建设工程安全监督备案申报表

建设工程安全监督备案申报表 一 建设工程安全监督备案申报表 监督备案号: 工程名称: 建设单位: (盖章) (申报单位) 申报日期: 江苏省建筑安全监督总站制 summer of masonry construction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plastic), high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference cracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying degrees, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures taken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temperature 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, but make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the supervising engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high temperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservation to prevent surface drying and covering thin-film wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction preparation 1) required winter construction materials, equipment, planning ahead of time comes into 申报说明 1、建设单位到安监机构领取本表，按要求填报。 2、办理安全监督备案时，所提交的申报资料须装订成册，申报资料中第2、3、9项应提供原件备核。 3、安监机构审查建设单位提供的安全监督备案资料，符合条件的5日内办理完备案手续;资料不全或不符合条件的，自收到备案资料之日起5日内退回备案资料并说明理由。 4、安监机构办理工程安全监督备案后5日内发出《建设工程安全监督通知书》。 5、工程类型:建筑、装饰装修、安装、市政基础设施和其它工程。 6、专职安全生产管理人员的配备按照建质〔2008〕91号文件要求填写。 7、建设单位应如实逐项填写本表，各安全责任主体单位名称应填写全称并对申报材料的真实性负责。 8、建设单位、监理单位、施工单位对报送的安全监督备案资料的真实性、有效性及是否具备安全监督备案条件签署意见并加盖单位公章。 9、《建设工程安全监督备案申报表》一式五份，安监机构、建设单位、监理单位、施工单位各一份。 film wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction preps into-aration 1) required winter construction materials, equipment, planning ahead of time comeprevent surface drying and covering thin ion toperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservating engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high tempervisut make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the sue 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, beraturaken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temps, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures tdegreecracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying , high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference astic)temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high summer of masonry constru1 1-1 建设工程安全监督备案申请书 (安监机构): 今有我单位建设的 工程，按照《建设工程安全生产管理条例》、《建筑工程施工许可证管理办法》、《建筑工程安全生产监督管理工作导则》等相关规定，现携下列材料到你单位办理工程安全监督备案手续。 序申报资料 证书( 合同 劳动合同范本免费下载装修合同范本免费下载租赁合同免费下载房屋买卖合同下载劳务合同范本下载 )号 号 1 建设工程开工安全生产条件审查表 2 施工中标通知书、 施工合同 综合布线施工合同下载隔墙施工合同工厂拆除工程施工合同工程地板砖施工合同协议书范本广场地砖施工合同 、企业安全生产许可证 项目经理、专职安全生产管理人员等安全生产知识考核合格证3 书 4 施工现场安全管理网络及安全技术措施 5 施工现场平面布置图 6 施工现场周边环境和地下设施情况交底表 7 危险性较大的分部分项工程清单和安全管理措施 8 工程项目安全生产事故应急救援预案 9 保险缴纳凭证 10 安全文明施工措施费支付计划或凭证 11 其它规定需要的文件 联 系 人: 建设单位(盖章): 联系电话: 年 月 日 summer of masonry construction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plastic), high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference cracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying degrees, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures taken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temperature 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, but make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the supervising engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high temperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservation to prevent surface drying and covering thin-film wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction preparation 1) required winter construction materials, equipment, planning ahead of time comes into 1-2 工程概况及建设各方责任主体基本情况 工程名称 工 工程地点 安全文明 程 施工目标 概 合同开工日期 合同竣工日期 况 工程类型 结构/层次 建筑面积 工程造价 名 称 建 地 址 设 组织机构 法定代表人 单 代码证 项目负责人 联系电话 位 现场负责人 联系电话 名 称 地 址 资质等级 资质证书号 监 组织机构 法定代表人 理 代码证 姓 名 单 项目 联系电话 总监 位 资格证书号 姓 名 总监 联系电话 代表 资格证书号 aration 1) required winter construction materials, equipment, planning ahead of time comes intofilm wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction prep-prevent surface drying and covering thin ion toperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservating engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high tempervisut make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the sue 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, beraturaken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temps, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures tdegreecracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying , high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference astic)temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high summer of masonry constru3 姓 名 姓 名 监 理 工程师 资格证书号 资格证书号 监 姓 名 姓 名 理 监 理 工程师 单 资格证书号 资格证书号 位 姓 名 姓 名 监 理 工程师 资格证书号 资格证书号 名 称 地 址 安全生产 组织机构代码证 许可证编号 资质证书号 资质等级 施 法定代表人或 工 安全考核证号 委托负责人 总 企业技术负责人 安全考核证号 承 企业分管安全负责人 安全考核证号 包 姓 名 联系电话 单 项目 经理 资格等级 安全考核证号 位 及证书号 项目技术负责人 安全考核证号 安 全 员 安全考核证号 安 全 员 安全考核证号 安 全 员 安全考核证号 安 全 员 安全考核证号 summer of masonry construction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plastic), high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference cracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying degrees, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures taken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temperature 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, but make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the supervising engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high temperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservation to prevent surface drying and covering thin-film wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction preparation 1) required winter construction materials, equipment, planning ahead of time comes into 名 称 地 址 安全生产 组织机构代码证 许可证编号 资质证书号 资质等级 专 法定代表人或 安全考核证号 委托负责人 业 单位技术负责人 安全考核证号 承 单位分管安全负责人 安全考核证号 包 姓 名 联系电话 单 项目 经理 资格等级 安全考核证号 位 及证书号 项目技术负责人 安全考核证号 安 全 员 安全考核证号 安 全 员 安全考核证号 安 全 员 安全考核证号 名 称 地 址 劳 安全生产 组织机构代码证 务 许可证编号 资质证书号 资质等级 分 法定代表人或 安全考核证号 委托负责人 包 单位分管安全负责人 安全考核证号 单 安 全 员 安全考核证号 位 安 全 员 安全考核证号 安 全 员 安全考核证号 s intoaration 1) required winter construction materials, equipment, planning ahead of time comefilm wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction prep-prevent surface drying and covering thin ion toperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservating engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high tempervisut make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the sue 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, beraturaken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temps, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures tdegreecracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying , high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference astic)temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high summer of masonry constru5 拟进场的大型机械设备情况: 序号 设备名称 规格型号 数量 1 2 3 我单位承诺所报送的工程安全监督备案资料真实有效。 建设单位(公章) 年 月 日 施意 工 单(盖章) 见位 年 月 日 监意 理 单 见位 (盖章) 年 月 日 summer of masonry construction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plastic), high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference cracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying degrees, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures taken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temperature 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, but make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the supervising engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high temperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservation to prevent surface drying and covering thin-film wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction preparation 1) required winter construction materials, equipment, planning ahead of time comes into 1-3 建设工程开工安全生产条件审查表 工程名称: 建设单位: 施工单位: 项目经理: 监理单位: 项目总监: 序号 审 查 内 容 审查意见 1 施工单位是否持有安全生产许可证 项目安全生产责任体系建立情况。是否按规定建立了安全生产 管理机构，并按规定配备专职安全生产管理人员，项目负责人、2 专职安全生产管理人员是否取得安全生产考核合格证书，并在 有效期内。 3 施工现场安全生产 管理制度 档案管理制度下载食品安全管理制度下载三类维修管理制度下载财务管理制度免费下载安全设施管理制度下载 建立情况 4 是否已按规定签订安全生产 协议 离婚协议模板下载合伙人协议 下载渠道分销协议免费下载敬业协议下载授课协议下载 书 5 是否按规定编制了施工组织设计，专项方案是否有计划 6 安全文明施工措施费是否有支付计划或凭证 7 拟进入施工现场的机械设备情况及布置方案 8 施工现场“三通一平”、“施工标牌”等设置情况 9 施工现场围挡、大门、道路、临时设施等是否符合规定要求 10 是否针对性地制定了工程项目安全生产事故应急救援预案 11 其它事项 审查结论: 项目负责人: 建设单位(公章) 年 月 日 注:本表一式四份，建设单位、监理单位、施工单位各一份，另一份为安全监督备案 的附件材料。 s intoperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservataration 1) required winter construction materials, equipment, planning ahead of time comefilm wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction prep-prevent surface drying and covering thin ion toing engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high tempervisut make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the sue 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, beraturaken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temps, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures tdegreecracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying , high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference astic)temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high summer of masonry constru7 1-4 施工现场平面布置图 建设单位项目负责人 总监理工程师 施工单位技术负责人 项目经理 项目经理签字: 总监理工程师签字: 项目负责人签字: 施工单位(章) 监理单位(章) 建设单位(章) 年 月 日 年 月 日 年 月 日 施工现场平面布置图应符合“边界清晰、围护美观、场内平实、物料整齐、文明有序”的总体要求，应详细标明办公区、施工区、生活区。 summer of masonry construction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plastic), high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference cracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying degrees, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures taken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temperature 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, but make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the supervising engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high temperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservation to prevent surface drying and covering thin-film wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction preparation 1) required winter construction materials, equipment, planning ahead of time comes into 1-5 施工现场周边环境及地下设施情况交底表 工程名称 建设单位负责人 总监理工程师 施工单位技术负责人 项目经理 序号 交底项目 交底情况 1 地上管线，如毗邻高压线、网线的状况 2 施工对毗邻建筑物、构筑物、地下工程的影响 3 深基坑施工对周边环境的影响 4 施工对周边通信、道路等公用设施的影响 施工现场的临建设施选址是否合理，结构是否安 5 全，围挡是否按标准设置 施工现场对周边交通、行人、集贸市场和学校等 6 人流密集区域的影响 施工中各种粉尘、废气、废水、固体废弃物以及 7 噪音、振动对环境的污染和危害 8 拟使用起重机械设备对周边环境的影响 施工现场及毗邻区域内地下管线资料、气象水文9 观测资料 10 其它可能造成严重后果的危险源 交底方负责人签字: 见证方负责人签字: 接收方负责人签字: 建设单位(章) 监理单位(章) 施工单位(章) 年 月 日 年 月 日 年 月 日 可另附页 s intoaration 1) required winter construction materials, equipment, planning ahead of time comefilm wet grass bag to make it moist State in 24 hours. 8.6.3 8.6.3.1 winter construction measures in winter construction prep-prevent surface drying and covering thinion toperatures. D. strengthen the conservation and high temperatures after pouring in the early days of continuous water conservating engineer. C. time control suitable for work at night, should seek to reduce the mixing time and shipping time at high tempervisut make some performance degradation of concrete, so when you are using additives must be implemented upon approval by the sue 0.5 degrees. B. with the controlled addition of retarder agent can reduce the effects of concrete under high temperature, beraturaken by a. temperature control the water temperature in your standard mix proportion of concrete 2 degrees, the concrete temps, on mixing processes, perfusion vibration and moisture conservation, effective measures should be taken. 2) main measures tdegreecracks. B. pouring daytime high temperatures, due to the high temperature effect of concrete strength, stability, in varying , high early strength, fast early hydration heat, less cooling, temperature increases rapidly, due to temperature difference astic)temperature impact on concrete a. hardening speed up, vibrating difficulties reduced bleeding, fast drying, easy to crack (plction, brick requires sufficient moist. 8.6.2.6 you must take the following measures to concrete construction in summer high summer of masonry constru9 1-6 危险性较大的分部分项工程清单 工程名称 结构层次 施工单位 项目经理 监理单位 总监理工程师 内 容 预计实施时间 分部分项工程 ? 开挖深度超过3m(含3m)的基坑(槽)支护、降水工程 一、基坑支护、降 ? 虽未超过3m但地质条件和周围环境复杂的基坑(槽) 水工程 支护、降水工程 ? 土方开挖深度超过3m(含3m)的基坑(槽)的土方 二、土方开挖工程 开挖工程 ? 各类工具式模板工程:包括滑模、爬模、大模、 飞模等工程 ? 混凝土模板支撑工程:搭设高度5m及以上 ;搭设三、模板工程 跨度10 m及以上;施工总载荷10KN/?及以上;集中 及支撑体系 线荷载15KN/?及以上;高度大于支撑水平投影宽度 且相对独立无联系构件的混凝土摸板支撑工程。 ? 承重支撑系统:用于钢结构安装等满堂支撑体系 ? 采用非常规起重设备、方法，且单件起吊重量在 四、起重吊装安装10KN及以上的起重吊装工程 ? 采用起重机械进行安装的工程 拆卸工程 ? 起重机械设备的安装、拆卸 ? 搭设高度在24m及以上的落地式钢管脚手架工程 ? 附着整体和分片提升脚手架工程 ? 悬挑脚手架工程 五、脚手架工程 ? 吊篮脚手架工程 ? 自制卸料平台、移动操作平台工程 ? 新型及异型脚手架工程 0 ? 建筑物、构筑物拆除工程 六、拆除、爆破工程 ? 采用爆破拆除工程 ? 建筑幕墙安装工程 ? 钢结构、网架、索模结构安装工程 ? 人工挖孔桩工程 七、其 他 ? 地下暗挖、顶管及水下作业工程 ? 预应力工程 ? 采用新技术、新工艺、新材料、新设备及尚无相 关技术标准的危险性较大的分部分项工程 安全管理措施(可另附页): 项目经理(签字): 总监理工程师(签字): 项目负责人(签字): 施工单位(盖章) 监理单位(盖章) 建设单位(盖章) 年 月 日 年 月 日 年 月 日 本项目工程所含的危险性较大的分部分项工程，应在以上栏目所列的相应分部分项填写 工程前的 “?”内打上“?”，没有的应在“?”内打“×” 说明 13 1-7 超过一定规模的危险性较大的分部分项工程清单 工程名称 结构层次 项目经理 施工单位 监理单位 总监理工程师 内容 财务内部控制制度的内容财务内部控制制度的内容人员招聘与配置的内容项目成本控制的内容消防安全演练内容 预计实施时间 分部分项工程 ? 开挖深度超过5m(含5m)的基坑(槽)的土方开挖、支护、 降水工程 一、深基坑 ? 开挖深度虽未超过5m，但地质条件、周围环境和地下管 工 程 线复杂，或影响毗邻建筑(构筑)物安全的基坑(槽)的 土方开挖、支护、降水工程 ? 工具式模板工程:包括滑模、爬模、飞模工程 ? 混凝土模板支撑工程:搭设高度8m及以上 ;搭设跨二、模板工程 度18m及以上，施工总载荷15KN/?及以上，集中线载荷 及支撑体系 20KN/m及以上 ? 承重支撑系统:用于钢结构安装等满堂支撑体系，承 受单点集中荷载700kg以上 ? 采用非常规起重设备、方法，且单件起吊重量在100KN三、起重吊装安以上的起重吊装工程 ? 起重量300KN及以上的起重设备安装工程、安装高度装拆卸工程 200m及以上内爬起重设备的拆除工程 ? 搭设高度50m及以上的落地式钢管脚手架工程 四、脚手架 ? 提升高度150m及以上附着式整体和分片提升脚手架 工 程 工程 ? 架体高度20m及以上悬挑脚手架工程 2 ? 采用爆破拆除工程 ? 码头、桥梁、高架、烟囱、水塔或拆除中容易引起有 毒有害气(液)体或粉尘扩散、易燃易爆事故发生的五、拆除、爆破特殊建、构筑物拆除工程 工 程 ? 可能影响行人、交通、电力设施、通讯设施或其它建、 构筑物安全的拆除工程 ? 文物保护建筑、优秀历史建筑历史文化风貌区控制范 围的拆除工程 ? 施工高度50m及以上的建筑幕墙安装工程 ? 跨度大于36m及以上的钢结构安装工程;跨度大于60m 及以上的网架和索模结构安装工程 ? 开挖深度超过16m的人工挖孔桩工程 六、其 他 ? 地下暗挖、顶管及水下作业工程 ? 采用新技术、新工艺、新材料、新设备及尚无相关技 术标准的危险性较大的分部分项工程 安全管理措施(可另附页): 项目经理(签字): 总监理工程师(签字): 项目负责人(签字): 施工单位(盖章) 监理单位(盖章) 建设单位(盖章) 年 月 日 年 月 日 年 月 日 填写本项目工程所含的危险性较大的分部分项工程，应在以上栏目所列的相应分部分项工程前 说明 的 “?”内打上“?”，没有的应在“?”内打“×” 13