PERMIT for WORKING AT HEIGHT - PACI

PERMIT for WORKING at HEIGHT VER 01/Sep/2009 Prepared by PACI Pty Ltd ABN 19 061622151 Page 1 of 2 PERMIT for WORKING AT HEIGHT PERMIT No. This PERMIT assumes that all other control methods have been considered and that the use of PPE has been deemed the only practicable alternative for the work to be undertaken. Only trained, competent persons who are current may work at HEIGHT . Person or contractor responsible for work: Job location: Job description: Schedule: Start time/Date: Finish time/Date: INDICATE TYPE OF FALL PROTECTION SYSTEM: Type of System (indicate) Description Authorisation [ ] Travel restraint system (total restraint) Falls are prevented PPE limits travel May proceed as planned [ ] Work positioning system Continuous tension, restrained by PPE May proceed only if PPE is suitable [ ] Fall-arrest system Does not prevent falls catches after fall STOP!

Permit for Working at Height VER 1.3 01/Sep/2009 Prepared by PACI Pty Ltd ABN 19 061622151 Page 1 of 2 PERMIT for WORKING AT HEIGHT Permit No. This permit assumes that all other control methods have been considered and that the use of PPE has been deemed the only practicable

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