PTW – work at height on suspended scaffold (gondola) permit

Magicsoft Asia night

PROJECT :

work at height on suspended scaffold (gondola) permit

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 NA 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 Yes

Monthly Inspection & colour coding of PPE implemented Yes

LP certificate valid for 6 months Yes

Buddy system implemented ie. at least 2 workers/ team Yes

PE design calculations & drawing available/ displayed Yes

PE certificate of supervision available/ displayed Yes

Competent operator appointed & name list with photo displayed Yes

Pre-operation check carried out by authorised operator Yes

Independent lifeline provided Yes

Comply with safe working load; no overloading of platform Yes

Barricades and signages provided below; area clear of incompatible works Yes

Good housekeeping maintained – no storage of unused materials/ debris on platform Yes

Competent Personnel appointed to carry out installation etc Yes

Competent Supervisor appointed & present during installation etc Yes

Inspection of work area after inclement weather – safe to work after inclement weather 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)	tinuously within CS & at the place of work	Environment within the confined space is safe for entry & safe to work in