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