          ___________             ________

                Contractor³Ð°üÉÌ                                                                   M+W Group

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