Work at Heights Permit - Permit Management New South Wales

About this form
It is prohibited to do any building or maintenance work in PMNSW building elements containing ACM or where it is presumed to be present, without formal written approval by PMNSW Authorised Representative.

Applications to be submitted a minimum of 7 working days excluding weekends and public holidays prior to the proposed work date. All documentation must be submitted with this application or the application may not be assessed.
Approval requires the following criteria to be met and information provided to the PMNSW Representative along with a Safe Work Method Statement prior to work commencement.
The permit is only valid for the time specified on the permit.
A copy of this permit must be carried and produced upon request.

How to complete this form

Ensure that all fields have been filled out correctly.
Please note that all fields on this form are mandatory and must be completed before submitting the application.
Once completed this form is to be submitted online.
Documents must use .pdf format and have a filename that does not exceed 255 characters.

Please nominate which category your permit application relates to from the selection below:

Projects

Facilities Management

Events/Activations/Installations

Private Applications

Tenant

Location

Darling Harbour

Rocks Precinct

White Bay

Section B

Location*

Street Number*

Between Streets*

and

Suburb*

Section C - Lodgement Details

Please note: Incomplete forms will not be processed until all information has been provided.

Description of work*

Reason why access is required*

APPLICATIONS WILL BE PROCESSED WITHIN SEVEN (7) WORKING DAYS OF RECEIPT

Permit start: *


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End: *


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Safety Checklist-Contractor to complete
Ladders
Rails, rungs, steps, ropes, stays, braces, hinges and feet all checked and OK	No Yes N/A
Roofs
Crawling boards in place	No Yes N/A
Safety harness used	No Yes N/A
Perimeter protection in place	No Yes N/A
Scaffolding
Designed constructed and examined in accordance with statutory regulations	No Yes N/A
Copy of examination report held	No Yes N/A
Fall restraint/arrest
Used above 3 metres	No Yes N/A
Inspected and checked prior to use	No Yes N/A
Secured to correct anchor points	No Yes N/A
Persons trained in use	No Yes N/A
Elevated work platform
Positioned in a safe stable manner	No Yes N/A
Persons operating equipment have necessary tickets or permits	No Yes N/A
Ensure work is carried out in such a manner that it would not endanger people or cause damage to the equipment/building	No Yes N/A
Are cordoned off with warning signs/ribbon/tape	No Yes N/A
Maintain good housekeeping at all times	No Yes N/A
Debris generated disposed off from site immediately	No Yes N/A

Fees

For works contracted by PMNSW or CBRE fees may be waived, please complete this section as required and fees will be assessed pre approval.

Application fee

$133.00

These fees are exempt from GST as Division 81 Fees & Charges.

SECTION D - DOCUMENTS

RISK ASSESSMENT DOCUMENT

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*Only Accept Adobe Acrobat Document (.pdf)

SAFE WORKING METHOD STATEMENT - This should outline exactly how the works will be carried out, identify all potential risks and what controls will be implemented and demonstrate how people will be protected from these risks, including falling debris/equipment, falls from a height, security of the site, trip hazards, traffic risks"

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*Only Accept Adobe Acrobat Document (.pdf)

INSURANCES - Insurances must be included with the application with the following;
1.Minimum $20 million public liability insurance
2.Expiry date
3.Permit Management New South Wales MUST be noted on the policy cover sheet as an "Interested" party

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*Only Accept Adobe Acrobat Document (.pdf)

Acknowledgement of Application

DECLARATION*

I declare that all information and plans that have been submitted are correct and that I will comply with all conditions of the approval.

I declare that the person/s undertaking the work at heights entry / work are authorised and competent to perform those tasks and will implement all planned and necessary controls to ensure safe entry / work.

I declare that the procedures, control measures and precautions appropriate for the safe execution of Work at Heights have been implemented and the person/s required to work have been advised of and understand the requirements of the Safe Working Method Statement/Risk Assessment.

I declare that the worksite will be inspected at the cancellation/completion of the Work at Heights and declared safe for normal operations to resume.

I declare that the following document: Code of Practice - Safe Work on Roofs and Code of Practice - Managing the Risk of Falls at Workplaces have been downloaded and read completely. has been downloaded and read completely.

I declare I have assessed, downloaded and will abide by all the rules, regulations & standards as included in this HSE Induction Document.

Work at Heights Permit
Registration Form

Section A - Application Details

Section B

Section C - Lodgement Details

SECTION D - DOCUMENTS

Acknowledgement of Application

Work at Heights PermitRegistration Form

Section A - Application Details

Section B

Section C - Lodgement Details

SECTION D - DOCUMENTS

Acknowledgement of Application

Work at Heights Permit
Registration Form