WORKING AT HEIGHTS PERMIT

___________________________________________
Name of the Project: ___________________
Contract No

Permit No_____

_________________________

Location of Work ______________________

Date ________________________________
Name of the Contractor: __________________
Sr.

Name of the Workers

Age

Trade

No

Skilled/

Relevant PPEs issued/not

Unskilled

1
2
3
4
5
6
7
8
9
10
Have been permitted to carry out the:
Nature of work ___________________________________________________________
________________________________________________________________
At (Location) _________________________on (Date) ______________
Mr.___________________________________ will be In-charge/Supervisor of
the Operations and has been instructed to ensure that all the Safety
Precautions as mentioned overleaf are strictly adhered to.

Signature of the Subcontractor Safety Officer

Date
Day 1

Start
Time

Signature of Al-Ojaimi
Safety Officer
Finish
Time

Sign of Al- Ojaimi

Signature of Consultant

Remarks

WORKING AT HEIGHTS PERMIT

___________________________________________
Day
Day
Day
Day
Day
Day

2
3
4
5
6
7

SAFETY INSTRUCTIONS:
Before commencing the work, Engineer/Supervisor/Persons In-Charge of the
work must ensure that the following points are compiled as per the Work
Instructions related to Height Works:

S.No.

Safety Instructions

All the equipment operators, should be experienced and

licenced.

The area at the ground floor is cordoned off and

barricaded & Unauthorised person should not enter into
the working area.

A signal man is always present for shifting the material using a

tower crane

In case a scaffolding is used, a separate Work Permit has

been issued for its erection / Scaffolding must be

inspected by safety officer and approved for used

All the workers working on the scaffolding are using
Safety Shoes, Safety Helmets, Safety belt and Personal

Fall Arrestor System

Proper site housekeeping is to be maintained

With every equipment there should be a fire extinguisher.

A maximum wind speed limit has been fixed beyond

which no one shall be allowed to work at heights

The ladders used for climbing purpose are made up of

MS and are having hand rails / Must be inspected by
safety officer and approved for used

Compliant Non-Compliant

WORKING AT HEIGHTS PERMIT

___________________________________________
10 Sign boards indicating height work, men at work, slow
speed, directions, etc. are to be sufficiently installed.
11 Safety Nets are provided throughout the periphery in two
levels
12 Sufficient illumination has been provided in case of night
works
13 Sufficient care has been taken to ensure that no
electrical wires are near the working area
14 An electrical supervisor or engineer is present while any
work near electrical work is in progress
15 The flat form is clear of loose material or any
hand tool so as to avoid falling on any person
below it?

Any other safety precautions to be taken:

The above work has been completed satisfactorily by taking all the necessary
safety precautions.
Closure of Work Permit (Date):________

Signature of the SubContractor

Supervisor

Signature of Safety Officer

(Al- Ojaimi)