work at height permit

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Why ehs4safety Careers E-Book Blog Our Partners Case Study

Electronic Aerospace Chemical Automotive Cement Shipbuilding Oil and Gas Mining Industry Construction Industry

Permit To Work Loto System Risk Assessment Near Miss Change Management Sustainability & ESG Incident Management Visitor Management Audit Inspection Headcount Emergency Preparedness Safety Training Tracker

AI PPE Detection AI Security Fall Detection System Form Recognizer Forklift Collision Avoidance

Contact Us

Work at Height Permit

(Authorization to Perform Work at Height)

Permit & Job Details

Company Name

Permit No

Department / Section

Date Issued

Valid From

Valid To

1. Work Description & Location

Exact Location of Work

Approximate Height of Work

Description of Work to be Performed

2. Personnel & Training

Work Supervisor

Name(s) of Work Crew

Are all workers trained for Work at Height?

Yes No

3. Hazard Assessment & Control Measures

Please check all hazards identified and the corresponding control measures applied.

Fall from height Falling objects Unstable work surface Adverse weather conditions (wind, rain) Poor access or egress Overhead power lines / obstructions Equipment failure (ladder, scaffold) Other:

Control Measures

Guardrails / handrails installed Fall arrest system used (harness, lanyard) Ladder secured and inspected Scaffold inspected and tagged Exclusion zone established below work area Tools secured to prevent falling Visual/physical barriers installed Other:

4. Authorization

Permit Issuer Name

Signature

Date

Lead Worker Name

Signature

Date

5. Work Completion & Permit Handover

Completion Time

Date

Work area is clear of tools and materials

Yes No