A free permit for non-routine work at height. It covers the access and protection method, the controls that must be confirmed before work starts, fall-protection details, rescue arrangements and closeout. Print the PDF, amend the wording in Word, or work through the Excel version with dropdowns.
Pick the formats you want: a fillable PDF to print and post, an editable Word document, or an Excel workbook with dropdowns.
The whole permit fits a single readable page so it can be posted at the work location. The guidance sheet carries the standards mapping and the roof rules, and is the only place citations appear.
The whole permit fits a single readable page so it can be posted at the work location. The guidance sheet carries the standards mapping and the roof rules, and is the only place citations appear.
A working at height permit is a formal authorization for non-routine work where a person could fall. It records the access and protection method chosen for the task, the controls that were verified before work started, the rescue arrangements, and who authorized the work and when.
Federal OSHA requires employers to protect employees from applicable fall and falling-object hazards, but it does not prescribe a working at height permit or its format. The permit is an employer control used to select, verify, authorize and record the precautions that apply to a particular job.
One permit per job per shift. Stop and reassess on any material change in conditions.
Ground level or permanent protection first, then a system suited to the actual task and fall hazard.
Every Part C control confirmed as Yes, or marked N/A with initials, before authorizing.
Where restraint or fall arrest is used, complete Parts D and E and confirm prompt rescue capability.
Issuer and person in charge sign, then the permit is posted at the work location.
When all personnel and equipment are down, complete Part G and retain the closed permit.
OSHA mandates the protections, not the permit. The template is an employer control built around the provisions that apply to the work, and every citation lives on the guidance sheet.
OSHA 1910.28 and 1910.29. The duty to protect from falls, including low-slope roofs and falling objects, and the criteria the protection systems have to meet.
OSHA 1910.140. Personal fall-protection systems: anchorage, inspection and the requirement for prompt rescue following a fall.
Federal general industry. Construction work is governed by 29 CFR 1926 instead. Check OSHA State Plan requirements, manufacturer instructions and company rules where they apply.
This template is provided as general guidance. Site-specific procedures and the requirements of the authority having jurisdiction, insurer and other applicable authorities take precedence. Have a competent person review and adapt the template before use. Confirm citations against the standard editions your site holds. This is safety information, not legal advice.
Welding, cutting and grinding outside a designated area, with fire watch and monitoring.
View template PermitThe parent permit that routes a job to its specialist permits, including work at height.
View template ProcedureThe equipment-specific procedure behind the Part C isolation record.
View templateNeed a live view of permits, approvals, isolations and closeout status? Zentri digitizes the full permit lifecycle.