Working at Height - Check list

• Permit to work number linked to this check list.

• Working at heights Permit/List number - (auto generated)

• Conducted on

  Date

• Prepared by

• Company

• Location

  Mars Melton Mowbray

  Mars Petcare Waltham

  Other

• undefined

• Sub Location

  Select NATIONAL OFFICE ZONE 1 WALTHAM LODGE ZONE 2 HACHIKO ZONE 3 ENDAL ZONE 4 LYNX ZONE 5 JAGUAR ZONE 6 LEOPARD ZONE 7 BETSY ZONE 8 NURSERY ZONE 9 LAB BLOCK ZONE 10 APOLLO ZONE 11 WPSI MAIN OFFICE ZONE 12

  • NATIONAL OFFICE ZONE 1
  • WALTHAM LODGE ZONE 2
  • HACHIKO ZONE 3
  • ENDAL ZONE 4
  • LYNX ZONE 5
  • JAGUAR ZONE 6
  • LEOPARD ZONE 7
  • BETSY ZONE 8
  • NURSERY ZONE 9
  • LAB BLOCK ZONE 10
  • APOLLO ZONE 11
  • WPSI MAIN OFFICE ZONE 12

• What works will be undertaken? Please give full details of the tasks involved.

• Special Tools / Equipment to be Used (MEWP, Ladders, scaffold etc)

• Is any other work currently being undertaken that may interact or affect this permit? (Quote Permit numbers where applicable)

Hazards - Fill in the relevant sections below.

• Are you Qualified / Trained to undertake this work?

  Yes

  No

  N/A

• Have all personnel effected by the work been notified?

  Yes

  No

  N/A

• Has the working area been fenced or barricaded and warning signs in place?

  Yes

  No

  N/A

• Is there a risk of coming into contact with Overhead services such as Power Cables / Live Busbars etc?

  Safe

  At Risk

  N/A

• Will the fire suppression system (sprinklers) need isolating?

  No

  Yes

  N/A

• Will the fire alarm/sensors need masking during the work?

  No

  Yes

  N/A

Roof Access (Only required if roof access required)

• Is a safe means of access to the roof provided?

  Yes

  No

  N/A

• Are Crawl boards with hand rails & roofing ladders to be used?

  Yes

  No

  N/A

• Is there a safe tested anchor point provided to secure workers using a Harness and Lanyard?

  Yes

  No

  N/A

• Have the Harness and Fall Arrest Lanyards to be used been inspected in the last 6 months?

  Yes

  No

  N/A

• Is the Fall Arrest Lanyard the correct length? (i.e. 3m shorter than the height of the structure)

  Yes

  No

  N/A

• Is Edge Protection required and fitted?

  Yes

  No

  N/A

• Is edge protection correct height? (Top Rail 1100mm Intermediate Rail 600mm 150mm Toe Board)

  Yes

  No

  N/A

• Have Fragile Surfaces been Protected? (i.e. Polycarbonate Skylights - Covered or Fenced off)

  Yes

  No

  N/A

• Has the weather forecast been checked?

  Yes

  No

  N/A

• Are the wind speeds being monitored using an anemometer? Max Speed 12.5m/s or 28mph gust.

  Yes

  No

  N/A

• Is the roof free of ice / frost?

  Yes

  No

  N/A

• Is lightning forecast?

  No

  Yes

  N/A

• Are there any ducts / vents / chimneys on the roof?

  No

  Yes

  N/A

• Is there a risk from fumes, dust or corrosion?

  No

  Yes

  N/A

• Is there a risk of encountering or disturbing asbestos?

  No

  Yes

  N/A

• Asbestos permit completed and other precautions in place to include additional PPE

  Yes

  No

  N/A

• Is there a rescue plan for getting an injured or ill worker down from the roof?

  Yes

  No

  N/A

MEWP (Scissor Lift / Boom Lift)

• Do you hold a current IPAF 3a / 3b Powered Access Licence? Please use media tag to add photographic evidence of licence.

  Yes

  No

  N/A

• Have you checked the work area including access ways for fragile surfaces i.e. drain lids/ manhole covers etc?

  Yes

  No

  N/A

• Have you checked wind speed using a handheld anemometer if working outside? Max Speed 12.5m/s or 28mph gust.

  Yes

  No

  N/A

• Have you got a Harness and Fixed Lanyard for operating a Boom Lift?

  Yes

  No

  N/A

• Have you checked for overhead hazards to avoid crushing injuries?

  Yes

  No

  N/A

• Is there a Standby Person on the ground trained to use the lowering controls in the event of a breakdown?

  Yes

  No

  N/A

• Have you got the Remote Control Tether to use the "Walking the Dog Method" when moving the platform in congested areas or through doorways?

  Yes

  No

  N/A

• Has the MEWP got a Valid LOLER Inspection Certificate?

  Yes

  No

  N/A

Scaffolding (Fixed)

• Has the scaffold been designed / erected and inspected by a competent person - and load rated for the works to be undertaken?

  Yes

  No

  N/A

• Is the scaffold tied to the structure using approved methods i.e. Hilti Fixings / Through Ties etc.

  Yes

  No

  N/A

• Has the scaffold got a Licence where required? i.e. Public Road / Pavement

  Yes

  No

  N/A

• Has the scaffold been fitted with a Scafftag Inspection System?

  Yes

  No

  N/A

• Has the Scafftag been completed in the last 7 days?

  Yes

  No

  N/A

• Is the Scaffolding protected from Vehicle Impacts at the base?

  Yes

  No

  N/A

• Is Debris Netting / Brick Guards required to stop items falling?

  Yes

  No

  N/A

• Are Rubbish Chutes required?

  Yes

  No

  N/A

• Are Ladders secured correctly / protected by self closing gates and have the required 3 rungs / 1m Take off area above the scaffold platform?

  Yes

  No

  N/A

• Is the scaffold protected at night, to prevent trespassers / unauthorised access?

  Yes

  No

  N/A

Tower Scaffold

• Do you hold a valid PASMA 3T competence card?

  Yes

  No

  N/A

• Has the tower been built correctly? Correct Height:Base Ratio / Use of Outriggers etc?

  Yes

  No

  N/A

• Is the work platform set up correctly - Top Guard Rail 1100mm high / Intermediate Guard Rail 600mm & Toe Boards 150mm high?

  Yes

  No

  N/A

• Have the Wheels been levelled and Locked?

  Yes

  No

  N/A

FLT - Man-Riding Cage

• Has the Cage been secured to the FLT using Clamps?

  Yes

  No

  N/A

• Has the Cage been secured using a back up method i.e. Chained the the Back Rest on the mast?

  Yes

  No

  N/A

• Has the FLT had a LOLER Check in the last 6 months (Used for lifting persons)?

  Yes

  No

  N/A

• Has the Man Riding Cage been LOLER Inspected in the Last 6 Months?

  Yes

  No

  N/A

• Has the Tilt Control in the FLT been locked out in accordance with the HSE Guidance issued in PM28 - Issue 4?

  Yes

  No

  N/A

• Having moving parts on the FLT been guarded so that the person working in the cage, doesn't make contact with moving parts?

  Yes

  No

  N/A

• Is there a method of communication between the Driver of the FLT and the worker in the Cage? i.e. 2 way radio.

  Yes

  No

  N/A

• Has the FLT Driver been trained in the use of FLT with the Cage mounted, and understands the safety rules. i.e. using handbrake / lock out of controls / remaining with the FLT at all times.

  Yes

  No

  N/A

• Has the Operative in the Cage got a Safety Harness and Fixed Lanyard (1.5 -2.0m) securely anchored to the designated floor anchor point in the platform.

  Yes

  No

  N/A

• Has the Harness and Lanyard been Thoroughly Inspected in the last 6 months?

  Yes

  No

  N/A

Ladders / Stepladders

• Is the ladder / stepladder being used for works of Short Duration (Max 30 mins in the same location) and Light Works (Max 25kg Tools / Equipment)

  Yes

  No

  N/A

• Is the ladder / stepladder the correct height for the works been undertaken? (Work not permitted from top 2 steps of a stepladder)

  Yes

  No

  N/A

• Is the Ladder / Stepladder Industrial Rated( i.e. SWL >150Kg)?

  Yes

  No

  N/A

• Is the Ladder / Stepladder in good condition? Is an Inspection Tag in place?

  Yes

  No

  N/A

• For Extension Ladders can the safe working Angle 75 Degrees (4:1 Ratio) be achieved?

  Yes

  No

  N/A

• Can the ladder be tied or secured at Top / Bottom?

  Yes

  No

  N/A

• Is the ladder suitable for the Environment - i.e. Fibreglass Non-conductive ladder for electrical works?

  Yes

  No

  N/A

Other Precautions Required

• Do you need to undertake any other precautions to undertake works safely?

• Do you require any further safety / rescue equipment to undertake works safely?

I confirm that all necessary measures are in place to carry out the tasks safely and in accordance with the hazards identified on the permit.

• Validity - Start time

  Date

• Validity - Estimated completion time.

  Date

• Permit acceptor

  Sign

Hand Back and Cancellation of permit

• I confirm that the work has been completed/partially completed, checked by myself and the area left in a safe and tidy condition.

• Full Name and Signature of the acceptor and competent person/persons in Charge

  Sign

• Full name and signature of the permit issuer

  Sign

• Full Name and Signature of Duty manager. (If required)

  Sign

• Date and time of completion

  Date

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