Havieron - Working at Heights Permit

• Site conducted

  Select

• Conducted on

  Date

• Region

  Select

• Country

  Select

• Project

  Select

• Project Name

• Project

• Project

• Project Name

• Yes

  No

  N/A

Requestor details

• Company requesting permit

• Name of person requesting permit

• Location of works to be undertaken - (e.g Rig 49)

Permit details

• Description of the work to be undertaken

• Time and date permit becomes active

  Date

• Time and date permit will become deactivated

  Date

• Permit issued to

• Special tools / equipment required

• Can the work be conducted at ground level?

  Yes

  No

  N/A

• Are you qualified / trained to undertake this work?

  Yes

  No

  N/A

• Have warning signs been erected warning of working at height taking place?

  Yes

  No

  N/A

• Has the exclusion / drop zone been installed?

  Yes

  No

  N/A

• Are overhead powerlines / structures in close proximity to work area

  Yes

  No

  N/A

• Have controls been implemented to minimise the risk of injury or damage?

  Yes

  No

  N/A

• Is the work at height equipment within current inspection standards?

  Yes

  No

  N/A

• Select current month

  Dec - Feb (Red)

  Mar - May (Green)

  Jun - Aug (Blue)

  Sep - Nov (Yellow)

• Has the weather forecast been checked?

  Yes

  No

  N/A

• Are the wind speeds been monitored using an anemometer? Max Speed 12.5m/s or 28mph gust.

  Yes

  No

  N/A

• Is lightning forecast?

  Yes

  No

  N/A

• Can the work be suspended until "ALL CLEAR" is broadcast?

  Yes

  No

  N/A

• Name of Person trained to undertake rescue

• Rescue Method - i.e. Rescue Reel, Sandline.

• Emergency Contact Phone Number

• Work Supervisor

  Sign

• Newcrest Representative

  Sign

• Newcrest Representative

  Sign

• Date and Time Permit Closed

  Date