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    Height Pass Format

    Uploaded by

    amit kumar
    This document is a screening form for issuing a height pass to a subcontractor worker. It collects personal information like name, address, age, sex, height, weight. It also requests work experience details including current job, duration at previous employers working at height. The applicant declares the information is true and correct and agrees to safety protocols like wearing harnesses and life lines above 2 meters. Supervisors then certify the applicant is suitable for a height pass.

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    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd

    Height Pass Format

    Uploaded by

    amit kumar
    642 views1 page
    This document is a screening form for issuing a height pass to a subcontractor worker. It collects personal information like name, address, age, sex, height, weight. It also requests work experience details including current job, duration at previous employers working at height. The applicant declares the information is true and correct and agrees to safety protocols like wearing harnesses and life lines above 2 meters. Supervisors then certify the applicant is suitable for a height pass.

    Original Title

    Height Pass Format(1)

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    This document is a screening form for issuing a height pass to a subcontractor worker. It collects personal information like name, address, age, sex, height, weight. It also requests work experience details including current job, duration at previous employers working at height. The applicant declares the information is true and correct and agrees to safety protocols like wearing harnesses and life lines above 2 meters. Supervisors then certify the applicant is suitable for a height pass.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    642 views1 page

    Height Pass Format

    Uploaded by

    amit kumar
    This document is a screening form for issuing a height pass to a subcontractor worker. It collects personal information like name, address, age, sex, height, weight. It also requests work experience details including current job, duration at previous employers working at height. The applicant declares the information is true and correct and agrees to safety protocols like wearing harnesses and life lines above 2 meters. Supervisors then certify the applicant is suitable for a height pass.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 1

    PHOTO

    SCREENING FOR HEIGHT PASS

    Name of the Subcontractor:


    1) Applicants Name :
    2) Residential Address :

    3) Age :
    4) Sex :
    5) Height : Weight:
    6) Gate Pass No :
    Name of the sub-agency with whom
    7) :
    engaged at present

    8) Description of present job :

    9) Previous experience of working at height in years

    Sl No Name of Employer Duration of employment Work Experience


    1
    2

    DECLARATION:

    I hereby declare that the above information furnished by me is true & correct. I shall always wear the full body safety harness and
    tie the life - line whenever working at unguarded heights of 2mtrs and above. I shall not misuse the height pass issued to me or
    transfer it to any other person. I shall never come to duty or work at height / depth under the influence of alcohol / drugs

    Date: Name:
    Sign:

    (Applicants name & Signature or LTI incase he cannot sign. In case LTI; an authorised person shall explain each point / item
    to the individual and certify on behalf below the LTI

    I certify that I am satisfied with the above certification of the individual for the application of height pass & request for issue of
    height pass to him.

    Name: Sign
    Safety Officer : -
    Engineer : -
    Project Manager : -

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