Site Safety & Administration
Working at Heights Permit
Permit to authorise work where a person could fall, including roof work, open edges, penetrations and work above 2 m. Records the fall control method selected from the hierarchy, anchor and equipment checks, and the rescue plan.
35 checklist items
Download this template
Checklist Items
| Item | Pass / Yes | Fail / No |
|---|---|---|
| PERMIT DETAILS | ||
| Permit Number | ___________________________ | |
| Site / Project | ___________________________ | |
| Work Location and Height Above Ground (m) | ___________________________ | |
| Date | ___________________________ | |
| Valid From / Until (Time) | ___________________________ | |
| Description of Work | ___________________________ | |
| Workers Performing the Work | ___________________________ | |
| SWMS Reference | ___________________________ | |
| FALL CONTROL METHOD | ||
| Work cannot be done from the ground or a solid construction | Yes ☐ | No ☐ |
| Passive fall prevention used (scaffold, edge protection, EWP, guardrails) | Yes ☐ | No ☐ |
| Work positioning system used (e.g. rope access, restraint) | Yes ☐ | No ☐ |
| Fall arrest system used (harness, lanyard, anchor or static line) | Yes ☐ | No ☐ |
| Control method(s) selected and why higher controls not practicable | ___________________________ | |
| PRE-WORK CHECKS | ||
| Edge protection / guardrails complete and secure | Pass ☐ | Fail ☐ |
| Penetrations and skylights covered, secured and marked | Pass ☐ | Fail ☐ |
| Fragile roof areas identified and protected | Pass ☐ | Fail ☐ |
| Scaffold / EWP inspected and tagged | Pass ☐ | Fail ☐ |
| Anchor points / static lines certified and inspection current | Pass ☐ | Fail ☐ |
| Harnesses and lanyards inspected before use (labels legible, in date) | Pass ☐ | Fail ☐ |
| Free fall distance and clearance calculated to avoid striking the ground | Pass ☐ | Fail ☐ |
| Ladders suitable, secured and used for access only or short-duration light work | Pass ☐ | Fail ☐ |
| ENVIRONMENT & EXCLUSION | ||
| Weather suitable (wind, rain, heat, lightning) | Pass ☐ | Fail ☐ |
| Exclusion zone set up below to protect from falling objects | Pass ☐ | Fail ☐ |
| Tools and materials secured against falling (tool lanyards, toe boards) | Pass ☐ | Fail ☐ |
| Overhead powerlines identified and approach distances maintained | Pass ☐ | Fail ☐ |
| RESCUE | ||
| Rescue plan prepared for this work location | Yes ☐ | No ☐ |
| Rescue equipment on site and workers trained in its use | Yes ☐ | No ☐ |
| Worker never left alone in a harness; suspension trauma response understood | Yes ☐ | No ☐ |
| AUTHORISATION | ||
| Issuer Name | ___________________________ | |
| Issuer Signature | ___________________________ | |
| Worker(s) Signature | ___________________________ | |
| CLOSE-OUT | ||
| Work completed and all persons down | Yes ☐ | No ☐ |
| Penetrations and edges left protected or handed over | Yes ☐ | No ☐ |
| Time Permit Closed | ___________________________ | |
| Issuer Close-Out Signature | ___________________________ | |