Height Work Permit
Project Name: Permit No: HTWP/_____________
Contractor's Name: Date : ______ /______ /2025
Supervisor's Name:
Permit Valid From: AM / PM To AM / PM
Activity to be executed at height: Location of Height Work:
Numbers of Workers going to be perform the job:
DESCRIPTION OF RISK YES NO COMMENTS & ACTIONS
Scaffolding
Scaffold installed in accordance to standard and acceptable to work?
Has Safe access been provided?
Are working platforms of sufficient width, secure and complete?
Is the edge protection in place – handrail, mid-rail, toe-board?
Is the safety net in is applicable and provided ?
Are suitable baseplates provided?
Are High Voltage clearances maintained?
Are outriggers in place in the required locations.
Are wheel locks present and in working order?
Is the safe tag provided ?
Roof Access
Weather condition is analysed to assess suitability for working at height?
Have workers received job specific Induction & Training?
Has the roof area been inspected for structural strength?
Is there safe and suitable access provided to work areas?
Are workers protected from falling from edges?
Are workers protected from falling from incomplete structures?
Are workers protected from falling through skylights and penetrations?
Are people protected from the dangers of falling objects?
Is electrical supply available at roof level?
Is the fall arrester system provided to arrest fall?
Do workers aware on the safe way to execute the job?
Plant & Electrical Equipment
All equipment's fitness certified and tagging done as per standard?
Have servicing requirements been met?
Are all guards in place?
Has electrical equipment been tested and tagged?
Are electrical leads clear from metal scaffold?
Is power being sourced from the same level/floor?
Is RCD/RCCB (mechanical) protection in place?
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Height Work Permit
Personal Protective Equipment
Is all relevant PPE available and serviceable?
Do harnesses, belts, ropes etc. are inspected and found safe for use?
CONTRACTOR AUTHORISED PERSON (i.e.Site Eng. / Supervisor) - (PERMIT GENERATOR )
Requesting and confirming by contractor’s representative: I confirm that the precautions specified above is complied with and the persons carrying out
the work are fully briefed on the safe method of work on safe execution.
Name Signature Date
CONTRACTOR COMPETENT PERSON WITH COLLIERS REPRESENTATIVE (i.e.Site Eng. / Manager) - (PERMIT ISSUER)
Confirmation:
I understand and certify that the precautions are adopted / not adopted for carrying out the height Permission
work as per the above check points and according to approved SWMS for the activity.
GRANTED DECLINED
Name Signature Date
Name Signature Date
IF DECLINED, ACTION REQUIRED BY CONTRACTOR WITH AGREED TIME LINE:
ACTION COMPLETED - APPROVAL GRANTED
Name Signature Date
Note: -
1. The completed permit is to be hanging adjacent to the work being carried out along with copy of SWMS of the activity.
2. The work cannot be allowed, if the permit is not signed from Authorised person.
3. The Permit is valid for one shift / for 8hrs, If the work extends beyond the shift, new permit to be generated.
4. This work permit must be completed by the work supervisor and then be reviewed & signed by a Colliers representative.
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