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HSE Documents 1
Work at Heights Permit
Building Maintenance Units (BMU)
Ref. No:
Project Engineer:
Issue Date: Project Manager:
Permit Number: Date:
Site:
Location:
Contractor/
Employee:
Phone:
This permit is valid from: am/pm On:
This permit is valid until: am/pm On:
Description of works:
A Safe Work Method Statement (SWMS), Job Safety Analysis (JSA) and/or Safe Work Procedure (SWP)
has been provided and is attached to this ‘work permit’ Yes No
Note: The following section of this permit must be completed and signed by the authorized
person(s) before work is to proceed and only work listed above may be completed.
The following equipment will be used during the works (all equipment to be used is in good working order and is fit for
use):
Elevated work platform
(i.e. scissor lift)
Roof and/or ladder anchor
points
Ropes and harness
Step ladder Extension ladder Edge protection
Mobile scaffold Appropriate footwear Safety net
Other (please specify): BMU
The following services have been isolated for the duration of the works:
Smoke / thermal detectors Pipes, tanks and valves
Electrical Outlets /
appliances
Other (please specify):
The following control measures have been implemented for the duration of the works:
Barricades Signage Spotter
Other (please specify):
CENTRAL OFFICE USE ONLY
/ /2020
HSE Documents 2
The following environmental factors have been assessed and are suitable for the works:
Weather/wind Stored material/vegetation
Other (please specify):
This permit should be prominently displayed at the worksite
Authorization
Permit Issued To:
(Print name) (Signature) (Date)
Permit Issued By:
(Print name) (Signature) (Date)
Cancellation/completion of the permit
Permit cancelled/returned by:
(Print name) (Signature)
Cancelled/returned at: am/pm On:
Reason for cancellation :
Final Sign Off
The work site has been inspected by me at the cancellation/completion of the work at heights and declared safe for
normal operations to resume.
Azhar
(Print name) (Signature) (Date)
Official use only:
Project Manager Signatures:
Project Engineer: Signatures:
HSE Officer: Signatures:

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Work at Heights_BMU_ Work Permisdfdsfsdfdsft.pdf

  • 1. HSE Documents 1 Work at Heights Permit Building Maintenance Units (BMU) Ref. No: Project Engineer: Issue Date: Project Manager: Permit Number: Date: Site: Location: Contractor/ Employee: Phone: This permit is valid from: am/pm On: This permit is valid until: am/pm On: Description of works: A Safe Work Method Statement (SWMS), Job Safety Analysis (JSA) and/or Safe Work Procedure (SWP) has been provided and is attached to this ‘work permit’ Yes No Note: The following section of this permit must be completed and signed by the authorized person(s) before work is to proceed and only work listed above may be completed. The following equipment will be used during the works (all equipment to be used is in good working order and is fit for use): Elevated work platform (i.e. scissor lift) Roof and/or ladder anchor points Ropes and harness Step ladder Extension ladder Edge protection Mobile scaffold Appropriate footwear Safety net Other (please specify): BMU The following services have been isolated for the duration of the works: Smoke / thermal detectors Pipes, tanks and valves Electrical Outlets / appliances Other (please specify): The following control measures have been implemented for the duration of the works: Barricades Signage Spotter Other (please specify): CENTRAL OFFICE USE ONLY / /2020
  • 2. HSE Documents 2 The following environmental factors have been assessed and are suitable for the works: Weather/wind Stored material/vegetation Other (please specify): This permit should be prominently displayed at the worksite Authorization Permit Issued To: (Print name) (Signature) (Date) Permit Issued By: (Print name) (Signature) (Date) Cancellation/completion of the permit Permit cancelled/returned by: (Print name) (Signature) Cancelled/returned at: am/pm On: Reason for cancellation : Final Sign Off The work site has been inspected by me at the cancellation/completion of the work at heights and declared safe for normal operations to resume. Azhar (Print name) (Signature) (Date) Official use only: Project Manager Signatures: Project Engineer: Signatures: HSE Officer: Signatures: