Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
Equipment being used
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What type equipment will be used?
- Step Ladder
- Extension Ladder
- Scaffolding
- Aerial work platform
- Unguarded building edge
- man basket on fork lift
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Are the steps in good condition?
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Is the spreader arms in good condition?
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Are the side rails in good condition?
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Are the feet in good condition?
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Photo of ladder / area
Ladder / work area photo
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Photo
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Are the steps in good condition?
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Are the side rails in good condition?
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Are the flip latches in good condition?
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Are the feet in good condition?
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Ladder / work area photos
Photo of ladder / work area
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Photo
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Are the end units in good condition?
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Are the stacked end units secured properly ?
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Are the cross braces in good condition?
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Are the cross braces secured?
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Do the wheels and brakes operate properly?
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Is the scaffold level and sturdy?
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Has a tag been attached to the scaffolding?
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Scaffold photos
Photo of scaffold
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Photo
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Are all the guards in place?
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Are there any oil leaks ?
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Are there any cracks in the welds or steel?
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Are the wheels in good shape?
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Are the fluid and fuel levels adequate?
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Does the main ground controls work properly?
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Is the operators manual on the machine?
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Does the man basket controls work properly?
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Does the deadman switch work?
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Do the brakes work?
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Do the warning lights, warning audio device and horn work properly?
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Date of last Maintanance performed
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Photos of equipment
Equipment photo
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Photo
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Has the prime contractor been notified of the lack of guard rails? If so who?
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Do our crew remove the rails?
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Is the area clean and free from slips, trips and falls?
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Is there engineered tie off and / or anchors?
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Photo of work area
Work area photo
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Photo
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Does it have a engineers stamp / seal posted on it?
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Is there engineered tie of points?
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Is it fastened to the machine securely?
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Is there evidence of a daily safety check has been performed?
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Are the proper guards in place?
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Does the man basket prevent a worker from placing a body part in the moving parts of the lift equipment?
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Photos of man basket and fork lift
Man basket / fork lift photos
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Photo of man basket / fork lift
Fall Hazards
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Identify all existing and potential fall hazards associated with work site
Fall Protection systems to be used
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Identify the fall protection systems to be used at the work site to protect the workers from fall hazards ( ie, travel restraint, fall arrest, safety net, control zone, etc.)
Anchors to be used during the work
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Identify the anchors, both engineered and improvised that workers are to use
Clearance distances to be confirmed
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Clearance distances must be sufficient to prevent worker from striking the ground ,and objects, or level below the area
Procedures
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Identify the procedures to assemble, inspect, use, maintain and dismantle the fall protection systems identified above
Rescue plan
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Describe the procedures that will be followed if a worker falls and needs to be rescued
Worker sign off
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Worker acknowledgement of fall arrest plan and fall arrest equipment inspection.
Worker
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No physical damage to harness webbing? (cuts, burns, frying, chemical)
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Stitching in good condition?
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Buckles in Good condition and operating properly?
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Chest strap in good condition?
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Carabiner in good condition and operating properly?
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Lanyard, no damage to (cuts, fraying, burns, chemicals, non factory markings)
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Lanyard shock absorber in place and not damaged?
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Harness and lanyard stored properly when not in use?
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Photo of harness and lanyard
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Signature worker using the harness and lanyard.
