Climbers Audit v2015-11

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Emergency Response Requirements

• Medivac Information (On Person)?

  Yes

  No

  N/A

• Area Map (On Person)

  Yes

  No

• Danger Tree Record

  Yes

  No

• Employee Comprehension of above?

  Safe

  At Risk

  N/A

Personal Protective Equipment (PPE)

• Hardhat in good condition (less than 5 years from date of issues, suspension in good conditions)

  Yes

  No

  N/A

• Chinstrap

  Yes

  No

  N/A

• Ear Muffs

  Good Condition

  Fair Condition

  Poor Condition

• Ear Piece

  Yes

  No

  N/A

• Visor

  Good Condition

  Fair Condition

  Poor Condition

• Safety Glasses

  Good Condition

  Fair Condition

  Poor Condition

• Boots

  Good Condition

  Fair Condition

  Poor Condition

• Caulks

  Good Condition

  Fair Condition

  Poor Condition

• Hi Viz

  Good Condition

  Fair Condition

  Poor Condition

• Rain Gear

  Good Condition

  Fair Condition

  Poor Condition

• Saw Pants

  Good Condition

  Fair Condition

  Poor Condition

• Pressure Bandage

  Yes

  No

• Time Piece

  Yes

  No

• Whistle

  Yes

  No

• Personal First Aid Kit

  Yes

  No

• Pocket Mask

  Yes

  No

• Fire Stop

  Yes

  No

• Danger Tree Ribbon

  Yes

  No

• Radio

  Yes

  No

  N/A

• Mic

  Good Condition

  Fair Condition

  Poor Condition

• Fuel Bottles

  Yes

  No

Saw 1

• Filing

  Good Condition

  Fair Condition

  Poor Condition

• Chain Tension

  Good Condition

  Fair Condition

  Poor Condition

• Chain Brake

  Good Condition

  Fair Condition

  Poor Condition

• Palm Lock

  Good Condition

  Fair Condition

  Poor Condition

• Filter

  Good Condition

  Fair Condition

  Poor Condition

Saw 2

• Filing

  Good Condition

  Fair Condition

  Poor Condition

• Chain Tension

  Good Condition

  Fair Condition

  Poor Condition

• Chain Brake

  Good Condition

  Fair Condition

  Poor Condition

• Palm Lock

  Good Condition

  Fair Condition

  Poor Condition

• Filter

  Good Condition

  Fair Condition

  Poor Condition

GEAR

Harness

• D-Ring

  Good Condition

  Fair Condition

  Poor Condition

• Bridge

  Good Condition

  Fair Condition

  Poor Condition

• Webbing

  Good Condition

  Fair Condition

  Poor Condition

• Stiching

  Good Condition

  Fair Condition

  Poor Condition

Flipline #1

• Length

• Gate

  Good Condition

  Fair Condition

  Poor Condition

• General Condition

  Good Condition

  Fair Condition

  Poor Condition

• MacroGrab

  Good Condition

  Fair Condition

  Poor Condition

• Carabiner

  Yes

  No

  N/A

Flipline #2

• Length

• Gate

  Good Condition

  Fair Condition

  Poor Condition

• General Condition

  Good Condition

  Fair Condition

  Poor Condition

• Macrograb

  Good Condition

  Fair Condition

  Poor Condition

• Carabiner

  Good Condition

  Fair Condition

  Poor Condition

Rope

• General Condition

  Good Condition

  Fair Condition

  Poor Condition

• MacroGrab

  Good Condition

  Fair Condition

  Poor Condition

• StopKnot

  Yes

  No

• Bag

  Good Condition

  Fair Condition

  Poor Condition

• Carabiner

  Good Condition

  Fair Condition

  Poor Condition

Split Tail

• Split Tail

  Good Condition

  Fair Condition

  Poor Condition

• Carabiner

  Good Condition

  Fair Condition

  Poor Condition

• Pulley

  Good Condition

  Fair Condition

  Poor Condition

Claw

• Claw

  Good Condition

  Fair Condition

  Poor Condition

• Claw Line

  Good Condition

  Fair Condition

  Poor Condition

• Ascender

  Good Condition

  Fair Condition

  Poor Condition

• Carabiner

  Good Condition

  Fair Condition

  Poor Condition

• Tear Away

  Good Condition

  Fair Condition

  Poor Condition

• Paint

  Good Condition

  Fair Condition

  Poor Condition

Spurs

• Spurs

  Good Condition

  Fair Condition

  Poor Condition

• Yes

  No

  N/A

• Filing

  Good Condition

  Fair Condition

  Poor Condition

• Axe(s)

  Good Condition

  Fair Condition

  Poor Condition

• Straps

  Good Condition

  Fair Condition

  Poor Condition

• Rings

  Good Condition

  Fair Condition

  Poor Condition

Other Gear

• Wedge(s)

  Good Condition

  Fair Condition

  Poor Condition

• Drop Tape

  Good Condition

  Fair Condition

  Poor Condition

• Accessory Carabiners

  Good Condition

  Fair Condition

  Poor Condition

• Approved Location of Carabiners

  Yes

  No

Field Kit

• Field Kit

  Yes

  No

• Chain

  Yes

  No

• Tools

  Yes

  No

• Pull Cord

  Yes

  No

• Torques

  Yes

  No

• Tape

  Yes

  No

• Knife

  Yes

  No

Chest Pack

• Chest Pack

  Good Condition

  Fair Condition

  Poor Condition

• Baggie

  Yes

  No

• Yes

  No

  N/A

• 2 Pencils

  Yes

  No

• 2 Markers

  Yes

  No

• Data Book

  Yes

  No

Safety Requirements

• AFO H&S

  Yes

  No

• Signed DWP

  Yes

  No

• Safe Working Distance

  Yes

  No

• Signed Pre-Work

  Yes

  No

• BC Safety Accord

  Yes

  No

• Known Heli Evacuation location(s)

  Yes

  No

• Man Checks

  Yes

  No

• Known location of First Aid Equipment

  Yes

  No

• Known location of First Aid Attendance

  Yes

  No

• Known location of Aerial Rescue Kit

  Yes

  No

• Know location of Fire Tools

  Yes

  No

• Known location of Aerial Rescue Personal

  Yes

  No

• Know location of Spill Kit

  Yes

  No

• Knowledge of Emergency Chain of Command

  Yes

  No

• Knowledge of Danger Tree Record

  Yes

  No

• Knowledge of Upset Conditiosn

  Yes

  No

• Bolts

  Good Condition

  Fair Condition

  Poor Condition

• Adequate use of Signage

  Yes

  No

• Gear Check

  Yes

  No

Employee

• Knowledge of Emergency Response Procedures

  Yes

  No

• Professional Attitude

  Yes

  No

• Prepared for Task

  Yes

  No

• Working well with other crews

  Yes

  No

Signatures

• Employee Signature

  Sign

• Select date

  Date

• Auditor Signature

  Sign

• Select date

  Date