Information
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Date of request
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Company / Organisation Name
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Requestor Name
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Position title
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Work Description
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Access reason
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Specify
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Access period start
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Access Period Finish
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Project manager Name
Site Details
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Site
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Location
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Location
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Building
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Key required for access
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Key Number
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Area to be accessed
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Has the working at heights register been reviewed to identify what safety systems are in place and is the systems compliance current?
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Is Supervised access required by Section Supervisor or Project Officer
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Have safety plan or SWMS been completed
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Attach Safety Plan or SWMS
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Have current height safety competency.
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TELCO installer/applicant
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Attach Telco Carrier’s authority
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Complete SWMS prior to Accessing
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Complete SWMS prior to Roof / Height Access
Person
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Name
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Company
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Height safety Competency - Card / Evidence
Authorised by
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Name & Signature
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Position
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Specify
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Section
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Specify
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Contact Number
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Date
