GC Fitout - Roof Work - Permit Requested

Project Name*

Select the Company You Work For

Supervisor Name*

Email for person requesting Permit*

On-site Emergency Contact Number

Description of Activities on the Roof*

Number of employees going onto roof?*

Is there a danger of objects or materials falling from or being blown from the roof?*

Is an exclusion zone required at ground level to protect others from the overhead works?*

Is protection required for the roof membrane to prevent it from being damaged?*

Other Precautions to be taken: Specify below any additional precautions or emergency arrangements to be taken, and limitations on work, work equipment, work materials, etc.*

Start date of Permit

All Operatives Involved in the Roof Works?*

(ALL OPERATIVES MUST ENTER NAME HERE)

Verification

Permit Requested By

Site Manager Signature

Hidden

Date of cancellation or closing of the permit*

Hidden

Contractor Sign Off

Hidden

Site Manager Sign Off