Suspended Work Platform Permit
Application Form

* Asterisk denotes a required field

Contact Information


Suspended Work Platform Location Information


Description of Type of Suspended Work Platform

Platform Type




Hoist Type





Suspension Type








Suspended Platform Description Details

Rope/Cable Diameter (in inches)





Type of Tiebacks



Other Details

Lifeline/lanyard provided?

Are workers experienced?

Are safe work procedures readily available?

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* Once the permit information is complete, hit SUBMIT and then PRINT this page for your records. The permit number will automatically generate.

Submit Permit Application