• Issuing Permits – The issuing of permits is strictly controlled; permits can only be issued by competent persons

  • Project & Job Location:

  • Work Description:

  • Approx. maximum height of the task

  • Justification for Use of Steps/Ladder

  • Describe (in detail) the reason safer means of access can’t be used?

  • Is a suitable and sufficient risk assessment completed?

  • Is a method statement applicable?

  • Has the requester inspected the area prior to commencement of the task?

  • Other Controls to the Reduce the Fall Hazard

  • (Please document additional control measures)

  • Height/size of Ladder/Step to be used:

  • APPROVALS

  • Requested By: Print Name

  • Date

  • Signature

  • Operative: Print Name

  • Signature

  • Approved By: Print Name

  • Date

  • Signature

  • Closed out by: Print Name

  • Ladder MUST be returned by end of shift

  • Date

  • Signature

  • To:

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