WORK AT HEIGHTS

RISK ASSESSMENT & ACCESS PERMIT Section 1 Risk Assessment

Document the hazards and analyse the risks associated with the height access and work activities to be undertaken.

P.T.W. Number:

Location at hei ht! BAC Area / Location: Method of access / work at heights: Reason "o# access! Work activity description: Nature of work to be undertaken: Ha$a#% i%enti"ication& #isk ana'(sis an% cont#o' meas)#e se'ection! S*eci"ic Access + Wo#k Iss)es!
(tick appropriate)
Add an additional page if the space below is insufficient Attach %oc)mentation & *#ocee% to Section , on the "o''o-in *a e. Com*'ete the Risk Assessment /e'o-.

The access / work is to be solely undertaken by a contracted party OR !" personnel and a detailed work method statement / risk assessment has been previously prepared# reviewed by !" $ is attached to this %orm. The access / work is to be solely undertaken by !" personnel as per the speci&ic access / work issues detailed below. Step 2 Consider Likelihood What is the likelihood (below) of the hazard consequence in Step 1 occurring. (lmost Cert in LikelPossible .nlikel- / ! re %s e$pected to occur in most circumstances Will probabl( occur at least once *+ent might occur at some time *+ent not e$pected to occur or onl( in e$ceptional circumstances

Risk Assessment Guide

Step 1 Consider Consequences What are the consequences of this hazard occurring? Consider what is the most probable consequence (below) with respect to this work hazard. )*treme Critic l & ,or &inor +nsi$ni0ic nt &ultiple fatalities or permanent in'uries Single fatalit( or permanent in'ur( &edical treatment or lost time in'ur( ,irst aid treatment %ncident or near miss - no treatment Step 3 C lcul te !isk 1. ake Step 1 rating and select the correct column. !. ake Step ! rating and select the correct line. ". #se the risk score where the two ratings cross on the matri$ below. " # "i$h% S # Serious% & # &edium% L # Lo' Consequences +ns &in & , Crit )*t (lmost Cert in & S " " " Likel& & S " " Possible L & & S S .nlikel- / ! re L L & & S

Ha$a#%
('ist the hazards relating to the work)

Cont#o's
('ist the controls to manage each o& the hazards)

)ikelihood

Res*onsi/'e Pa#t(
('ist the role# contractor# competency $/or prescribed occupation responsible &or implementing the controls)

Risk Assessment
((ith controls in place) *igh# +erious# ,edium or 'ow)

Risk Assessment Pe#sonne'!

Risk !ssessment "ompleted by)

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.mployer) .mployer) .mployer)

Date) Date) Date)

0e#sion 1 Pa e 1 o" 1

WORK AT HEIGHTS
RISK ASSESSMENT & ACCESS PERMIT Section , Access Pe#mit

P.T.W. Number:

!s per the method o& access / work at heights described in !ection "# identi&y control re/uirements in the relevant parts below or mark as not applicable.

2oom T(*e E'e3atin Wo#k P'at"o#m 4EWP5 Re6)i#ements .(0 "ontrols) 7es
Mini#u# clearance distances will need to be #aintained fro# overhead ha$ards %power lines& structures& #oving plant& etc' !pecific controls will be re(uired to ensure an appropriate ground / surface slope for place#ent of the )W* Barriers or signage will need to be erected around the )W* %to restrict access by persons or other plant ite#s' )W* of any type will re(uire a certified / authorised operator *ersonnel using the )W* will be fa#iliar with set+up& control of the )W* and e#ergency egress ,ther:

-! (-ot !pplicable)
NA
I" 7es& Inc')%e A%%itiona' Cont#o' 8etai's to /e 9se%!

Sca""o'%in Re6)i#ements Type o& +ca&&old)

*refabricated scaffold %fi-ed length co#ponents& fittings and general design configuration' Mobile scaffold %free+standing& #ovable scaffold' .ube and couple scaffold %variable lengths of tube& couple attach#ents and configurations' Co#ple- scaffold %cantilevered& hung& other co#ple- configuration': /etails:

-! (-ot !pplicable)
7es NA

+ca&&old "ontrols)
.he scaffold will be erected / dis#antled by a certified scaffolder %#andatory if deck is 01# fro# ground / surface' A scaffold plan has been developed *rovide plan or drawing nu#ber / reference: Barriers will be erected around the scaffold during erection / dis#antling %to prevent potential falling ob2ect incidents' .o ensure the safety of those erecting / dis#antling& indicate which of the following will be i#ple#ented: a prescribed scaffold work #ethod will be used %i##ediate and progressive installation of platfor# and edge protection& internal ladder/stair access and retention of full deck& to ensure falls 03# are prevented' a fall arrest harness syste# will be used %only suitable where anchorages of "4 kN 5 safe fall clearances e-ist' an alternative safe work at height #ethod will be used& as detailed:

7es

NA

.he scaffold is to be a fi-ed scaffold that will be: safely secured via scaffold ties and appropriate base plate supports6 and erected with ade(uate access provisions& edge protection and falling ob2ect protection .he scaffold is to be a #obile scaffold that will be: supported on ad2ustable and lockable castors to ensure the scaffold is level and not able to #ove when locked6 no greater than 7# high or 8+ti#es the s#allest base di#ension6 and erected with ade(uate access provisions& edge protection and falling ob2ect protection

Tem*o#a#( E% e P#otection o# Co3e# Re6)i#ements Type o& Temporary .dge 0rotection or "over)
9i-ed handrail along an unprotected edge or guardrail along an unprotected rooftop edge Movable edge protection& secured in place around a penetration Movable cover& secured in place over a penetration %ade(uate for potential loadings of people 5 e(uip#ent'

-! (-ot !pplicable)
7es NA

.dge 0rotection or "over "ontrols)

!pecific controls will be re(uired to fi- a #ovable cover in place and clearly warn people of its location !pecific controls will be re(uired to ensure the edge protection can be erected fro# a safe location and without the installing person being e-posed to a fall ha$ard /ue to the nature of edge protection to be secured& a certified scaffolder or si#ilar co#petent person& will be re(uired to set up the te#porary edge protection Mandatory if setting up edge protection rather than a cover + .he edge protection to be set+up will be: capable of withstanding the potential force of a person falling downwards or outwards onto the barrier6 at least 7::## high with additional rails& infill& etc to prevent persons falling through or under the barrier6 and not able to be dislodged fro# an edge or fro# over a penetration by a person falling against it

7es

NA

I" 7es& Inc')%e A%%itiona' Cont#o' 8etai's to /e 9se%!

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WORK AT HEIGHTS
RISK ASSESSMENT & ACCESS PERMIT Pe#sona' :a'' P#otecti3e E6)i*ment Re6)i#ements Type o& +ystem to be 1sed)

P.T.W. Number:

-! (-ot !pplicable)
7es NA

.ravel restraint syste# + %use of harness& suitable attach#ents& anchorage line that does not allow a person into a fall position': will have an ade(uate anchorage%s' to withstand potential loadings %; kN for single person attach#ent'6 will enable personnel to attach to the syste# prior to being in a position where they could fall6 will not co#e into contact with anything that could affect the integrity of the syste#6 and if it is a fi-ed/per#anent syste# < inspection records have been reviewed and are current % =es / NA ' 9all arrest syste# < %use of a harness& lanyard asse#bly/shock absorbing device& anchorage& in a potential fall position': will have an ade(uate anchorage%s' to withstand potential loadings %"4 kN for single person attach#ent'6 will enable personnel to attach to the syste# prior to being in a position where they could fall6 will not co#e into contact with anything that could affect the integrity of the syste#6 will consist of a device %shock absorbing device' to ensure that no greater than ;kN of force could be applied to a falling person6 will allow enough fall clearance for those who #ay fall& once force has been applied to all syste# co#ponents6 if it is a fi-ed/per#anent syste# < inspection records have been reviewed and are current % =es / NA '6 will enable a rescue/retrieval #ethod to be i#ple#ented %provide details below'

Othe# S*eci"ic Wo#k Metho% Re6)i#ements Description)

An industrial rope access syste# will be i#ple#ented by a specialist contracted party An industrial safety net will be erected by a specialist contracted party

-! (-ot !pplicable)
7es NA
Attach! A s*eci"ic -o#k *#oce%)#e o# -o#k metho% statement s)**'ie% /( the cont#acto#.

Resc)e + Ret#ie3a' Consi%e#ations! ,inimum provisions re/uired)

Co#petent stand+by person to individually #anage rescue / retrieval e(uip#ent !afety harness/rescue kit in vicinity with co#petent user/s !pecific retrieval e(uip#ent / plant ite#s ,ther:

-! (-ot !pplicable)
7es NA
P#o3i%e A%%itiona' 8etai's S*eci"ica''( "o# Com*'e; Access Scena#ios!

:a''in O/<ect & Othe# P#eca)tions Other items re/uired)

.e#porary barrier #esh to restrict access .ool restraints / lanyards to be used at height Catch platfor#s / decks for falling ob2ects Covers over sharp roof / plant edges >ead protection !pecific access clearance / keys for controlled areas Warning notices / barricades re(uired !pecific lighting provisions re(uired ,ther: Attach#ents %other docu#ents/plans prepared'

7es

NA

P#o3i%e C'a#i"(in 8etai's as Re6)i#e%!

Pe#mit Re6)est!
This acknowledgement signi&ies a &ormal re/uest to commence height access / works. !s the person re/uesting this permit# 2 hereby certi&y that) 2 am competent to coordinate this height access / work in accordance with the previous Risk !ssessment $ !ccess 0ermit details3 2 shall undertake to implement all planned and necessary controls to ensure sa&e access / work at heights3 and 2 shall monitor access and work at height hazards and control methods throughout the access / work.

-ame)

+ignature)

Date)

Time)

2AC A)tho#isation!
This !" !uthorisation signi&ies that the planning component o& the Risk !ssessment $ !ccess 0ermit has been completed and that height access / work is authorised to commence in accordance with the 0ermit Re/uest.

-ame)

+ignature)

Date)

Time)

Section = Im*'ementation Hei ht Access A)tho#isation %Work Coordinator in /irect Control':

The procedures# control measures and precautions appropriate &or the sa&e access $/or e4ecution o& work at heights have been implemented and the persons re/uired to work at heights have been advised o& and understand the re/uirements o& the Risk !ssessment $ !ccess 0ermit.

-ame)

+ignature)
This !uthorisation is valid until the &ollowing occurs# or the date and time shown)

Date)

Time)
0e#sion 1 Pa e = o" 1

"onstraints)

WORK AT HEIGHTS
RISK ASSESSMENT & ACCESS PERMIT
Date)

P.T.W. Number:

Time)

0e#sion 1 Pa e 1 o" 1