Whsmp · OPW16/0021

                                                                                                           Working at Heights Permit
                                                                                                                                                 HB-HSEQ-F-077
                                                                                                                                                     Version: 6


Are guardrails and toe boards in place on all open sides of the scaffold
The work area will require specific cleaning to ensure ground conditions are stable
(e.g.; firm, level & safe) Ensure mobile scaffold is not located closer than 2 meter to any
slab edge, penetration or other step down, unless a fixed fence, rail or suitably high
upturn is in place.
Has a work method statement been developed for the work activity


Section 5 – Working off Trestles and Planks
Requirement                                                                                   Yes   No
                                                                                                         If No, Additional Control measures must be put in place
                                                                                                         or work activities must be terminated
Are trestles and planks in good condition and are free from cracks or broken parts –
braces, lock pins etc
Planks are only to span to take the applied load – provide diagram of set up distances
between trestles required for intended weight

Where a ladder access is to be provided it shall be 900mm above platform height

Is the base of the trestles mounted on good and stable ground
                                                                                                         If yes an internal and external hand rails are to
Will your job task require you to work above 2 meters
                                                                                                         be fitted
Has fall hazards been access for working under 2 meters – keeping area clear of objects                  If No install a hand rails system on trestles
by 1.5 meters from trestles
Has a work method statement been developed for the work activity


Section 6 – Working off portable step and platform ladders
Requirement                                                                                   Yes   No
                                                                                                         If No, Additional Control measures must be put in place
                                                                                                         or work activities must be terminated

Is the ladder in good condition and treads secure and not cracked or broken

Will you be conducting light works when working off the ladder? If No return to section
3 or 4 on this permit.
Will you be able to have and maintain three points of contact at all times working off                   If No a Platform ladder must be used
the ladder?
Is the base of the ladder mounted on good and stable ground
                                                                                                         If Yes return to section 3 or 4 on this permit.
Will your job task require you to work above 2 meters
If required to use as a n access to a work platform – to be extended 900mm above
landing
Can work be completed without over reaching and or standing or kneeling on the top                       If No return to section 3 or 4 on this permit
step of platform
Has a work method statement been developed for the work activity


Section 7 – Working on Roof –
No access/work within 2m of a live edge or any fragile roof/sky lights without controls measures in place
Requirement                                                             Yes     No
                                                                                      If No, Additional Control measures must be put in place
                                                                                                         or work activities must be terminated

Number of employees going onto the roof
                                                                                                         _____________
                                                                                                         Type:
Is there safe access to the roof?

Has all fragile sections of the roof been identified? E.g. Sky lights, fiberglass sheeting?                  Barricade
And controls implemented?                                                                                     Solid Cover
                                                                                                         If Yes return to section 3 or 4 on this permit.
                                                                                                         If Yes What Controls in Place:
Will your job task require you to work within 2m of a live edge or a fragile section of the                  Temporary Perimeter Handrails
roof?                                                                                                        EWP
                                                                                                             Fall Restraint/Fall Arrest
                                                                                                              Highlighted Exclusion Zones Minimum 2m
Is there a signed exclusion zone below the work area where there is a risk off falling
objects?
                                                                                                         If Yes Specify
Other Hazards Identified

Has a work method statement been developed and approved by HB for the work
activity?




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