• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • 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:

  • 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

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

  • Site Safety Induction

  • Site specific safe work method statement

  • Appropriate safety equipment (including safety equipment inspection certificate)

  • Maintenance equipment inspected prior to use

  • Is building maintenance unit being used for work task

  • Building maintenance unit checked and safe to operate

  • Operator appropriately trained or qualified to operate building maintenance unit

  • Approved Safety Harness to be worn at all times

  • Permit Approved:

Period of Permit

  • From:

  • To:

  • Approved By:

  • 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:

  • Date:

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