Whittlesea Working at Heights Permit

• Client

  Whittlesea

• Report

  Select Whittlesea Working at Heights Permit

  • Whittlesea Working at Heights Permit

• Building Name and Address

• Inform Number

• AroFlo Job Number

• Inspection Date

  Date

• Employee(s) Completing Inspection

• Email(s) of Employees Completing Inspection

Working at Height Permission

• Rooftype

• Designed safe access/aggress point

• Specific work at height activities

Job Site Condition

• Clear of adjacent operating equipment

  Yes

  No

  N/A

• Safe access & aggress available

  Yes

  No

  N/A

• Full edge protection (guard rails)

  Yes

  No

  N/A

• Clear of overhead lines/services

  Yes

  No

  N/A

• Stable ground conditions

  Yes

  No

  N/A

• Weather conditions OK

  Yes

  No

  N/A

Work At Heights Controls

• Scaffolding

  Yes

  No

• Work on Tanks

  Yes

  No

• Ladders

  Yes

  No

• Fall Arrest System

  Yes

  No

• Work on Roofs

  Yes

  No

• Overhead Work

  Yes

  No

Spotter

• Communication Method

  Radio

  Visual

  Verbal

  Other

• Please provide all relevant information.

• Spotter Name 1

• Spotter Name 2 (if required)

Retrieval Plan Requirements

• Please make sure that you have fully identified the following requirements:
  Identify how to raise the alarm
  Identify all escape routes
  Provision of first aid
  Retrieval of suspended persons

Additional Precautions and Controls

• Please list any Precautions and Controls

Permit Authorisation

• Permit Start Date and Time

  Date

• Permit End Date and Time

  Date

Sign Off

• I understand the precautions and controls which must be taken to perform the specified work safety. I will communicate these requirements to all members of my crew and ensure ongoing compliance with the OHS legislation. I will finalise or update the permit when the work is complete or ceases for the day.

• I have read and acknowledge the Working at Height Policy and Procedure

  Sign