Dropped & Falling Objects Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

The purpose of this form is to provide a safe system of work for the prevention of dropped and falling objects and to ensure that all persons working on Adaptable Training Partnerships worksites are protected form dropped and falling objects. Is a task involves a hazard of potential dropped or falling objects. this form must be completed before commencing this task.

• Date & Time:

  Date
• Location:
  Address

• Can you eliminate the hazard by doing the task at ground level?

  YES

  NO

• If NO, Complete a Risk assessment and a housekeeping check of the area you are working in before you start the task.

What controls are in place to prevent falling objects?

• Tool lanyards

  Yes

  No

  N/A

• Rubber tool grommets

  Yes

  No

  N/A

• Covering gaps in flooring, opening & grid mesh with appropriate material (e.g. safety mats, blankets, boards)

  Yes

  No

  N/A

• Toolboxes / Tool bags with lids / Tool Bags

  Tool Boxes

  Tool Bags with Lids

  ToolBags

• Barrier Safety Mesh on handrails

  Yes

  No

  N/A

• Storage area (suitable bins, buckets, cages etc.)

  Yes

  No

  N/A

• Secure/Tie-down of equipment/objects and tools in windy conditions or inclement weather

  Yes

  No

  N/A

• OTHER; (please specify)

• Hard barricading

  YES

  NO

  N/A

• Danger Tape with Information Tags

  Yes

  No

  N/A

• Exclusive Control Zone

  Yes

  No

  N/A

• "Working Above" signs

  Yes

  No

  N/A

• Spotter/s

  Yes

  No

  N/A

• OTHER (please specify)

• Is your work area "Drop Zone" barricaded - Every 4 meters up in height must be a minimum of 2 meters out from direct vertical drop to allow for deflection?

  Yes

  No

  N/A

• Have you checked and have communication with persons working above, below or in close proximity of each other?

  Yes

  No

  N/A

• NOTE: On completion of the task, conduct a thorough housekeeping and equipment check to ensure no loose items with the potential to fall are left at the work area.

• Work Group Supervisor:
  As workgroup supervisor I have verified that the above controls are in place and are effective in controlling the risk of dropped and falling objects.

• Work Group Supervisor Name and Sign:

  Sign

• Date & Time:

  Date