Colliers International - Roof Access Permit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

An authorised Site Management representative prior to any person entering the roof areas must approve all roof access. All roof access must be recorded on this permit form and kept in the permit register file.

• Date:

  Date

• Name:

• Company:

• Reason:

Prior to permitting the person/s intending to access the roof areas they must produce and have participated in the following

• Appropriate Insurance Certificates received

  Yes

  No

• Appropriate Licenses, Training or Qualifications for Specific works tasks Received

  Yes

  No

• Site Safety Induction

  Yes

  No

• Site specific safe work method statement

  Yes

  No

• Appropriate safety equipment (including safety equipment inspection certificate)

  Yes

  No

• Maintenance equipment inspected prior to use

  Yes

  No

• Is building maintenance unit being used for work task

  Yes

  No

• Building maintenance unit checked and safe to operate

  Yes

  No

• Operator appropriately trained or qualified to operate building maintenance unit

  Yes

  No

• Approved Safety Harness to be worn at all times

  Yes

  No

• Permit Approved:

  Yes

  No

Period of Permit

• From:

  Date

• To:

  Date

• Approved By:

  Sign

• All personnel accessing roof areas or using the Building Maintenance Unit agrees to comply with, and conduct all activities i accordance with the current OH&S Act, Regulations, Codes and Legislations including all policie s and procedures

• Name of Person requesting Access & Signature:

  Sign

• Date:

  Date