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Permit to work at height form

Permit to work at height form

Manage safety at heights with this permit to work template. It’s a ready-to-use form that guides you in assessing risks and tracking safety measures for each project.

Use this template
or download pdf
Permit to work at height form

Manage safety at heights with this permit to work template. It’s a ready-to-use form that guides you in assessing risks and tracking safety measures for each project.

Use this template
or download pdf

About the Permit to work at height form

Falls from height are a leading cause of serious workplace injuries and fatalities. Using a permit to work at height form can help you assess potential hazards, ensure the right equipment is used, and confirm that all safety measures are in place. Whether you’re coordinating a maintenance job or managing a construction project, this template allows you to maintain control and prioritize safety throughout the process.

With this form, you can ensure that your team is protected and risks are minimized, all while maintaining efficiency on site.

Key elements of the permit to work at height form

A well-structured permit to work form is essential for safety and compliance in elevated work environments. Here are its main components:

  1. General information: This section captures basic details like the work location and the date and time of the task. It’s important to provide a clear overview of the project so that everyone involved knows where and when the work will be carried out.
  2. Risk assessment: In this section, you’ll address risks before starting any work and implement appropriate control measures. By documenting risks in advance, you can uphold safety standards and avoid accidents.
  3. Equipment and PPE: You’ll need to verify that all necessary protective equipment is available and in good working order. Use this section to confirm whether workers have received training on how to properly use their gear.
  4. Emergency arrangements: Every work-at-height task requires a solid emergency plan. Rescue procedures, emergency contacts, and nearby services should be in place in case of accidents.
  5. Authorization: This final section confirms that the work has been reviewed and approved by the responsible parties. It includes the names and signatures of the permit issuer and the person overseeing the task.

How to customize the permit to work at height form

You can tailor the permit to work at height form to your organization’s needs.

First, add inspection points for your company’s specific equipment and hazards. If you use specialized fall protection gear, you can include questions that ensure it meets your safety standards before work begins.

Another option is to use conditional logic to streamline responses and trigger additional actions based on user input. For example, if a user selects “No” in response to “Have weather conditions been considered?”, the form could prompt them to provide a reason and initiate a checklist for additional precautions, such as postponing the work or securing temporary shelters.

The template also allows you to add text fields for comments and photo uploads anywhere. Workers can use these to note specific hazards or upload images of equipment setup and site conditions.

Download Lumiform’s permit to work at height form today

Make managing safety at heights easier and more efficient. With our user-friendly permit to work at height template, you can structure tasks, assess risks, and keep documentation organized. Adapt it easily to your team’s requirements to stay on top of safety regulations.

Related categories

  • Health and safety management templates
  • Risk management and compliance templates
  • Construction templates
  • Facility management templates
  • Risk assessment templates
  • Workplace safety templates
Preview of the template
Page 1
General Information
geolocation!!!
Date and Time of Work
Description of Work
Work to be Carried Out By
Risk Assessment
Have the hazards associated with the work been identified?
Have the risks been evaluated and appropriate control measures been put in place?
Is the work area clear of obstructions and hazards?
Have anchor points been identified and assessed as suitable?
Have weather conditions been considered?
Equipment and PPE
Have the appropriate fall protection equipment been provided?
Has the equipment been inspected and found to be in good working order?
Have operatives been trained in the use of the equipment?
Is the necessary PPE available and being used?
Emergency Arrangements
Have emergency procedures been established?
Have emergency contacts been identified?
Is a rescue plan in place?
Have the nearest emergency services been notified?
Authorization
Name of Responsible Person
Signature of Responsible Person
Date
Name of Permit Issuer
Signature of Permit Issuer
Date

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Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

Read in-depth guides covering key topics related to this article.

Working at height: A complete guideOSHA regulations: A compliance guide for professionalsPermit to work (PTW): Your guide for safe operations
See all topic guides

Template collections

See comprehensive collections of best practice templates related to this topic.

Top 7 working at height risk assessment templates3 free OSHA 300 form templates for informed workplace safety13 free permit to work templates
See all template collections

Use cases

Check out how the Lumiform software can be utilized for related use cases.

Risk management software for anticipating and adressing safety risksSafety inspection appPermit to work software
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Other resources

Explore all the additional resources we offer to assist you in mastering this topic.

4 ways that workplace safety increases worker productivity10 reasons why workplace safety is important4 benefits of safety management and how to communicate themBridging the gap: How Lumiform connects managers and frontline teams

Frequently asked questions

What is the minimum height for work to be considered “at height”?

The minimum height for considering work as “at height” varies by region, but generally, it’s any work conducted over four feet above the ground. It’s crucial to assess the specific regulations in your area and always conduct a risk assessment before beginning any work at this level.

What PPE is required for working at height?

Personal Protective Equipment (PPE) for working at height typically includes harnesses, helmets, and non-slip footwear. Always inspect your gear for wear and tear before use. In some cases, extra equipment like safety nets or guardrails may be necessary, depending on the specific task and environment.

What are some unexpected hazards when working at height?

Unexpected hazards include strong winds, which can cause loss of balance, and loose materials that may fall or shift. Unstable surfaces, like poorly secured scaffolding, also pose risks. Regularly inspect the site for hidden dangers such as weak structures or electrical lines. Training on hazard recognition and emergency procedures is crucial for safety.

How can I keep safety gear in top condition?

To maintain safety gear, conduct thorough inspections before each use, checking for frayed straps or cracked helmets. Follow the manufacturer’s cleaning guidelines, typically using mild soap and water. Equipment should be stored in a dry, cool area to prevent mold and degradation. It’s important to implement a routine maintenance schedule and document inspections for accountability.

How do weather conditions affect safety when working at height?

Weather conditions like rain, wind, and extreme temperatures can have a major impact on safety when working at height. Wet surfaces become slippery, increasing the risk of falls. Strong winds can destabilize equipment and personnel. Always check forecasts before starting work and postpone tasks if conditions are hazardous. Dress appropriately for temperature changes to maintain focus and safety.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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