Work at Height Permit to Work
Author: Novade Solutions
Ensures safety for elevated work with fall protection and access control. Manages approvals, rejections, revocations, and extensions for compliance.
Work at Height Permit to Work
General Information
*Work Location Photo
Items to check
Select (✓) to indicate OK; (✘) to indicate not OK; (N/A) for conditions not required.
A. General Requirements
Every open side or opening through which a person may fall is covered or guarded by an effective barrier to prevent falls.
Covers used for openings are securely fixed to prevent accidental displacement.
Every open side of a staircase is provided with a substantial handrail and lower rail or other effective means and is maintained properly.
Secure handholds and footholds are provided for any person working at a height of more than 2m or above hazardous substances.
Safe means of access to and egress from the work at height area are provided.
B. Work Planning and Risk Management
A Fall Prevention Plan (FPP) has been developed and implemented.
A permit-to-work (PTW) for hazardous work at height is available and implemented.
A risk assessment (RA) has been conducted, and safe work procedures (SWP) have been developed.
Hazards and risk control measures have been communicated to all workers.
C. Processes and Procedures
All workers have received the necessary instruction, information, and training for working at heights.
Adequate supervision is provided to ensure safe work practices for working at heights are in place.
Anchor Checklist
Workers know the appropriate anchorage points for each task.
All anchorage points are stable, substantial, and have sufficient strength to withstand twice the potential impact energy of a free-fall.
All anchorage points for body harnesses are located at shoulder height.
Anchorage points for self-retracting lifeline systems are located overhead.
Workers can move from one station to another or climb up and down without exposure to a fall.
The entire lifeline system has been designed and approved by a competent person.
The anchorages to which the lifeline is attached have been designed and evaluated specifically for a lifeline.
The rope or cable is free from signs of wear, abrasion, or discoloration.
The rope or cable has the required initial sag.
Identification and inspection labels are displayed clearly.
Connecting hardware is not damaged or in poor condition (e.g., unable to lock).
Ladder Checklist
Every ladder and step-ladder used is of good construction, sound material, and adequate strength for its intended purpose.
Adequate handholds are provided to a height of at least one meter above the highest rung to be reached by the feet of any person on the ladder.
Firm and level ground is provided without obstruction for ladder placement.
The ladder or step-ladder is secured to prevent undue swaying.
The ladder is not used in close proximity to an open edge of the building (>1m).
The ladder is used for short-duration, light-duty work.
No visible damage is present, and the ladder checklist is in place.
The top three rungs of A-frame ladders are covered to prevent use.
Lifelines or anchorage points are provided for anchoring the safety harness.
A buddy system is provided to hold the platform during use.
Remarks
Extension
*Is an extension required for this PTW?
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Work at Height Permit to Work
General Information
*Work Location Photo
Items to check
Select (✓) to indicate OK; (✘) to indicate not OK; (N/A) for conditions not required.
A. General Requirements
Every open side or opening through which a person may fall is covered or guarded by an effective barrier to prevent falls.
Covers used for openings are securely fixed to prevent accidental displacement.
Every open side of a staircase is provided with a substantial handrail and lower rail or other effective means and is maintained properly.
Secure handholds and footholds are provided for any person working at a height of more than 2m or above hazardous substances.
Safe means of access to and egress from the work at height area are provided.
B. Work Planning and Risk Management
A Fall Prevention Plan (FPP) has been developed and implemented.
A permit-to-work (PTW) for hazardous work at height is available and implemented.
A risk assessment (RA) has been conducted, and safe work procedures (SWP) have been developed.
Hazards and risk control measures have been communicated to all workers.
C. Processes and Procedures
All workers have received the necessary instruction, information, and training for working at heights.
Adequate supervision is provided to ensure safe work practices for working at heights are in place.
Anchor Checklist
Workers know the appropriate anchorage points for each task.
All anchorage points are stable, substantial, and have sufficient strength to withstand twice the potential impact energy of a free-fall.
All anchorage points for body harnesses are located at shoulder height.
Anchorage points for self-retracting lifeline systems are located overhead.
Workers can move from one station to another or climb up and down without exposure to a fall.
The entire lifeline system has been designed and approved by a competent person.
The anchorages to which the lifeline is attached have been designed and evaluated specifically for a lifeline.
The rope or cable is free from signs of wear, abrasion, or discoloration.
The rope or cable has the required initial sag.
Identification and inspection labels are displayed clearly.
Connecting hardware is not damaged or in poor condition (e.g., unable to lock).
Ladder Checklist
Every ladder and step-ladder used is of good construction, sound material, and adequate strength for its intended purpose.
Adequate handholds are provided to a height of at least one meter above the highest rung to be reached by the feet of any person on the ladder.
Firm and level ground is provided without obstruction for ladder placement.
The ladder or step-ladder is secured to prevent undue swaying.
The ladder is not used in close proximity to an open edge of the building (>1m).
The ladder is used for short-duration, light-duty work.
No visible damage is present, and the ladder checklist is in place.
The top three rungs of A-frame ladders are covered to prevent use.
Lifelines or anchorage points are provided for anchoring the safety harness.
A buddy system is provided to hold the platform during use.
Remarks
Extension
*Is an extension required for this PTW?