Title Page
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Conducted on
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Name of site
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Prepared by
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Location
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Brief description of works
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Expected duration of works?
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Type of MEWP being used?
- Vehicle Mounted MEWP
- Cherry Picker
- Scissor Lift
- Other
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MEWP's Safe Working Load (SWL)
Pre-use checks (Operator and Site Manager to Confirm Y / N / NA as applicable).
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Project Number (if applicable)
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Completion Date:
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Is the item of plant in good condition and suitable for the works to be carried out?
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STOP - Contact your line manager
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Has the equipment been selected in accordance with the works risk assessment and method statement (RAMS)?
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Do not proceed until the correct item of plant is being used.
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Are all plant operators in possession of or familiar with and have signed onto the Risk Assessment & Method Statement for this work activity?
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Must ensure plant operators familiar themselves with the RAMS and sign off to them confirming they understand it's content and what is required of them to operate the MEWP safely.
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Does the MEWP have an up to date 6 monthly thorough examination certificate?
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STOP - contact your line manger and inform them of this.
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Has the MEWP been inspected prior to use and recorded?
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STOP - Complete daily checks and record findings.
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Do all those operating the MEWP have the appropriate training and documentation evidence such as an IPAF certification?
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STOP - Only trained competent persons can operate the MEWP. Inform your line manager.
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Are the weather conditions and wind speeds suitable for the works (12.5 m/s / 28mph)?
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STOP - Wait until wind speeds decrease to a safe level and contact your line manager.
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Is the area on which the MEWP will be sited firm / level and free from voids or obstruction and capable of withstanding the weight of the equipment imposed on to it?
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STOP - Contact your line manager
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Has an exclusion zone been put in place to segregate the work area from traffic or the general public by using the appropriate barriers, signage or bollards etc?
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STOP - only proceed once suitable segregation methods have been installed.
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Where there is a risk of the MEWP being driven into an open excavation or void, has a suitable means of prevention such as edge protection or stop blocks been installed?
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STOP - Only proceed once suitable edge protection has been installed.
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For internal works, has the working area been examined ensuring it is free from obstacles, holes etc. If these are present, have these areas been suitably cordoned off with barriers as appropriate?
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STOP works until areas are made safe.
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Are there any overhead or underground hazards, e.g., power lines or voids that may affect works?
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Have suitable controls been put in place to ensure the works can be carried out safely?
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STOP - Inform your line manager of this and do not commence works until suitable controls have been implemented.
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Scissor lift operations - Are the operations and conditions suitable for harnesses NOT to be worn?
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Do operators have the necessary fall arrest PPE such as a harness and fixed lanyard?
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STOP - Inform your line manager
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Are all operators in possession of a fixed harness and lanyard of lengths 1 or 2m as appropriate and carried out a visual inspection to ensure items are not damaged and safe for use?
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STOP - do not proceed until operators either acquire a harness and lanyard / carry out a visual inspection of the equipment or both.
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Do operators fully understand why a shock absorbing lanyard is not to be used whilst operating a MEWP as this will not prevent them falling of the MEWP basket?
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STOP - Before commencing, provide suitable information and training as to why a fixed lanyard must be used.
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Are all operators fully aware of the reasons why a Harness and Lanyard must be worn when operating ALL BOOM operated MEWPs (cherry pickers)?
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STOP - Before commencing, provide suitable information and training as to why a harness and lanyard must be used.
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An emergency plan is in place for rescuing / retrieving someone from height?
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STOP - Must ensure a plan is in place and fully understood by all involved prior to commencing works.
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Are all those involved with the works fully aware of the action to be taken in case of an emergency?
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STOP - Ensure all those involved are fully briefed and understand the actions that need to be taken in the event of an emergency.
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Are all operators in possession of all appropriate safety equipment and PPE to carry out the task safely?
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STOP - DO NOT continue until the required safety equipment and PPE is made available and being used.
3. List of operators
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Operator 1
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Name:
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Card type:
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Card number:
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Expiry date:
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Operator 2
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Name:
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Card type:
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Card number:
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Expiry date:
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Operator 3
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Name:
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Card type:
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Card number:
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Expiry date:
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Operator 4
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Name:
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Card type:
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Card number:
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Expiry date:
4. Permit Acceptance
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By signing this permit, it is confirmed that I accept responsibility for carrying out the work as detailed within it, and no attempt will be made by me or persons under my control to work on any other part of the site or outside of the stated scope of works.
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Operator 1 Name & Signature:
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Operator Employer:
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Date & Time:
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Operator 2 Name & Signature:
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Operator Employer:
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Date & Time:
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Operator 3 Name & Signature:
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Operator Employer:
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Date & Time:
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Operator 4 Name and Signature:
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Operator Employer:
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Date & Time:
5. Authorisation to carry out works (to be completed by the Wildanet Site Manager / Supervisor). On the basis of the above information, I hereby authorise this work to be carried out
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Site Manager / Supervisor Name & Signature:
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Date & Time:
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Permit expires no later than (date & time)
6. Cancellation (to be completed by both the Wildanet Site Manager / Supervisor and Operator). I confirm that the work(s) detailed within this permit has been completed and the area thoroughly inspected and left in a safe condition and the MEWP is isolated against use by others.
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Operators Name & Signature:
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Site Manager / Supervisor Name & Signature:
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Date & Time:
