MAGICSOFT ASIA SYSTEMS

PERMIT TO USE GONDOLA INSPECTION CHECKLIST

Project: Company: MAGICSOFT ASIA SYSTEMS

Gondola Number: text Location: text

Application Date: 28/08/2017

S/ S/
ITEMS CHECKED ITEMS CHECKED
No. No.
Are the operators attended the Safety Orientation Briefing
1 (Safe use of Gondola) conducted by the Gondola
Supervisor?
☐ 9
Are there two suspended wire ropes and two safety wire ropes
provided for the cradle? ☐
2 Are the operators authorised to use the Gondola? ☐ 10
Are the wire ropes used to suspended the cradle kept tight and
vertical? ☐
Are the signboard “safe working load (maximum 300kg)” and
3 Are LM certificate update? ☐ 11 “maximum allowable number of operators (not more than 2
persons)” prominently displayed on the cradle?
☐
4
Are the operators briefed on the safe work procedure for the
work to be carried out? ☐ 12 Are the lifelines strong enough to carry man load? ☐
5 Are ground floor barricaded with proper access? ☐ 13 Are all lifelines anchorage point secure? ☐
6
Are warning signboard (minimum 2 in no.) placed at
strategic? ☐ 14 Are lifeline free from kinks and damage? ☐
Are operators equipped with good condition and compatible
7 personal protective equipment for safety harness and rope
grab?
☐ 15
Are the tension weights properly secured to the safety wire ropes
above ground level? ☐
The Gondola titled less than 30 degree when it raise 1 meter
8 Is the control box in the Gondola covered and locked? ☐ 16 above ground. (To check whether the safety devices (Block Stop)
is in good working condition)
☐
Personnel authorized to use this Gondola

a. Name of Worker: text Site Pass Number: text

Signature:

b. Name of Worker: Site Pass Number:

Signature:

Inspected By: text Signature: Date: 28/08/2017

Supervisor-In-Charge

Main Contractor

Endorsed By : - Signature: - Date: -

Main contractor's Supervisor

Reviewed By: - Signature: - Date: -

WSHO / EHS Personnel

Approved By: - Signature: - Date: -

PM / Engineer