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Acknowledgement Required for Working at Heights Permit

I confirm that this request to obtain an Working at Heights Permit complies with Relevant Legislation and Curtin University Policies.

I have inspected the workplace, have determined and put into place appropriate control measures to minimise health, safety and operational risks, and I agree to accept full responsibility for these risks.

I have read and understood the following:
Apply for Working at Heights Permit guide
Contactor Safety Handbook (pdf)
Curtin's Risk Management Information

Working at Heights / Roof Access Permit - I have read and understood the following:
Safe Work Australia - Managing the Risk of Falls at Workplaces (pdf)

I accept and acknowledge all of the above.

Documents Required

Permit requests may require the following documents:

Only standard document types accepted. Please name files appropriately.
NOTE - Combined document filesize limit is only 15MB.

Attach a Work Methodology

Attach a Risk Management Plan

Attach a Location Plan

Working at Heights Registration details

Project Details The Curtin project number or project name

Location and Reason for Working at Heights:
(inc. building number, room number and/or other specific access details)

Project Duration Start date

End date

Your Details Your Company's Name

Your Name

Your email address. We send important administration notices to this address

Your Contact Number

Curtin Permit Manager Details

Please Note

This is the person who will be responsible for the approval of this permit.
Please make contact with your Curtin Permit Manager about this application prior to submitting.

Your Curtin Permit Manager name

The information gathered from this form will be sent to this Curtin email address

Your Curtin Permit Manager phone number

Site Contact Details The Site Contact name

The Site Contact job title

On-Site Contact Number

APPLY FOR WORKING AT HEIGHTS PERMIT

I confirm that all of the supporting documentation and information contained in this access permit request is complete and accurate.

ONLINE PERMITS

Acknowledgement Required for Working at Heights Permit

Permit requests may require the following documents:

Please Note

APPLY FOR WORKING AT HEIGHTS PERMIT