Title Page
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Site conducted
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Client / Site
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Personnel
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Conducted on
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Prepared by
Person being Assessed
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Name:
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Department:
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Position:
Details of Machinery or Equipment
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Description of machinery/equipment
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Model or Type
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Major risks
Safety Procedures
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Have relevant SAFE OPERATING PROCEDURES (SOP) or a SAFE WORK METHOD STATEMENT (SWMS) been issued to the person being assessed?
COMPETENCY ASSESSMENT
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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
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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>-
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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
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Do you give approval for the person to operate the equipment or machinery with NO direct supervision?
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Name of Assessor
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Position: