Andrew Moar

Roof Access Permit

Contractor Roof Permit

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Information

Date of request
Company / Organisation Name
Requestor Name
Position title
Work Description
Access reason
Specify
Access period start
Access Period Finish
Project manager Name

Site Details

Site
Location
Location
Building
Key required for access
Key Number
Area to be accessed
Has the working at heights register been reviewed to identify what safety systems are in place and is the systems compliance current?
Is Supervised access required by Section Supervisor or Project Officer
Have safety plan or SWMS been completed
Attach Safety Plan or SWMS
Have current height safety competency.
TELCO installer/applicant
Attach Telco Carrier’s authority
Complete SWMS prior to Accessing
Complete SWMS prior to Roof / Height Access
Name
Company
Height safety Competency - Card / Evidence

Authorised by

Name & Signature
Position
Specify
Section
Specify
Contact Number
Date

Andrew Moar

Roof Access Permit

Contractor Roof Permit

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.