Checklist · 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 · Last reviewed

Checklist Items

ItemPass / YesFail / 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 constructionYesNo
Passive fall prevention used (scaffold, edge protection, EWP, guardrails)YesNo
Work positioning system used (e.g. rope access, restraint)YesNo
Fall arrest system used (harness, lanyard, anchor or static line)YesNo
Control method(s) selected and why higher controls not practicable
PRE-WORK CHECKS
Edge protection / guardrails complete and securePassFail
Penetrations and skylights covered, secured and markedPassFail
Fragile roof areas identified and protectedPassFail
Scaffold / EWP inspected and taggedPassFail
Anchor points / static lines certified and inspection currentPassFail
Harnesses and lanyards inspected before use (labels legible, in date)PassFail
Free fall distance and clearance calculated to avoid striking the groundPassFail
Ladders suitable, secured and used for access only or short-duration light workPassFail
ENVIRONMENT & EXCLUSION
Weather suitable (wind, rain, heat, lightning)PassFail
Exclusion zone set up below to protect from falling objectsPassFail
Tools and materials secured against falling (tool lanyards, toe boards)PassFail
Overhead powerlines identified and approach distances maintainedPassFail
RESCUE
Rescue plan prepared for this work locationYesNo
Rescue equipment on site and workers trained in its useYesNo
Worker never left alone in a harness; suspension trauma response understoodYesNo
AUTHORISATION
Issuer Name
Issuer Signature
Worker(s) Signature
CLOSE-OUT
Work completed and all persons downYesNo
Penetrations and edges left protected or handed overYesNo
Time Permit Closed
Issuer Close-Out Signature