PTW – excavation trenching (= 1.5m) permit

Magicsoft Asia night

PROJECT :

EXCAVATION/ TRENCHING (≥ 1.5m) 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 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

Open sides & openings guarded by effective guard rail & barriers Yes

Adequate safe means of access into or egress out of excavation provided Yes

Designated person/ supervisor appointed for excavation works Yes

Daily inspection carried out by designated person Yes

Competent excavator operator appointed Yes

Daily inspection carried out by authorised operator Yes

Competent banks man appointed & clearly identified Yes

Adequate lighting provided at workplaces Yes

Temporary shoring provided for excavation ≥ 1.5m deep Yes

PE design calculation & drawing for temporary shoring ≥ 4m deep available Yes

PE Certificate of Supervision (COS) for temporary shoring available Yes

PE design calculation & drawing for excavation ≥ 1.5m deep (slope/ without shoring) Yes

PE certificate of supervision COS for slope available Yes

Adequate de-watering equipment available 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