Leading edge permit
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Site Information
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Description of Work To be Completed
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Checklist
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Are engineered and approved anchor systems in place?
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Are the appropriate anchor locations identified for tie off in fall restraint?
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Has all PPE been inspected and is in good condition?
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Has the proper equipment been selected for the intended application?
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Has the fall protection plan been reviewed and signed by all workers?
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Has the fall protection plan been updated if necessary?
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Have workers assessed the risk of swing fall?
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Are weather conditions suitable (high winds, slippery surfaces, etc?) for work to be completed safely?
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Has a control zone below been established and clearly marked?
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Have warning lines with appropriate signage been erected at the high work location where required?
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Has the floor plan drawing indicating anchor selection and projections been attached?
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Are all workers working in pairs?
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Housekeeping is in good order?
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Have photos been circulated to site displaying the establishment of your control zone?
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Control zone assessment performed?
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Windows
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High Work / Leading Edge Permit
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The undersigned Starline Installation employees have reviewed all of the high work to be performed and have verified and/or confirmed that the necessary precautions as required in Starline Windows Fall Protection Program and this permit have been taken:
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Signoff:
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Name:
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Signature:
