Magicsoft Asia night
PROJECT : 
CONFINED SPACE (CS) ENTRY PERMIT
Permit No. : 
Part 1: Application

Validity Period (Date & Time of work) :

From: 09/08/2018 (Date) 19:00 (Time)

To: 10/08/2018 (Date) 07:00 (Time)

Contractor : Magicsoft Asia

No. of Supervisors : test

Description of work : test

No. of Workers : 10

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
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
Safety barriers & warning signs erected to prevent unauthorised entry   Yes
Competent Confined Space Assessor appointed   Yes
Competent Manhole/ Confined Space/ Tunnel Supervisor appointed   Yes
Competent Manhole/ Confined Space/ Tunnel Worker appointed   Yes
Competent Confined Space Attendant appointed   Yes
Confined Space Register available   Yes
Adequate safe means of access into or egress provided   Yes
Suitable & Sufficient lighting provided at workplaces   Yes
Adequate & effective mechanical ventilation provided 1 hr before entry   Yes
Adequate & effective mechanical ventilation provided continuously within CS & at the place of work   Yes
Gas meter calibrated & records available   Yes
Records of continuous gas detection/ monitoring available & attached   Yes
Environment within the confined space is safe for entry & safe to work in   Yes
Emergency response/ rescue plan & equipment available & tested   Yes
Sufficient number of Competent Rescuers appointed (ratio 1:25)   Yes
Suitable & sufficient means of communication provided   Yes
Confined Space Attendant stationed at entrance & exit to ensure proper exchange of passes   Yes
Buddy system implemented   Yes
Safety harness & lifeline provided   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 and satisfied that the confined space is safe & healthy for persons to enter and work in

a. Applicant / Work Supervisor (Manhole/
Confined Space/ Tunnel Supervisor)
Name Keke –
Signature
Time 16:56

b. Safety Assessor (Shimizu) (Confined
Space Safety Assessor)
Name Safety Assessor
Signature
Time 11:06

c. Shimizu Engineer/ Supervisor In-Charge
(Manhole/ Confined Space/ Tunnel
Supervisor)
Name Engineer
Signature
Time 11:07

Part 3: Issued By

a) I am satisfied that proper evaluation of risk & hazards involved based on available information

b) I am satisfied that the confined space is safe & healthy for person to enter and work in

c) I am satisfied that effective steps have been taken to prevent any ingress of toxic/flammable subst/gas/vapor

d) The working personnel are informed of the hazards & protection counter measures to be taken

Site Overall In-Charge (SC PM / Appointed
Duty Personnel)
Name PM
Signature
Time 11:07

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 (Manhole/
Confined Space/ Tunnel Supervisor)
Name Applicant
Signature
Time 11:08

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 / Appointed
Duty Personnel)
Name PM
Signature
Time 11:08

Photo Attachment
Safety barriers & warning signs erected to prevent
unauthorised entry

Confined Space Register available

Adequate safe means of access into or egress provided

Suitable & Sufficient lighting provided at workplaces)

Adequate & effective mechanical ventilation provided
continuously within CS & at the place of work

Environment within the confined space is safe for
entry & safe to work in

Confined Space Attendant stationed at entrance &
exit to ensure proper exchange of passes

Buddy system implemented

Safety harness & lifeline provided