Scribd Logo
Upload

Welcome to Scribd!

  • 163 views

    Permit To Work at Heights

    Uploaded by

    Rj Hush Esguerra
    This permit document outlines the requirements and approvals needed for any work conducted at heights, including describing the location and tasks, listing required safety equipment and control measures, and requiring signatures from the issued to/by parties to authorize the work and again to cancel the permit upon completion. Authorized parties must assess environmental factors and attach any relevant job safety documents before signing off to allow the described high elevation work to proceed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Permit To Work at Heights

    Uploaded by

    Rj Hush Esguerra
    163 views2 pages
    This permit document outlines the requirements and approvals needed for any work conducted at heights, including describing the location and tasks, listing required safety equipment and control measures, and requiring signatures from the issued to/by parties to authorize the work and again to cancel the permit upon completion. Authorized parties must assess environmental factors and attach any relevant job safety documents before signing off to allow the described high elevation work to proceed.

    Original Description:

    permit to work at heights

    Original Title

    Permit to Work at Heights

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This permit document outlines the requirements and approvals needed for any work conducted at heights, including describing the location and tasks, listing required safety equipment and control measures, and requiring signatures from the issued to/by parties to authorize the work and again to cancel the permit upon completion. Authorized parties must assess environmental factors and attach any relevant job safety documents before signing off to allow the described high elevation work to proceed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    163 views2 pages

    Permit To Work at Heights

    Uploaded by

    Rj Hush Esguerra
    This permit document outlines the requirements and approvals needed for any work conducted at heights, including describing the location and tasks, listing required safety equipment and control measures, and requiring signatures from the issued to/by parties to authorize the work and again to cancel the permit upon completion. Authorized parties must assess environmental factors and attach any relevant job safety documents before signing off to allow the described high elevation work to proceed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    No:

    Title: Permit to Work – Work at Heights Permit Authorised By:

    Issue Date: Number of Pages:


    Last Reviewed:
    Next Review Date:

    Permit Number:       Date:      


    Site:      
    Location:      
    Contractor/       Phone:      
    Employee:
    This permit is valid from:       am/pm On:      
    This permit is valid until:       am/pm On:      
    Description of works:      

    A Safe Work Method Statement (SWMS), Job Safety Analysis (JSA) and/or Safe Work Procedure (SWP)
    has been provided and is attached to this ‘work permit’ Yes No

    Note: The following section of this permit must be completed and signed by the authorised
    person(s) before work is to proceed and only work listed above may be completed.
    The following equipment will be used during the works (all equipment to be used is in good working order and is fit for
    use):

    Elevated work platform (i.e. Roof and/or ladder anchor


    Ropes and harness
    scissor lift) points
    Step ladder Extension ladder Edge protection
    Mobile scaffold Appropriate footwear Safety net
    Other (please specify):

    The following services have been isolated for the duration of the works:
    Smoke / thermal detectors Pipes, tanks and valves Electrical Outlets / appliances
    Other (please specify):

    The following control measures have been implemented for the duration of the works:
    Barricades Signage Spotter
    Other (please specify):

    The following environmental factors have been assessed and are suitable for the works:
    Weather / wind Stored material / vegetation
    Other (please specify):
    This permit should be prominently displayed at the work site

    Authorisation
    Permit Issued To:
    (Print name) (Signature) (Date)

    Permit Issued By:


    (Print name) (Signature) (Date)

    Cancellation/completion of permit
    Permit cancelled/returned by:
    (Print name) (Signature)

    Cancelled/returned at: am/pm On:


    Reason for cancellation :

    Final Sign Off


    The worksite has been inspected by me at the cancellation/completion of the work at heights and declared safe for
    normal operations to resume.

    (Print name) (Signature) (Date)

    You might also like