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Pwh
GRA.075 Permit to Work at Height
Project
- None -
Site A
Site B
Site C
Site D
Site E
Project Name
Date
Permit Period
Start
Finish
Authorised Person
Name
Position
Exact Location
Nature of the Hot Work to be undertaken
Signed
Sign above
Date
Date: Date
Date: Time
The PTW is to be completed by the authorised person onsite. This is to be the Site Supervisor provided they are trained and competent in working at heights or the Senior Rigger onsite.
Checklist
Can the risk of fall be eliminated by modifying the job? (conduct task at ground level?)
Yes
No
Can the risk be reduced by performing the work from a platform? E.g. scaffolding, scissor lift
Yes
No
Can the risk be reduced by erecting railings/barricades to prevent a fall?
Yes
No
If yes to the above then utilise the control identified and consider the remaining questions.
If no to the above you must implement a fall arrest/restraint system and address the following questions.
Nb: If using a boom lift the following questions must be completed.
IF THE ANSWER IS NO TO ANY OF THE FOLLOWING QUESTIONS THEN THE CONTROLS MUST BE IMPLEMENTED
Are workers trained and authorised for working at heights and in use of harness/lanyards?
Yes
No
N/A
Controls
Select other trained personnel
Is the fall arrest equipment compliance test/tag inspection date current and has it been visually inspected prior to use?
Yes
No
N/A
Controls
Select other equipment
Will the fall arrest system restrain a person before striking an object? (is the equipment right for the job?)
Yes
No
N/A
Controls
Use alternative method of fall arrest
Is the anchor point above the attachment point of the lanyard to harness and strong enough to withstand load?
Yes
No
N/A
Controls
Select another anchor point
Is the potential fall direction within 30 degrees of vertical? (pendulum effect)?
Yes
No
N/A
Controls
Ensure the anchor point is above the person
Will the worker remain attached to one point at all times?
Yes
No
N/A
Controls
A dual lanyard system is required
Will someone else be in the nearby vicinity that can raise the alarm immediately if someone falls? (Direct eye sight)
Yes
No
N/A
Controls
Esnure a stand-by person present
Has the risk of falling objects been managed and a drop zone in place?
Yes
No
N/A
Controls
Tie tools off. Establish zone and demarcate it
Do you need a mechanical lifting aid e.g. EWP and has it been maintained with pre-start inspection conducted?
Yes
No
N/A
Controls
Do not use EWP if not maintained and no prestart
Workers have been asked if they have any medical conditions that may affect their ability to work safely e.g. vertigo
Yes
No
N/A
Controls
Ask workers now
Is there an effective means of communication available e.g. mobile phone with clear coverage, 2-way radio
Yes
No
N/A
Controls
Source means of communication
Have any existing overhead services crossing and/or adjacent to proposed height working been noted and compliant clearances maintained?
Yes
No
N/A
Controls
Identify and ensure compliant clearances inplace now
Is an emergency rescue plan in place to retrieve a person who has fallen or stranded at heights? Plan must be documented.
Yes
No
N/A
Controls
Document now
Comments
All persons conducting working at heights understand the intentions and content of this permit and height rescue plan. This permit must be signed by those conducting the work and referred to in the SWMS.
Authorising Person
I have completed the above permit and attached the relevant SWMS. The people conducting the work are competent.
Name
Company
Signature
Sign above
Date
