Title Page

  • Site conducted

  • Client / Site

  • Personnel

  • Conducted on

  • Prepared by

Person being Assessed

  • Name:

  • Department:

  • Position:

Details of Machinery or Equipment

  • Description of machinery/equipment

  • Model or Type

  • Major risks

Safety Procedures

  • Have relevant SAFE OPERATING PROCEDURES (SOP) or a SAFE WORK METHOD STATEMENT (SWMS) been issued to the person being assessed?

COMPETENCY ASSESSMENT

  • PRE OPERATION CHECKS: <br>Rate the person's ability to conduct all the required pre-operation safety checks.<br>- Organise a person to assist<br>- Safely transport ladder to location<br>- Set up cones or barricades if busy area<br>- Check feet of ladder <br>- Check rungs/steps are clean

  • OPERATING:<br>Rate the person's ability to operate the equipment/machinery safely with no risk of injury to self or others.<br><br>- Assistant to stand at bottom of ladder and secure with both feet<br>- 3 points of contact rule<br>- Do not use top two rungs<br>- Do not sit on top rung<br>- Descend ladder facing rungs<br>-

  • POST OPERATION CHECKS: <br>Rate the person's ability to conduct all the required post-operation safety checks.<br>- Clean ladder rungs<br>- Check feet<br>- Return ladder safely to designated location

APPROVAL

  • Do you give approval for the person to operate the equipment or machinery with NO direct supervision?

  • Name of Assessor

  • Position:

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.