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Work at Height Permit

1. This work at height permit outlines the safety precautions and equipment required for work being done at a specified location between specified dates and times. 2. It requires checks that the work area, fall arrest equipment, and access equipment are all safe and properly maintained or erected. 3. The permit must be signed by the authorized workers and operating authority to confirm the safety precautions have been understood and will be followed, and that the work area will be cleared upon completion of the work.

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Aldrin M
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199 views1 page

Work at Height Permit

1. This work at height permit outlines the safety precautions and equipment required for work being done at a specified location between specified dates and times. 2. It requires checks that the work area, fall arrest equipment, and access equipment are all safe and properly maintained or erected. 3. The permit must be signed by the authorized workers and operating authority to confirm the safety precautions have been understood and will be followed, and that the work area will be cleared upon completion of the work.

Uploaded by

Aldrin M
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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WORK AT HEIGHT PERMIT PERMIT NO.

:
REF :

Location : ........................................................................... Other : ...........................................................................


Date : Time : Expiry Time:

Contract : Name :
Company: Signature:
Scope of Works:

Special Instructions
PRECAUTIONS TO BE TAKEN Yes / No
See at. risk Assessment
1. WORK AREA
Surface is stable
Clear of trip hazards
Clear of employees / visitors
Work area is isolated
Access to work area is free
Access to work area is controlled
Measures taken to prevent tools being dropped
2. FALL ARREST
Safety lines certified and checked
Workers have appropriate harness
Workers trained in the use of the harness
Harness is in good working order
Harness is certified for use
3. EQUIPMENT
Scaffold is erected correctly
Scaffold has controlled access
Tower scaffold is erected correctly
Kickboards are intact
Ladder is appropriate for the job
Ladder is certified for use
Mechanical / powered system suitable for the task
Workers certified in the correct use of mechanical equipment
Any equipment has been checked in the last 6 months
4. REMINDERS TO WORKERS
Not to over reach
Keep work area clear to prevent tools being dropped
Weather conditions are acceptable
PPE required Y N Delete if not applicable Y N Traffic Vest Y N
Hard Hats Boots Gloves Coverall Ear Defenders Goggles Breathing apparatus Safety Harness Dust / Gas Mask

OPERATING AUTHORIZED
Name Mobile No. Telephone No. Signature

I understand the precautions to be taken and will notify the operating authority when work is completed
Performing Authority Signature :
WORK COMPLETION , SITE CLEARED OF EQUIPMENT
Date Time Operating authorized Name Signature

Contractor / Company Contact Details :


Mobile : Tel.: Fax :

Cc :..........................................................................
* Permit valid for a Maximum of 8 hours *

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