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    Work at Heights Permit

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    rashid zaman
    This document is a Work At Heights (WAH) permit that contains 4 sections: [1] Application by WAH Supervisor describing the work location and control measures, [2] Evaluation by WAH Safety Assessor verifying control measures are implemented, [3] Approval by WAH Authorized Manager authorizing the work, and [4] Task Completion by WAH Supervisor confirming work is done. It also includes attachments of a risk assessment, emergency response procedure, fall protection equipment list, and worker training certificates.

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    © All Rights Reserved
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    Work at Heights Permit

    Uploaded by

    rashid zaman
    2K views4 pages
    This document is a Work At Heights (WAH) permit that contains 4 sections: [1] Application by WAH Supervisor describing the work location and control measures, [2] Evaluation by WAH Safety Assessor verifying control measures are implemented, [3] Approval by WAH Authorized Manager authorizing the work, and [4] Task Completion by WAH Supervisor confirming work is done. It also includes attachments of a risk assessment, emergency response procedure, fall protection equipment list, and worker training certificates.

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    This document is a Work At Heights (WAH) permit that contains 4 sections: [1] Application by WAH Supervisor describing the work location and control measures, [2] Evaluation by WAH Safety Assessor verifying control measures are implemented, [3] Approval by WAH Authorized Manager authorizing the work, and [4] Task Completion by WAH Supervisor confirming work is done. It also includes attachments of a risk assessment, emergency response procedure, fall protection equipment list, and worker training certificates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2K views4 pages

    Work at Heights Permit

    Uploaded by

    rashid zaman
    This document is a Work At Heights (WAH) permit that contains 4 sections: [1] Application by WAH Supervisor describing the work location and control measures, [2] Evaluation by WAH Safety Assessor verifying control measures are implemented, [3] Approval by WAH Authorized Manager authorizing the work, and [4] Task Completion by WAH Supervisor confirming work is done. It also includes attachments of a risk assessment, emergency response procedure, fall protection equipment list, and worker training certificates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4
    At a glance
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    The document outlines the procedures and responsibilities for obtaining a Work At Heights permit, including risk assessment, control measures, supervision, and completion/cancellation of work.

    The WAH permit is an application that must be completed to obtain authorization for work at heights. It involves assessment of risks, control measures, supervision, and approval from authorized managers.

    The responsibilities of the WAH Supervisor include conducting a risk assessment, outlining control measures, declaring they have been implemented, and confirming work area restoration upon completion.

    Work At Heights (WAH) Permit

    Section 1 : Application By WAH Supervisor


    Description of Work To Be Carried Out

    Location of Work

    Vessel :___________________________________ Land : ____________________


    (Please specify Vessel Name & exact location of work) (Please specify the exact location of work)
    Start Date / Time End Date / Time

    Company Name

    S/N Description of WAH Control Measures Implemented Yes No NA Remarks


    1 Safe means of access / egress provided?
    2 Edge protection provided wherever there is falling hazards?
    Refer to Fall Protection
    3 Fall prevention equipments used to access/ egress work platform? Equipment List
    4 Fall prevention equipments used are adequate and in good condition?
    5 Anchorage / lifeline installed and inspected?
    6 Travel restraint system used to safeguard persons from falling hazards?
    All person subjected to falling hazards are equipped with Personal Fall
    7
    Arrest System?
    All person subjected to falling hazards are adequately trained to perform Attached Certificates
    8
    work at heights?
    Attached RA
    9 Fall Protection Plan & Risk Assessment conducted and communicated?
    Emergency Response Procedure for WAH activities developed and Attached Procedure
    10
    communicated to workers?
    Risk Assessment and workers training certificate placed on site for
    11
    inspection?
    WAH Permit displayed on site for the duration of the approved task and
    12
    removed only upon task completion or upon its expiry?
    13 Others (Please specify):_________________________________________
    Sketch of the falling hazard area (attached separate sheet/photo if necessary)

    Remarks

    I declare that the information provided is accurate and the control measures listed above
    have been effectively implemented. (attach WAH course certificate for the role)
    Company Stamp
    __________________________ __________________ _______________ _______________
    Name / Designation Signature Date & Time Contact No.

    Effective Date: 01 January 2014 Pg 1 of 4


    Section 2: Evaluation By WAH Safety Assessor
    S/N Description of Evaluation List Yes No NA Remarks
    Assessment of Control Measures:
    1 All reasonably practicable measures have been taken?
    2 Verification of documents/ interview workers / others?
    Site Survey with Supervisor
    3 All persons on site are protected from falling hazards?
    4 Surrounding areas do not pose additional hazards?
    Multiple Locations / Extended Duration
    5 Hazards are common at various locations / time period?
    6 Control measures are applicable and effective?
    Remarks:

    I have evaluated the application and is satisfied that all reasonably practicable measures have been taken
    effectively. (attached WAH course certificate for the role)

    _____________________________ ____________________ __________________ __________________


    Name / Designation Signature Date & Time Contact No.
    Section 3: Approval By WAH Authorized Manager
    S/N Description Yes No NA Remarks
    1 Proper Permit-to-work evaluation has been completed?
    2 No incompatible works that may pose additional hazards?
    3 Control measures have been implemented effectively?
    4 Fall from height risks have been effectively mitigated?
    Remarks:

    I authorize the work at heights to the conditions and duration stated in this permit.

    _____________________________ ____________________ __________________ __________________


    Name / Designation Signature Date & Time Contact No.
    Daily Endorsement (If task exceed 1 day , Daily Endorsement by Authorized Manager is required)
    Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

    Section 4: Task Completion By WAH Supervisor


    The WAH task has been : Completed
    Date /Time
    Suspended due to permit expiry
    Terminated due to change in conditions Remark

    I confirm that the work area has been restored to its original condition and no hazards have been introduced.

    _____________________________ ____________________ __________________ __________________


    Name / Designation Signature Date & Time Contact No.
    Effective Date: 01 January 2014 Pg 2 of 4
    Workers List
    I, as per name list below, have been briefed on the risk assessment and falling from heights hazards of the work process and
    fully understands all the control measures mentioned in the risk assessment prior to work commencement and will abide to
    it. I have been issued with the Personnel Fall Arrest System and have inspected that it is in working conditions prior to use.

    S/N Name NRIC / Work Permit no. Designation Signature

    I, ________________________, hereby confirm that I have made the necessary inspection before
    completing the said declaration. I have also briefed and ensured that all the workers (as per name list
    above) understand the risk assessment prior to work commencement.
    Company Stamp

    __________________________ __________________ _______________ _______________


    Name / Designation Signature Date & Time Contact No.

    Effective Date: 01 January 2014 Pg 3 of 4


    Fall Protection Equipment List

    Condition of Equipment
    S/N Equipment Serial No. Expiry Date Remark
    (Good / Bad)

    I, ________________________, hereby confirm that I have made the necessary inspection before
    completing the said declaration.
    Company Stamp

    __________________________ __________________ _______________ _______________


    Name / Designation Signature Date & Time Contact No.

    Effective Date: 01 January 2014 Pg 4 of 4

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