Working at Height

• Site conducted

  Select

• Document No.

• Conducted on

  Date

• WORKING AT HEIGHT PERMIT
  SAFE HOME EVERY DAY

• Name

  Select Justin Wood Dean Aitken Adrian Kiwara Glen Simpson Simon Jowett Ben Earnshaw Other - please list below Rob Brady Leo Singh

  • Justin Wood
  • Dean Aitken
  • Adrian Kiwara
  • Glen Simpson
  • Simon Jowett
  • Ben Earnshaw
  • Other - please list below
  • Rob Brady
  • Leo Singh

• Name

• Select date

  Date

• Job Details

• Location

  Select A Block B Block Winding Twisting Blending Dyehouse Confin Despatch Services External Upstairs

  • A Block
  • B Block
  • Winding
  • Twisting
  • Blending
  • Dyehouse
  • Confin
  • Despatch
  • Services
  • External
  • Upstairs

• Photo of job location

  Media

• The following equipment will be used during the works and is in good working order and fit for purpose

  Select Step ladder Extension ladder Edge protection Mobile scaffold Elevated work platform Safety net Stationary scaffold

  • Step ladder
  • Extension ladder
  • Edge protection
  • Mobile scaffold
  • Elevated work platform
  • Safety net
  • Stationary scaffold

• The following services have been isolated for the duration of the works

  Select Fire Protection Gas Electricity Compressed air Steam Hot or cold water N/A

  • Fire Protection
  • Gas
  • Electricity
  • Compressed air
  • Steam
  • Hot or cold water
  • N/A

• The following control measures have been implemented for the duration of the works

  Select Barricades Signage Spotter N/A

  • Barricades
  • Signage
  • Spotter
  • N/A

• The following environmental factors have been assessed and are suitable for the works

  Weather

  Stored Materials

  Other - Please state below

• Other environmental factors

Risk Assessment - Risk assessment has been carried out and the following hazards identified

Access/Egress

• Safe access for all employees in place

  Yes

  No

  N/A

• Firm level ground for scaffold/mobile access, ladder etc

  Yes

  No

  N/A

• Overhead services/obstructions have been identified

  Yes

  No

  N/A

• Ladders, roof and other meas of access in good condition

  Yes

  No

  N/A

• Systems for the safe removal of waste materials are in place

  Yes

  No

  N/A

Fall Protection

• Where appropriate, adequate guard rails are in place

  Yes

  No

  N/A

• An appropriate fall restraint system is in place

  Yes

  No

  N/A

• An appropriate anchor point has been selected

  Yes

  No

  N/A

• Safety net has been installed by a qualified person

  Yes

  No

  N/A

• Permit Approval

• Select date

  Date

• Add signature

  Sign

• Permit Sign Off

• Select date

  Date

• Add signature

  Sign