Height Work Permit

Project Name: Date:

Contractor's Name: Trade:
nd
Supervisor's Name: 2 :
Names and Licence
Numbers of Workers
seeking access:
Scope of Work to be Permit valid from: am/pm
performed at height: Permit valid to: am/pm

DESCRIPTION OF RISK YES NO COMMENTS & ACTIONS

Scaffolding
Is the condition of the scaffold acceptable as per JLL and the relevant local
standards for scaffold?
Has proper access been provided?
Are platforms of sufficient width, secure and complete?
Is comprehensive edge protection in place – handrail, mid-rail, toe-board?
(mesh / safety net where applicable?)
Are suitable baseplates provided?
Are High Voltage clearances maintained?
Are outriggers in place? (where required)
Are wheel locks present and in working order?
Roof Access
Has an assessment of weather conditions been conducted to assess suitability
for working at height?
Have workers received a Work Activity Induction, including reading and signing
their SWMS?
Has the roof area been inspected for structural strength?
Is there safe and suitable access to work areas?
Are workers protected from falling from edges?
Are workers protected from falling from incomplete structures?
Are workers protected from falling through skylights and penetrations?
Are people protected from the dangers of falling objects?
Is electrical supply available at roof level?
Has a rescue plan been developed for use in the event of an arrested fall?
Do workers have appropriate UV protection?
Plant & Electrical Equipment
Has all equipment been listed in the relevant register and fitness certificate/tag
provided as per local legislation?
Have servicing requirements been met?
Are all guards in place?
Has electrical equipment been tested and tagged?
Are electrical leads clear from metal scaffold?
Is power being sourced from the same level/floor?
Is RCD/ELCB (mechanical) protection in place?

Document Name: Version: Correct as at: Page No.:

19.82 Height Work Permit 05 08/06/2016 1 of 2
 Height Work Permit
DESCRIPTION OF RISK YES NO COMMENTS & ACTIONS

Personal Protective Equipment

Is all relevant PPE available and serviceable?
Do harnesses, belts, ropes etc. have current log books / inspected?

References (include available and/or surrogate local regulatory references OR DELETE):

XXXX Scaffolding
XXXX Code for Fixed Platforms, Walkways, Stairways and Ladders
XXXX Industrial Safety Belts and Harnesses – Selection, Use and Maintenance
XXXX Self-Locking Safety Anchorages for Industrial Use
XXXX Safety Signs for the Occupational Environment
XXXX Eye Protectors for Industrial Applications
XXXX Respiratory Protective Devices
XXXX Sunscreen Products – Evaluation and Classification
Please add as appropriate

Comments:

SIGNED: (Contractor Supervisor) DATE:

Approval for Work at Height: Granted / Declined

SIGNED: (JLL PDS Representative) DATE:

IF DECLINED, ACTION REQUIRED BY SUBCONTRACTOR WITH AGREED TIME LINE:

ACTION COMPLETED - APPROVAL GRANTED

SIGNED: DATE:

Procedure:

1. A separate permit has to be completed for each and every height work activity.
2. Maximum approval period is one day / one shift.
3. This work permit must be completed by the work supervisor and then be reviewed & signed by a JLL representative.

Note: - A copy of this work permit must be posted at the work place adjacent where the work is being conducted.

Document Name: Version: Correct as at: Page No.:

19.82 Height Work Permit 05 08/06/2016 2 of 2