Roof Access Permit

The roof access permit will need to be completed before any employee, contractor or site visitor may be allowed access to any roofs on DEXUS properties.

The roof access permits are valid for one day only and must be returned to the person who gave the original authority at the end of each working day or when the need for access has been satisfied.

Risk Management
All boxes to be ticked: / Risk Assessment Form completed (please attach)
Safe Work Method Statement completed (please attach)
This roof access permit is required for access to any property building roofs, for whatever purpose, by the employee, contractor or visitor.
Reason Why Access is required:
Location where work is to be done:
Hazards
Steep pitched roof i.e. >1 in 6 or 15 degrees in slope / Yes / No
If Yes, will suitable safety equipment be used? / Yes / No
Fragile covering / Yes / No
If Yes, will suitable safety equipment be used? / Yes / No
Work near (2 metres) roof edge) / Yes / No
If Yes, will fall arrest equipment be used? / Yes / No
Is equipment lanyard off or otherwise contained to prevent equipment / tools / materials falling from a height? / Yes / No
Has fall arrest or abseil access anchors (if used), been tested and certified in the last 12 months? / Yes / No
Have workers been formally trained in working at heights and use of fall arrest / abseil access? / Yes / No
Will equipment, tools, materials be required in the work area? / Yes / No
If Yes, will provide details in SWMS to control hazard specifically on method of raising to work area? / Yes / No
Will Personal Protection equipment (PPE) be worn? / Yes / No
If Yes, will provide (e.g. non-slip footwear, sunglasses, hat, sunscreen) details within the SWMS / Yes / No
Does all PPE comply with Australian Standards? / Yes / No
Has all PPE, e.g. harness, lanyards, etc, been inspected and is in a safe working condition? / Yes / No
Are there radio frequency equipment hazards to be considered such as mobile phone antenna? / Yes / No
Weather Factors
Strong Wind / Yes / No
If Yes, is it safe to go ahead? / Yes / No
Rain or likelihood of Rain? / Yes / No
If Yes, is it safe to go ahead? / Yes / No
Heat? / Yes / No
If Yes, is it safe to go ahead? / Yes / No
Glare / Yes / No
If Yes, is it safe to go ahead? / Yes / No
Electrical Storms / Yes / No
If Yes, is it safe to go ahead? / Yes / No
The underside of the roof has been inspected for structural soundness (including meshing for sky lights)? / Yes / No
If major repair is to be carried out, will the contractor follow the Code of Practice for safe work on the roof? / Yes / No
I have carefully reviewed the hazards inherent in the intended task and taken into account the factors noted above and I am confident that the task can be carried out in safety.
Signed: / Name
(Contractor / Employee / Visitor)
Declaration
I have satisfied myself that the Contractor / Employee / Visitor has taken into account all safety hazards and any weather conditions that may impact on the safe execution of the work.
Operations or Engineer Manager: / Date:
NOTE: This permit is valid until 5.00pm on the date of issue or completion of the task, whichever is the earlier.