Magicsoft Asia night

PROJECT : Confirmed

WORK AT HEIGHT ON MOBILE ELEVATED WORK PLATFORM (MEWP- SCISSOR LIFT/ BOOM LIFT) Permit No. : AAG-PTW-WH_WEWP-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 : LP No. : test

Description of work : test LP Expiry Date : 29/08/2018

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

Traffic Management Plan established and 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

LP certificate valid for 6 months Yes

Competent mechanics appointed Yes

Monthly maintenance done authorised mechanics Yes

Competent operator appointed & name list with photo displayed Yes

Pre-operation check carried out by authorised operator 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

Banksman deployed & station on site when in operation/ work in progress 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 12:19

b. Safety Assessor (Sub-con) (WSHO/ WAHAssessor)

Name Safety Assessor

Signature

Time 12:21

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

Name Safety Assessor

Signature

Time 12:21

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

Name Engineer

Signature

Time 12:21

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 12:22

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 12:22

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 12:22

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

Banksman deployed & station on site when in operation/ work inprogress