• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • 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:

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

  • 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

  • Rubber tool grommets

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

  • Toolboxes / Tool bags with lids / Tool Bags

  • Barrier Safety Mesh on handrails

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

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

  • OTHER; (please specify)

  • Hard barricading

  • Danger Tape with Information Tags

  • Exclusive Control Zone

  • "Working Above" signs

  • Spotter/s

  • 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?

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

  • 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:

  • Date & Time:

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.