Magicsoft Asia night
PROJECT : Confirmed
WORK AT HEIGHT ON A SCAFFOLD (>2M) PERMIT Permit No. : AAG-PTW-WH_SC-18-00008
Part 1: Application
Validity Period (Date & Time of work) : From: 10/08/2018 (Date) 19:00 (Time) To: 11/08/2018 (Date) 07:00 (Time)
Contractor : Magicsoft Asia
Description of work : test
Daily Check By Work Supervisor-In-Charge and/or Safety Assessor (Yes, No, “NA“ for Not Applicable)
Minimum Safety Requirements
Approved Risk Assessments available Yes
Safe Work Procedures available Yes
Job Specific Fall Prevention Plan available Yes
PTW/ Location Plan displayed at place of work Yes
Workers are briefed on the hazards & corresponding control measures Yes
Workers are medically fit to work/ not feeling unwell/ not overworked Yes
Workers are reminded to do Last Minute Risk Assessment (LMRA) before start work Yes
Adequate safe means of access/ egress provided. Yes
Adequate lighting provided at workplaces & along access/ egress Yes
Safety harness with double lanyard & shock absorber provided/ used as fall arrest-eqpt or Safety belt provided & used asfall-restrain eqpt
Yes
Monthly Inspection & colour coding of PPE implemented Yes
Adequate edge protection provided - top rail/ mid rail/ toe board (Top rail ≥ 1m high / mid rail < 0.6m high / toe board ≥90mm high)
Yes
Safe work platform - min. 500mm width/ secured Yes
Comply with Safe Working Load; no overloading of platform Yes
Valid 'Safe to use' tag displayed (after inspection, at least once a week or after increment weather) Yes
Barricades and signages provided below; area clear of incompatible works around work area Yes
Good housekeeping maintained - no storage of unused materials/ debris on platform Yes
MOM Approved Scaffold Contractor/ Team (Scaffold >4m high) Appointed Yes
PE certificate of supervision available for lifeline Yes
Lifeline & anchorage points are provided/ constructed/ inspected as per PE Design Yes
Others :
Part 2: Check & Endorsement
a) I have read & understood this permit & agree to work in accordance with the provisions of the RA/ SWP/ Method Statement & the safety requirements stated in this permit.
b) I have checked the site & satisfied that reasonably practicable steps will or have been taken to safeguard the safety & health of the persons working & in the vicinity
a. Applicant/ Work Supervisor (Work atHeight Supervisor)
Name Applicant
Signature
Time 12:03
b. Safety Assessor (Shimizu) (WSHO/ WAHAssessor)
Name Safety Assessor
Signature
Time 12:24
c. Shimizu Engineer/ Supervisor In-Charge(Work at Height Supervisor)
Name Engineer
Signature
Time 12:25
Part 3: Issued By
a) I am satisfied that proper evaluation of risk & hazards involved based on available information b) I am satisfied that no incompatible works will be carried out e.g no concurrent activities@ same elevation, etc
c) I am satisfied that all reasonably practicable measures will or have been implemented & enforced d) The working personnel are informed of the hazards & protection counter measures to betaken
Site Overall In-Charge (SC PM / WAHManager/ Manger with CSCPM Certificate)
Name PM
Signature
Time 12:25
Part 4: Notice of Revocation or Closure
a) Work has been terminated/ completed b) Housekeeping has been carried out c) Work area is safe for other personnel
Applicant/ Work Supervisor (Work atHeight Supervisor)
Name Applicant
Signature
Time 12:26
Part 5: Confirmation of Revocation or Closure
a) Work has been terminated/ completed b) Housekeeping has been carried out c) Work area is safe for other personnel
Site Overall In-Charge (SC PM / WAHManager/ Manger with CSCPM Certificate)
Name PM
Signature
Time 12:26
Photo Attachment
Adequate safe means of access/ egress provided. Adequate edge protection provided - top rail/ mid rail/ toe board (Top rail ≥ 1mhigh / mid rail < 0.6m high / toe board ≥ 90mm high)
Safe work platform - min. 500mm width/ secured Valid 'Safe to use' tag displayed (after inspection, at least once a week or afterincrement weather)
Barricades and signages provided below; area clear of incompatible worksaround work area
Good housekeeping maintained - no storage of unused materials/ debris onplatform