Ryobi Kiso (S) Pte Ltd

WORK AT HEIGHT PERMIT

Permit Attach Permit no.: No: This permit is valid for 7 days from the time of approval. Application must be submitted at least 3 day in advance. Work on Saturday Sunday and !onday must be applied by Friday. Sketch to be attached Part 1: Application To Be Co pleted By !"#$Contractor
Work Performed by : Name of Supervisor in $har&e: 'ocation: (ate ) Time of *ot Work: +rom: To: No. of Workers: "name of Sub#$ontractor%

,*S -e.uirements Prior Application of /eneral Work permit by Permit Applicant S 5tems Status Si&n 0 1 3 2 3 4 7 9 : Provision of safety harness Provision of 'ife line6+all arrestor system Affected 7ork area belo7 to be barrier +all ha8ards eliminated Scaffolds to be certified safe use *andtools to be slin& to body /ood condition ladders 1 men system for ladder

In%pection By EH! Per%onnel d"rin& co"r%e o' (or) 0

Sta. Si&n Sta.

1
Si&n Sta .

3
Si&n Sta.

2
Si&n Sta .

3
Si&n Sta.

4
Si&n Sta .

7
Si&n

Small ) loose materials to be in containers -yobi ;iso Sup6,n&r6*<( W5S $omply (escription of Work:

Part *: C+ec) , Endor%e By Ryo#i Ki%o EH! -epart

ent

Work area is safe. -easonably practicable steps have been taken to safe&uard the safety and health of the 7orkin& personnel
Name6Si&natur e: Part .: Endor%e By Ryo#i Ki%o !"per/i%or0En&ineer (ate6Time:

A7are of the 7ork to be done and ensure that all safe 7ork procedures to be complied 7ith. Name6Si&natur (ate6Time: e: Part 1: Appro/al By Ryo#i Ki%o Head o' -epart ent 5=m satisfied that all reasonably practicable measures have been implemented and enforce and the 7orkin& personnel are informed of the ha8ards and protection counter measures to be taken. The above mentioned 7ork is: Name6Si&nature: Part 2: 3oti'ication O' Co Approved 6 Not Approved (ate6Time: pletion O' Wor) By !"#$Contractor

Work has completed.

*ousekeepin& has been carried out. (ate6Time:

Work area is safe for other personnel.

Name6Si&nature: Part 4: Con'ir ation By Ryo#i Ki%o !"per/i%or0En&ineer

Work has completed.

*ousekeepin& has been carried out. (ate6Time:

Work area is safe for other personnel.

Name6Si&nature: Note: 0. <ri&inal $opy > to be displayed at 7ork location 1. Portable tools to be slin& to ri&id point 7hen at hei&ht

'e&ends:

? @ <;6/ood

A @ Not <;6Bad NA @ Not Applicable

Page 1 of 2 Issued on 15 Sept 2010

EOHSMS-02-F04_Rev 0

Ryobi Kiso (S) Pte Ltd

EOHSMS-02-F04_Rev 0

Page 2 of 2

Issued on 15 Sept 2010