• Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Personnel interviewed and accompanying auditor


  • Is there a written and approved site procedure for working at height?

  • Has it been communicated to the employees ?

  • Has it been communicated to the contractors?

Risk assessment

  • Has a risk assessment been conducted and signed off before starting work at height?

  • Has a permit to work been completed and approved?

  • Has fall prevention been implemented wherever possible?

Safe system of work

  • Are protective and prevent measures implemented for the task?

  • Are personal protective equipment used and are adequate?

  • Is there adequate equipment for the task ?

  • Are there right tools for the job?

  • Is there proper supervision for the job?

  • Is there safe access and agrees ?

Fall prevention

  • Is there a safe working platform such as scaffold or Mobile access tower?

  • Is there a safe working platform such as scissor lifts or telescopic man-lifts?

  • Is there travel restrictions system such as lanyard with a fixed length to prevent workers from reaching the danger zone ?<br>

  • Is there permanent installation working platform for the frequent routine working at height activities?

Fall protection

  • Are appropriate fall protect (full body harness)with shock absorbing lanyard used?

  • Is there a system for ensuring that fall protection equipment tested and certified for use and inspected by the user before use and being destroyed following a fall or where inspection has shown evidence of excessive wear or mechanical malfunction?

  • Is there a register of all fall protection equipment?

  • Is the anchorage point used capable with standing the considerable forces generated if a fall did occur?

  • Is there a system to ensure anchorage points are tested and approved by a competent person to ensure that they are secured and can take required load?

  • Is there a system for preparing and testing emergency rescue procedures for fall victims?

Falling objects

  • Is there barricade for overhead work being conducted?

  • Are scaffolds and work platforms maintained tidy and orderly at all time?

  • Do all items on the scaffold or work platform secured when not in use and untended to prevent them falling

Scaffold and work platforms

  • Are scaffolds planned, erected, dismantled or altered by capable trained personnel under appropriate capable supervision?

  • Are scaffolds and working platforms constructed so that they are?<br>A) level, straight, and erected on a firm stable solid foundation with supporting metal base plates and timber sole plates, loose bricks or similar objects must never be used to support a scaffold <br>B) of sufficient strength and rigidity and are suitable for the purpose for which they are intended<br>C) Secured, stable and properly braced and tied (secured to another structure)<br>D) Assembled so that all components are securely fastened and cannot be accidentally displaced

  • Are tools, objects or materials not thrown from scaffold or work platforms to the ground?

  • Is the working platform fully and completely assembled with all decking, toe boards, guardrails and mid rails in place?

  • Is ladder used to access or egress mobile scaffold towers instead of climbing the scaffold members as means of access or egress?

  • Is mobile tower or scaffold structure being used even if some of the component parts are missing, broken or incompatible or it doesn’t display current inspection tag?

  • Are Mobile tower never moved when people are still on the working platform?when in use all brakes are securely applied?

  • Are all towers inspected by a capable person after assembly and prior to any use and an inspection tag displayed?

Mobile elevated platforms

  • Are employees working on mobile platforms wearing fall protection?

  • All MWEPs are well maintained, serviced and regularly inspected and evidence of regular maintenance, servicing and inspection available?

  • Are MWEPs never used as a lifting machine or any similar activity?

  • Do all work activities involving MWEPs have an appropriate risk assessment?

  • Are only trained and certified people operate and work from MWEPs?

  • Are daily pre used checks and inspection recorded on the inspection card for that piece of equipment?

  • Are hardhats, safety boots, suitable eye protection and gloves as well as full body harness with a fall arrest or restraint lanyard worn every person working from an elevated working platform?


  • Is there a system in place for registration, marking, inspecting and maintenance of all ladders and step ladders?

  • Are homemade or temporary ladders used on site

  • Are ladders or step ladders used for routine tasks with low risk and of short duration

  • Are barricades and signs used to prevent pedestrians and vehicles from inadvertently colliding with the ladder ?

  • Are users inspect the ladder or step ladders prior to any use, for any visible defects?

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.