PROJECT U2 New Plant FIGUIL (NPF) CIMFIG
Permit No.:
WORKING AT HEIGHT PERMIT
Refer to HSE Working at Height
CONTRACTOR: GEMAT SARL LOCATION: AIRE DE CONSTRUCTION DES MIRADORS
EQUIPMENT TO BE USED: scaffold, safety harness, manual tools, EXISTING SERVICES:
EXISTING SERVICES:
PERMIT PERIOD: 20/01/25 to 31/01/25 PERMIT ISSUED BY: GEMAT SARL
…………………MBA…………….….
EMERGENCY PHONE NO: +237 670188676 …………………………………….
(name) (signed)
HAZARDS LIST: (select your hazards from the list below)
□ Fall from height 5 meters or above. □ Fall from work platform. □ Lifting/pushing/pulling. □ Obstructions ground level.
□ Fall from height 2 metres or above □ Falling into water. □ Live work (only under separate □ Obstructions overhead.
but not exceeding 5 meters.
□ Falling into hazardous permit).
□ Poor lifting environment.
□ Fall from height below 2 meters. substance. □ Lone working.
□ Restricted space.
□ Fall from steps. □ Falling objects. □ Manual Handling.
□ Slips/trips.
□ Fall from ladder. □ Fragile roof/surfaces. □ Moving Materials.
□ Other Anticipated Hazards:
□ Vehicles/Traffic. □ Weather/temperature. □ Fall into working at height.
PRECAUTION/ HAZARD CONTROL REQUIREMENT
No. REQUIREMENT YES No. REQUIREMENT YES No.
Access equipment to be used only for its intended
Confirm that there are no reasonably practicable
1 yes 7 purpose, in the manner designed and within its rated yes
alternatives to work at height?
capacity?
Risk assessment and method statement/safe system
Harnesses to be worn and attached to a secure point by
of work documented and take into account falling risk
an inertia device, or by a line so short so as to prevent a
2 as well as associated hazards eg falling objects, yes 8 yes
fall? Required for use of cherry pickers, access
overhead lines, weather, unauthorised access, fragile
cradles, locations without edge protection?
surfaces?
Scaffolding has certificate of inspection by competent
Workers are suitably qualified to erect/use access person prior to use as well as arrangements for re-
3 yes 9 yes
equipment or fall arrest equipment involved? inspection every 7 days or as necessary eg after high
winds?
Fall prevention eg guard railing, used where
Maximum height of tower scaffold within manufacturer’s
4 appropriate in preference to methods which minimise yes 10 yes
spec.?
the consequences of a fall?
Rescue plan in place, where appropriate, with
5 equipment readily to hand and workers trained? Eg for yes 11 Competent supervision provided? yes
use of nets and air bags?
Ladders only to be used for access and light, short
6 yes 12 Area below cordoned off/protected? yes
duration work?
IN THE EVENT OF ANY UNANTICIPATED SERVICE OR OBJECT BEING DISCOVERED, OR ANY OTHER EMERGENCY,
WORK SHALL BE STOPPED IMMEDIATELY AND THE RELEVANT AUTHORITY NOTIFIED.
PPE REQUIREMENTS: safety harness, helmet,
Prior to working
I have inspected the work area, fall protection measures and relevant paperwork and confirm that work can go ahead as detailed in this permit.
name …………………………………………... signed ……………………………………………………. date ……………………………........
The permit is now cancelled; all additional works will require a new permit to be issued.
Permit cancellation
name …………………………………………... signed ……………………………………………………. date ……………………………........
CANCELLATION BY SAFETY OFFICER: This permit to work is now cancelled. A new permit is required for further working at height in this location.
name …………………………………………... signed ……………………………………………………. date ……………………………........
