CONTRACT CR205

PERMIT TO WORK DESIGN AND CONSTRUCTION OF KING ALBERT PARK

INTERCHANGE STATION FOR CROSS ISLAND LINE

GENERAL WORKS

Project: Permit Number:

Company: Scope of Work: Main Contractor / Sub Contractor*

Description of Work:

Date and Duration: Location:

This permit is valid only for the period stated above (12 hours). Conditions of issue must be complied with throughout
the duration of the work. This permit is void if site condition deviates from method statement, safe work procedures or
statutory requirements. The permit must be displayed in a prominent location.

STAGE 1 – PERMIT REQUESTER (SITE SUPERVISOR)

Condition of issue must be confirmed and ticked (), if not applicable write ‘NA’
RA & SWP for intended work of the PTW is available and
Fire Watchman Required
communicated to all operatives (Attached RA and SWP)

Provision of Appropriate PPEs Fire Extinguisher

Electrical Insulation Checked (LEW Certified) No Smoking or Naked Flame

Machine/ Equipment’s Rotating Parts and Pinch Points

Adequate Ventilation and Sufficient Lighting
Guarded

Safe Means of Access / Egress First Aid Kit

Proper Working Platforms Scaffolding / MEWP / Portable

All Open sides/ Openings are properly Guarded
Ladder etc. Required

Explosibility / Toxicity Checked Barriers and Warning Signages Required

Fall Control Measures Required (Lifeline, Anchorage Point,

Area Clear of Combustibles
Full Body Harness)
Materials, tools & equipment shall be placed/ stored in a
Noise Control Measures Required
proper and safe manner

I have checked and confirmed that the above-mentioned safety requirements have been complied with.
I will ensure that the works carried out comply with the safe work procedures and statutory requirements at all time.

Name / Designation: ______________________________ Sign: _______________ Date/Time: _______________

STAGE 2 – ASSESSED BY COMPETENT PERSON (SUPERVISOR / ENGINEER)

I have inspected the area and confirmed that it is safe to work. I will ensure compliance with the statutory requirements
and safe work procedures at all times.

Name / Designation: ______________________________ Sign: _______________ Date/Time: _______________

STAGE 3 - ENDORSED BY WSHE DEPARTMENT

I have inspected the above-stated location and confirmed that the safety measures are in place and the said location is
safe for work.
Name / Designation: _______________________________ Sign: _______________ Date/Time: _______________

STAGE 4 – APPROVAL BY PROJECT MANAGER

I am fully satisfied that a thorough inspection and proper assessment of the work area and its surroundings have been
made so that the work can be carried out safely.

Name / Designation: ______________________________ Sign: _______________ Date/Time: _______________

STAGE 5 – COMPLETION OF WORK (SITE SUPERVISOR)

The work is completed and conditions were rendered safe for the day.

Name / Designation: ______________________________ Sign: _______________ Date/Time: _______________

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 CONTRACT CR205
PERMIT TO WORK DESIGN AND CONSTRUCTION OF KING ALBERT PARK
INTERCHANGE STATION FOR CROSS ISLAND LINE

NAME LIST OF WORKERS INVOLVED PTW No.:

We are briefed and made aware of the hazards and precautionary measures that must be undertaken and
complied with when working, in accordance to the Permit To Work.

Mon Tue Wed Thur Fri Sat Sun

S/No Name of Worker

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Safety Briefing Conducted By:

(Name, Signature, Supervisor In-Charge)

Confirmed by CCCC Area In-Charge:

(Name, Designation, Signature)