The document outlines a permit form for the use of a mast climber or cradle, including sections for project information, permit issuance details, operator information, and safety prerequisites. It emphasizes the importance of safety checks, operator competence, and equipment certification. Acknowledgement and authorization by the initiator and evaluator are required, along with a process for ensuring the work area is restored to a safe condition post-task.

1. MAST CLIMBER & CRADDLE PERMIT
Page 1 of 2 Form # HSEQ-MCP (Rev 2 - 2023)
1. Project Information: (To be filled by initiator/originator)
Project Name: Permit No.:
Project Location:
Requesting Contractor/Company
2. Permit Issuance Details: (To be filled by initiator/originator)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE
Description of Task:
Area / Location of Mast
Climber or Cradle:
Permit Validity: Time (from): __________Hrs. Time (To): __________Hrs. Date:
Serial No. of Mast Climber or Cradle:
No. of persons working on Mast Climber or Cradle:
Safe Working Load of Mast Climber or Cradle: Other(s):
3. Mast Climber or Cradle Operators Details: (To be filled by initiator/originator)
Operator Contact:
Rigger-1 Contact:
Rigger-2 Contact:
Rigger-3 Contact:
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed,
approved and communicated? ☐ ☐ ☐
Area below mast climber or cradle free
from personnel and barriers in place when
working?
☐ ☐ ☐
Mast climber or cradle have a valid 3rd
party
certificate and displayed?
☐ ☐ ☐
All mast climber or cradle rigging points
secure to building?
☐ ☐ ☐
Operator competent and certified?
☐ ☐ ☐
Are the mast climber or cradles brakes
working?
☐ ☐ ☐
Wire ropes in good conditions? ☐ ☐ ☐ Proper barricade and signage are posted? ☐ ☐ ☐
Counterweights sufficient and properly
anchored/secured?
☐ ☐ ☐
Mast climber or cradle SWL displayed?
☐ ☐ ☐
Electrical wires are in good conditions and free
from obstructions?
☐ ☐ ☐
Access and egress will be on ground level?
☐ ☐ ☐
Anchor point for safety harness available and in
good condition?
☐ ☐ ☐
Rescue plan available and communicated?
☐ ☐ ☐

2. MAST CLIMBER & CRADDLE PERMIT
Page 2 of 2 Form # HSEQ-MCP (Rev 2 - 2023)
Personnel working in mast climber cradle
wearing safety harness and clipped on?
☐ ☐ ☐
Others (specify):
☐ ☐ ☐
5. Acknowledgement by Initiator and Evaluator:
☐ Acknowledge that all above precautions have been taken. These have also been fully explained to the operatives,
and I consider them competent to do it safely.
Initiator/Originator
Name:
Designation:
Signature: Date /Time:
☐ Acknowledge that I have checked above control measures and consider the work area safe to carry out the activity
Evaluator (HSE Team): Designation:
Signature: Date /Time
Comments (if any):
6. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
7. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I have checked the area and been restored to a safe and orderly condition.
Evaluator Signature: Time: