Title Page
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Permit to use ladders/stepladders
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Contract name
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Contract no.
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Contractor name
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Issued by (Osborne site manager)
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Description of task
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Issued to (name)
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Select date
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Location
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Items to be checked
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1 (a) Can the need to access /work at height be avoided? If no, see 1 (b)
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Reason
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Action
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1 (b) Can alternative methods be employed? If no, see qn2
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Reason
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Action
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2 (a) Can a suitable working platform be provided? I.e (tick) If no, see qn3
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Podium type tower with handrails
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Mobile tower with x2 handrails & toe boards
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Scaffold at least 600mm wide with x2 handrails & toe boards
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Birdcage scaffold
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MEWP
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Note. Only trained persons to erect scaffolds/operate MEWP'S/erect towers
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Reason
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Action
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2 (b) Can suitable access be provided - I. E (tick) If no, see qn3
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Internal access via ramp/stair/lift
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External access via an existing fire escape stair
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External access by passenger hoist
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External access by 'Haki' type stair
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Note. Seek permission to use lifts & fire escapes from building owners. Only trained persons to operate passenger hoist
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Reason
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Action
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3. A step ladder/ladder is suitable for use on site, but only if a suitable working platform/access as identified above cannot be provided
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3 (a) Step ladder - provide a suitable stepladder for use on site - I. E the stepladder must be (tick)
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Class 1 & of suitable size
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Erected on a smooth, even, nonslip surface
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Able to be used without overreaching
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Note. Never work from the top third of a stepladder
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Action
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Reason
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3 (b) Pole/extension ladder - provide a suitable pole/extending ladder for use on site - I. E it must be (tick)
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Class 1 industrial, correct length, unpainted & free of defects
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Placed at an angle of 1:4
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Tied from the top of the ladder to a suitable fixing point, OR
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Fixed at the bottom in a manner to prevent sideways movement, OR
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Provided with a person to foot the ladder throughout
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Able to be used without overreaching
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Note. Ladders are not work platforms
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Action
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Reason
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** where it is not reasonably practicable to implement the first hierarchy measure, pass to the next giving reasons for unsuitability.
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This Permit To Work Is Valid For The Date Of Issue Only
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Returned: (date/time)
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Confirm Return (site manager signed)
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KEEP PERMIT ON SITE TO BE RETURNED TO GROUP SAFELY UPON CONTRACT COMPLETION
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FRM/WAH/001 Rev 2 May 2014
