Magicsoft Asia night

PROJECT : Confirmed

WORK AT HEIGHT ON SUSPENDED SCAFFOLD (GONDOLA) PERMIT Permit No. : AAG-PTW-WH_GND-18-00007

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 LP No. : test

Description of work : test LP Expiry Date : 02/01/2019

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 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 11:58

b. Safety Assessor (Shimizu) (WSHO/ WAHAssessor)

Name Safety Assessor

Signature

Time 12:27

c. Shimizu Engineer/ Supervisor In-Charge(Work at Height Supervisor)

Name Engineer

Signature

Time 12:27

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 12:27

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 12:27

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 12:28

Photo Attachment

Adequate safe means of access/ egress provided. Competent operator appointed & name list with photo displayed

Barricades and signages provided below; area clear of incompatibleworks

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