Exiting and Entering and Elevated Aerial Work Platform
Permit for Exiting/Entering Aerial Work Platform
Project Name:
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Company Name:
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Date:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time issued:
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Hour Minutes
AM
PM
AM/PM Option
Expiry time:
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Hour Minutes
AM
PM
AM/PM Option
AWP Operation: Describe in detail the work to be performed and the location/area involved:
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Why can the work not be done by means other than exiting the AWP? (Scaffolding, alternate access)
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AWP
1. Make, type, model number:
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2. Describe accessories attached to the boom:
Boom length and type:
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3. Weight or capacity of aerial work platform:
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4. Required operating radius:
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5. Required lift height for AWP (specific height):
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6. Pre-use inspection of AWP completed?
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Yes
No
7. AWP operators trained in the use of AWP?
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Yes
No
Fall Protection
1. Are workers wearing approved fall protection equipment that allows for 100% tie-off?
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Yes
No
2. Do workers have fall-protection training?
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Yes
No
Site and Structure Conditions
1. Ground condition (level, dry, wet, undisturbed, etc.):
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2. Wind direction and speed (specific speed and direction):
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3. Weight of materials and/or small tools inside manbasket (specific weight):
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4. Does adjacent structure have an approved tie-off point?
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Submitted by
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Date required:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Project Superintendent
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Project HSE
*
Date Approved:
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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