Title Page

  • Site name

  • Installation unit number

  • Conducted on

  • Prepared by

  • Location

Safe Places of Work

  • Adequate fall protections are in place (fall arrest systems, guiderails, barriers, etc.)

  • Holes and openings along hoistway, landing entrances, and machine rooms are sufficiently secured

  • Workplace is free from slip, trip, and fall hazards e.g trailing cables, spillages, waste, etc.

  • Storage areas are tidy, materials are safely stacked and correctly stored.

  • Is there sufficient lighting in the hoist way.

Scaffold

  • Scaffold erected, altered, or dismantled by a competent person

  • Working platform is secured from slip trip or fall hazard

  • Scaffold inspection is current, signed and with an attached Scaff tag

  • Scaffold is secured adequately secured to building or structure

  • Scaffold is safely protected from trespassers and unauthorised use (warning signs and secured full gate)

False Car/Running Platform

  • False car is installed according to Specification include as stated in method statement and the Field Installation Manual (FIM) with safety function tests carried out, recorded and signed on the daily register before putting in operation.

  • Guardrails, intermediate rails, toe board and safe load sign are appropriately installed and the platform is secured and free from any slips trips and hazards.

Pit Area

  • Is the pit area adequately lit?

  • Pit ladders are safe, without defects and suitable to access and egress pit

  • Pit is free from oil, material obstructions and water?

  • Appropriate fall protection available when accessing or egressing the pit<br>

Ladders

  • Ladders are safely and correctly restrained and secured.

Top of Car

  • Top of car is clean, tidy and free of any slip and trip hazards.

  • Operatives adhere to appropriate required procedures when accessing, egressing and working on the top of car. (If operatives are on site)

Manual Handling

  • Mechanical lift equipment is available on worksite

  • Operatives can demonstrate safe manual handling lifting techniques

Hot Works

  • Fire extinguishers are available where hot works are carried out

  • Operatives have been informed and understood the site fire emergency procedures

Electrical Equipment

  • Electrical equipment is 110v

  • GFCI are not bypassed

  • Equipment is safe and maintained in safe condition

  • Cables are protected from damages and are double insulated

In Process Checks (IPC’s)

  • Has an IPC been completed depending on what stage of the installation you are at? <br>

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.