CCMP Field Observation - Working at heights

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Audit details

• Name of auditors:

• Date / Time:

  Date

• Task being undertaken (description and title):

• Activity (Planned or Unplanned)

  Planned activity

  Unplanned activity

• Name of company:

• Task Supervisor details:

• Person being audited

• Are they working at heights?

  Yes

  No

• Are they HVO Work at Heights trained?

  Yes

  No

• Date of last training?

• Sight evidence of work at heights tickets

• How often do you do this task?

• Are you familiar with this task / equipment?

• Are you authorised for this piece of equipment (if applicable)

  Yes

  No

• Sight evidence of authorisation for that piece of equipment

  Media

Pre-start inspections

• Can you show me your pre-start inspection?

  Yes

  No

• Did you identify anything wrong in your pre-start inspection?

  Yes

  No

• How would you know if something was not fit for purpose?

• What did (or would you do) if it was not fit for purpose?

• Pick one element of the pre start / pre use inspection and ask the person to demonstrate how they would check it

  Yes

  No

• Compare todays pre start against previous pre starts. Were there any issues identified on previous pre-starts that are not on the current pre start. If yes, has it been repaired and if neccessary re-inspected?

  Yes

  No

• What equipment is being used?

• Type of test tag is present

  Select Coloured band Date tag Scaffold tag Service label Other Non-compliant

  • Coloured band
  • Date tag
  • Scaffold tag
  • Service label
  • Other
  • Non-compliant

• Colour of test tag?

• Date of test tag?

  Date

• Check equipment is in date

  Yes

  No

• What inspection process was used and by whom?

• Is all equipment being used fit for use?

  Yes

  No

• If applicable service label / test tag is appropriately signed / certified (e.g. a scaffold tag must be signed by a certified scafffolder) Record the name and check competent and authorised to sign off?

• If applicable, where and how would a person wearing a harness fall?

  Yes

  No

  N/A

• If applicable, are any in use working at height designated attachment points (painted pink and labelled) included on the approved attachment register?

  Yes

  No

  N/A

• If applicable, is working at heights equipment included on the register?

  Yes

  No

  N/A

• If applicable, are all ladders in use labelled, identifiable and included on a service and inspection register?

  Yes

  No

  N/A

• If applicable, confirm workers task is not exceeding equipment weight requirements (e.g. weight specified by scaffold tag, EWP etc.?

  Yes

  No

  N/A

Working at heights permits

• Record permit number

• Record permit date

  Date

• Permit signed by whom?

• All sections completed as required?

  Yes

  No

• Detailed emergency rescue plan for fall victims correctly accounts for the likely situation in the event of an emergency?

  Yes

  No

• Is permit sign off competent in working at heights / understand the risks?

  Yes

  No

• Are all persons locked on as required (if applicable)?

  Yes

  No