Working at Heights Permit

Permit form to authorize elevated work and verify fall protection, anchor points, and rescue arrangements before work begins at heights above the OSHA threshold.

Permit Overview

• Permit title
• Work order or job number
  Optional reference for internal tracking and audit trail.
• Site / area where work will be performed
• Description of work at height
• Planned work date
• Planned start time
• Planned end time

Work at Height Details

• Estimated work height above ground or lower level (feet)
• Does this work exceed the applicable OSHA fall protection threshold?
• Primary access method
• If other, specify access method
• Work area condition

Fall Protection and Equipment

• Fall protection system to be used
• Has all fall protection equipment been inspected before use?
• Describe any damaged, missing, or out-of-service equipment
• Have anchor points been verified for strength, compatibility, and location?
• Anchor point details
  Include anchor location, attachment method, and any engineered or approved anchorage information.

Hazards and Controls

• Known hazards at the work location
• Other hazards
• Control measures to prevent falls or dropped objects
• Are weather and surface conditions acceptable for the planned work?
• Weather or surface condition notes

Rescue and Emergency Plan

• Is a rescue plan in place for a fall event?
• Primary rescue method
• If other, specify rescue method
• Are trained rescuers and required equipment available on site?
• Emergency contact number
  Use the site emergency number or control room contact.

Authorization and Acknowledgment

• Permit requestor name
  Enter the name of the person requesting the permit.
• Requestor role
• Approving supervisor name
• Permit approval status
• Approval conditions or restrictions
• I confirm the information provided is accurate and work will not begin until all controls are in place.