• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Work at Height, Roof Access and BMU Permit

  • Centre/Location:

  • Date

  • Company Name:

  • Permit Receiver & Phone Number

  • Description of Work

  • Location of Work:

  • Permit Issuer Name:

  • Vicinity Centres Position:

Work At Height

  • Appropriate SWMS or risk assessment in place

  • Ladder use is appropriately addressed by SMWS or other risk assessment documentation

  • Demonstrated appropriate competency for use of fall restraint/arrest equipment

  • Fall restraint/arrest equipment inspected prior to use e.g. equipment tagged or log books available

  • Anchor points have been inspected/tested and tagged (current)

  • Rescue plan in place where fall arrest equipment is in use, including spotter

  • High risk license in place for boom type EWP that extends > 11m

  • Controls in place for potential falling objects e.g. tools tethered, barricading, spotter, catch platform, signage

  • Barricades/signs in place to control access to mobile plant e.g. EWPs

  • Spotter in place for use of EWP

  • Scaffolds > 4m erected and dismantled by a licensed person

  • Voids, skylights, penetrations adequately protected and signposted

Roof Access

  • Appropriate SWMS or other risk assessment documentation in place

  • Communication protocols included in SWMS or other risk assessment documentation

  • Appropriate keys obtained

  • Radio frequency radiation plan/manual reviewed and understood

  • Roof Safety Audit Report reviewed and understood

Additional Permits Required

  • Hot Work

  • Excavations and Penetrations

  • Critical Lift

  • Fire System Impairment

  • Confined Space Entry

Permit Approval

  • Copy of SWMS or risk assessment attached?

  • This permit is valid from: Start date & Time

  • This permit is valid till: Expiry date & Time

  • I understand the permit requirements and the controls specified will be implemented and monitored for effectiveness throughout the works:

  • Permit Receiver:

  • Permit Issuer:

Permit Close Out

  • I have checked the worksite and confirm that all persons and tools are accounted for and that the site has been made safe:

  • Date & Time

  • Permit Receiver:

  • Permit Issuer:

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.