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Work at Height Permit...

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Thoufik Ahmed
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32 views

Work at Height Permit...

Uploaded by

Thoufik Ahmed
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PERMIT TO WORK AT HEIGHT

Work Permit No.:


Name of Permit :Initator:
Date:
Area / Location of site:
Permit required from time: to time:
Nature of the Work to be carried:

Not
Risk Control measures to prevent Fall of Person Yes / No
Reqd
1. Whether Safe access to work place is provided
2. Whether the edge protection provided adequate
3. Is the work area away from the vicinity of moving objects?
4. Whether work platform is adequate with respect to strength and
dimension.
5. Is the working platform fully boarded?
6. Work platforms provided with guard rail.
7. Are the workmen screened for working at height?
8. Are the workmen equipped with basic PPEs (Safety helmet,
shoes, jackets, goggles) and full body harness
9. Adequate fall protection arrangement made (Static line, Double
Lanyard harness, Fall Arrestor, Safety Net)
Risk Control measures for avoiding Fall of Materials
1. Work at more than one elevation at the same segment is
restricted.
2. Walkways, aisles & all overhead workplaces cleared of loose
material.
3. Whether all tools & tackles inspected before use.
4. Whether hand tools and handling materials secured against
accidental fall?
5. Workmen provided with bag / box to carry bolt, nuts & hand tools.
6. Whether area below, where the height work being performed is
cordoned and unauthorised entries are avoided.
7. Tool box talk carried out and job specific training given
8. Adequate supervision is available

Permit Requested by: Area In charge Issuing Authority: Safety Incharge:


Name: Name: Name: Name:
Designation: Designation: Designation: Signature:
Signature: Signature: Signature:
Closing of the Permit
Time & Date at which the permit is closed.

Name of the Dept HOD: Name of the Safety Incharge:


Signature: Signature:
Date & Time: Date & Time:
Note: Frontline supervisor of the group performing the activity should have PTW copy with
him. One copy should be retained by the issuing Authority. The permit is valid till the issue
time; extension of permit may suitably have obtained before expiry of permit. Once the
activities are over work place shall be left safe.

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