Work at Height Permit - Testing in Progress

• Work at Height Permit is not needed for Mobile Elevated Work Platform (MEWP) use.

• Permit To Work Number

Further Information

• All Persons working at height have been trained and any relevant certification has been provided

  Yes

  No

• All tools will be secured with no potential of them falling from height

  Yes

  No

• The area below will be cordoned off where necessary

  Yes

  No

  N/A

• What form of work at height will be used

  Select Cherry Picker or articulated MEWP Ladders / Step Ladders Scaffold

  • Cherry Picker or articulated MEWP
  • Ladders / Step Ladders
  • Scaffold

• Has the user Completed an IPAF 3c certified Training Course

  Yes

  No

• Has the certification been seen / stored in the relevant H&S folder

  Yes

  No

• YOU WILL NOT BE ALLOWED TO DRIVE OR OPERATE A MEWP ON THIS SITE

• Has the user completed a Pasma certified training course

  Yes

  No

• Has the certification been seen / stored in the relevant H&S folder

  Yes

  No

• The user is to ensure the scaffold is checked for defects, is built correctly and safely and the scafftag has been completed and correctly displayed (Blank Scafftags are supplied by our H&S manager in unit 1 - contact ext 3142)

  Yes

  No

• YOU WILL NOT BE ALLOWED TO ERRECT OR CERTIFY THE SCAFFOLD TOWER - ASK YOUR HOST TO ARRANGE FOR THE TOWER TO BE BUILT FOR YOU AND THE PASMA TRAINED PERSONNEL TO INSRUCT YOU ON THE SAFE USE OF THE TOWER .

• Ladders have been checked, are in good condition and are appropriate for this task

  Yes

  No

• DO NOT USE THIS LADDER, YOUR HOST MAY BE ABLE TO ARRANGE FOR YOU TO USE A SET OF OUR ENGINEERS LADDERS

• A second person must be used to stabilise the ladder, this applies to all ladder types, is a second person available

  Yes

  No

• DO NOT ATTEMPT TO USE THE LADDER UNASSISTED, YOUR HOST MAY BE ABLE TO PROVIDE SOMEONE TO ASSIST YOU

• Is a safety harness required for this task

  Yes

  No

• The user is to inspect the harness and ensure it is in an acceptable condition

  Yes

  No

• PLEASE REPLACE THE HARNESS OR ASK YOUR HOST IF YOU CAN BORROW ONE OF JIGSAW FOODS HARNESS'S

Work-at-height Supervisor sign as all above information are correct and application will be routed over to WAH Assessor

• Work-at-height Supervisor Name

• Work-at-height Supervisor Signature

  Sign

• Date / Time of Signature

  Sign

• Work-at-height Worker Name

• Work-at-height Worker Signature

  Sign

• WAH Worker Signature

  Sign

• Date / Time of Signature

  Date

• Select date

  Date

Route to WAH Assessor for check & endorsement

• WAH Assessor to ensure all fall preventive measures are set-up and not expired

  Yes

  No

  N/A

• Work-at-height Assessor Name

• Work-at-height Assessor Signature

  Sign

• Date and Time of Signature

  Date

Route to WAH Manager for check & approval

• Are all the above stated safety provisions and check in-place?

  Yes

  No

  N/A

• Are the WAH worker(s) trained in working-at-height?

  Yes

  No

  N/A

• Work-at-height Manager Name

• Work-at-height Manager Signature

  Sign

• Date and Time of Signature

  Date

Sign Off - Work Complete and area left in a safe and tidy condition and checked by Work-at-height Supervisor

• Work-at-height Supervisor Name

• Work-at-height Supervisor Signature

  Sign

• Date and Time of Signature

  Date