Which of the following hazards are associated with this work:

Does the work involve the use of:

Ladders:

Access Scaffolding:

Working at Height:

Lone Working:

The danger(s) associated with the work identified above in carrying out the work are:

I declare that the above has been made known to the competent person in charge of the work and consider the above mentioned area to be safe for the competent person to commence work.

Acceptance by competent person prior to commencement

I understand the work that is to be carried out and the safety precautions that are necessary to complete the work safely as outlined in the appropriate method statement and risk assessments. If conditions are such that the method statement and risk assessments become invalid it is my responsibility to stop work immediately and notify the person who authorised this permit to work.

Continuation of Work

I hereby authorise the work specified above to continue until the time stated below and that I have checked the safety arrangements and confirm that they remain adequate.

Permit Cancellation

This permit is cancelled. The work is / is not complete. Safety precautions have / have not been removed.

Completion of Work
Final check by Contractor / Employee

I declare that the work described above is complete all work equipment, persons and materials under my control have been withdrawn. All safeguards have been reinstated and the work area returned to a safe status and service.

Completion of Permit - Permit Controller

I declare that the permit is now closed and I have received copies of the permit back from the Competent Person. The area has been inspected and is free from risk and all fire protection systems have been reinstated to their normal operating status.

GUIDANCE NOTES

USE OF LADDERS

• Ladders should be in good condition
• They should be long enough for the work in hand
• Ladders should be secured both at the top and bottom
• If extensions are used there should be at least two rungs overlap
• Sufficient clearance must be provided at the base of the ladder with barriers and warning signs
• Observe the 1 in 4 rule
• Ladder tags are in place

USE OF STEP LADDERS

• Hinges, fittings and cords should be in good condition
• Treads should be secure and not cracked or broken
• Steps should be set correctly, level and secure, open to full extent and adjusted to the correct angle
• Ensure that work can be completed safely without over-reaching or standing or kneeling on the top step or platform
• Sufficient clearance must be provided around the ladder with barriers and warning signs provided
• Ensure that excessive the work does not require excessive weight to carried i.e. sheets of wood or plaster board
• Ladder tags are in place

USE OF SCAFFOLDING

• Scaffolding must be erected by a competent person
• It must be protected against damage from traffic
• It must be barriered off and any one inside the barrier must wear head protection
• Kick boards must be in-place to stop items from being knocked off the scaffolding
• Hand rails must be fitted at all points where there is a risk of falling through
• Scaffold tags are in place

WORKING AT HEIGHT

• It is a danger to yourself and others when working above a height of 2 metres (6 feet)
• Fall prevention measures should be used i.e. barriers
• A safety harness should be worn wherever reasonably practical, where other controls are not employed
• Crawling boards must be used when working on elevated surfaces that are not designed for pedestrian traffic access

LONE WORKING

• When working alone, workers must have adequate communication or:
• Adequate levels of supervision

IF IN DOUBT - ASK