Working at Heights Permit Example
Example document for Working at Heights Permit. Use this as a reference when creating your own.
Professional Review Required
This document involves significant legal, financial, or compliance considerations. You must have a qualified professional review and approve this document before use. Do not rely on this template as legal advice.
Document: Working at Heights Permit
Example Document
Last updated 7/27/2026
WORKING AT HEIGHTS PERMIT
Permit Number: WAH-2023-045 Date of Issue: 24 October 2023 Time of Issue: 07:00 AM Valid Until: 24 October 2023 Time Valid Until: 04:00 PM
COMPANY DETAILS
Company Name: Apex Roofing Services Pty Ltd ABN: 12 345 678 901 Site Address: 42 Smith Street, Parramatta NSW 2150
WORK DETAILS
Task Description: Replacement of damaged colorbond sheets on warehouse roof. Location of Work: Southern quadrant of the main warehouse roof.
HEIGHT ASSESSMENT
Height at which work will be performed: 6.5 metres Type of structure: Metal warehouse roof with skylights.
HAZARD IDENTIFICATION
Identify all hazards present at the worksite:
- Fragile roof surfaces (skylights)
- Unguarded edges
- Falls through openings
- Falling objects (tools/debris)
- Weather conditions (wind/rain)
- Overhead powerlines (western edge)
- Uneven ground for equipment
- Other: Heat stress
RISK CONTROL MEASURES (HIERARCHY OF CONTROLS)
Level 1: Elimination
- Can the work be done on the ground? (Yes/No)
- Details: No. Physical access to roof required for repair.
Level 2: Engineering Controlsn- [x] Guard rails installed (Mobile scaffolding with edge protection used)
- Scaffolding erected (Tag Number: SCAF-99)
- Elevated Work Platform (EWP) used
- Safety mesh installed (Existing mesh verified)
- Details: Scaffolding with perimeter guardrails erected 1.5m from edge. Skylight covers fitted and labelled.
Level 3: Administrative Controls
- Warning signs erected (Falling objects area)
- Exclusion zones established (Ground level under work area)
- Permit system in use
- Details: 10m exclusion zone taped off on ground. Traffic controller engaged for driveway access.
Level 4: PPE
- Safety harness worn (Travel restraint system)
- Lanyards/Inertia reels used
- Hard hat
- Safety boots
- Details: Full body harness with 2m retractable lanyard anchored to scaffold.
EQUIPMENT CHECK
| Equipment Type | ID Number | Inspection Status | Inspector Initials |
|---|---|---|---|
| Harness | H-101 | [x] Current | JB |
| Lanyard | L-205 | [x] Current | JB |
| EWP | N/A | [ ] Current | N/A |
| Ladder | L-45 | [x] Current | JB |
WORKER COMPETENCY
Workers authorised to perform this task:
- Name: John Smith | Licence/Qualification: Certificate III in Roof Tiling
- Name: Mike Jones | Licence/Qualification: High Risk Work Licence (WP)
AUTHORIZATION AND SIGN-OFF
I confirm that the above control measures are in place and understood.
Authorised Person: Sarah Jenkins Position: Site Supervisor Signature: S Jenkins
Worker Acknowledgement: I acknowledge I have read and understood the risks and controls listed above.
Worker Name: John Smith Signature: J Smith
PERMIT CLOSURE
Work completed at: 02:30 PM Area left safe and clean: [x] Yes [ ] No Final inspection by: Sarah Jenkins Signature: S Jenkins Date: 24 October 2023
Notes
Key Decisions in this Example:
- Hierarchy of Controls: The permit notes that elimination was not possible, so engineering controls like scaffolding and skylight covers were prioritised. PPE (harnesses) was used as a secondary measure (travel restraint) rather than the primary control.
- Skylights: These were identified as a specific hazard because they can be fragile. Covers were explicitly listed as a control measure.
- Exclusion Zone: Because work was happening 6.5m up, falling objects were a risk to the public below. An exclusion zone and traffic controller were noted to mitigate this.
- Competency: The qualifications were checked and recorded. Mike Jones holds a High Risk Work Licence, which is relevant if he were using an EWP, though here he used scaffolding.
About this Example
Part of the Working at Heights Permit document collection
Document Type
Working at Heights Permit
A formal document authorising specific high-risk work at heights to ensure safety compliance and risk management on site.