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* Asterisk denotes a required field
Name of Employer: *
First Name of Contact: *
Last Name of Contact: *
Street Address: *
City / Town: *
Province: * Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code: *
Phone Number e.g. (xxx) xxx-xxxx *
Fax Number e.g. (xxx) xxx-xxxx *
Site Owner Name: *
Site Supervisor Name: *
Does work Platform have a mechanical lift/lower? * YesNo
Does the personnel cage/basket have approval by a professional engineer?* YesNo
Maximum Height of Work: * Select unit... ft m
Rated capacity of platform: Select unit... lb kg
Lifeline/lanyard provided? YesNo
Are workers experienced? YesNo
Are safe work procedures readily available? YesNo
* 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