Whsmp · OPW16/0021

                                                                                                       Working at Heights Permit
                                                                                                                                             HB-HSEQ-F-077
                                                                                                                                                 Version: 5




                                                                                                                       Permit No.
Section 1 – General Details
Subcontractor:
Project:

Work Activity Description:

Location of work:
                                                                Falling objects                   Manual handling of loads
                                                                Ungraded Edges                    Risk of falling person
                                                                High Winds                        Overhead electric cables
Likely hazards associated with this work                        Lack of space                     Unsecure ladders
                                                                Uneven floor surfaces             Fragile roofs
                                                                Other
Selection of Work Station – Hierarchy of                     Can this task be completed from;
Control.                                                          1. From the ground? Preferred                            YES / NO - Permit
                                                                  2. From scaffold?                                        YES / NO
Selection of the first (1 to 5) available work at                 3. From Mobile Scaffold?                                 YES / NO
height processes will increase control                            4. From a Scissor Lift/EWP                               YES / NO
effectiveness. Circle One                                         5. From a Ladder/Platform Ladder? Least Preferred         YES / NO

Section 2 – Fall Restraint & Fall arrest
Requirement                                                                               Yes    No
                                                                                                         If No, Additional Control measures must be put in place or
                                                                                                         work activities must be terminated.

Has a safe work method statement been developed for the work activity
Do all persons involved in the working at heights process undergone working at heights
training
Has fall protection equipment been inspected by a competent person prior to use. Has
the equipment been tested and tagged and in date
All personnel involved in working at heights must be involved in the rescue plan
process. Refer to SWMS

All anchorage points have been accessed by competent person

Section 3 – Working off EWP
Requirement                                                                                             If No, Additional Control measures must be put in place or
                                                                                          Yes    No     work activities must be terminated.
Has all pre-operational checks been carried out and recorded in the machinery log book
prior to use
Has a work method statement been developed for the work activity
Working off an EWP 11+ meters, the operator of plant holds a licence to operate a
boom-type elevating work platform
Has fall protection equipment been inspected by a competent person prior to use. Has
the equipment been tested and tagged and in date
Are harnesses correctly fitted to all personnel and attached to the manufacturer’s
anchor point in the elevated work platform.
The work area will require specific cleaning to ensure ground conditions are stable
(e.g.; firm, level & safe) to extend and travel the EWP. Have these conditions been
assessed by the operator
Elevating work platforms must never by overloaded due to structural failure or tipping
of plant. Have loads been assessed by operator


Section 4 – Working off Mobile Scaffolds
Requirement                                                                                             If No, Additional Control measures must be put in place or
                                                                                          Yes    No     work activities must be terminated
                                                                                                        If yes you are required to be instructed in the
Will you be required to erect or dismantle a mobile scaffold less than 4 meters in
                                                                                                        manufacturers erection and dismantling
height?
                                                                                                        requirements
Have you checked physical defects before every use, including the access ladder, braces
and decks, (Refer to the manufacturer’s directions if available)
Have you checked the safe working load of the scaffold before including tools and any
other equipment to the scaffold? Keep scaffold loads to a minimum.
Are all casters locked or chocked against any possible movement before any work is
preformed from the scaffold.


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