EPCM - Working At Heights - Loss Prevention Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Working at Heights - Documentation Compliance

• CPM -Working at Heights Checklist present?

  Yes

  No

  N/A

• JHEA Captures CPM procedural requirements for consideration of potential falls, controls for falls, influence of environmental conditions and assessment of suitable anchor points?

  Yes

  No

  N/A

• Personal Risk Assessment (Good-To-Go) complete and captures working at heights hazards/controls?

  Yes

  No

  N/A

• Rescue Plan in place with Plant/Equipment stipulated in Rescue Plan available?

  Yes

  No

  N/A

Working at Heights - Safety Systems Compliance

• Have personnel working at heights maintained 100% hook-up?

  Yes

  No

  N/A

• Are anchor points used suitably rated or capable of withholding personnel in the event of a fall?

  Yes

  No

  N/A

• Are personnel working at heights wearing the Appropriate PPE? (Harness/ Lanyard/ Chin Strap/ Tool Lanyards)

  Yes

  No

  N/A

• Maintenance inspection schedule adhered to? (Colour coded tags)

  Yes

  No

  N/A

• Sufficient precautions taken to prevent dropped objects? (Edge protection / Mesh)

  Yes

  No

  N/A

• Drop Zones established with danger tape wrapped around hard barricading and warning signs on all sides of drop zone in areas where there is a potential for falling objects?

  Yes

  No

  N/A

• No personnel are within the confines of the Drop Zone?

  Yes

  No

  N/A

• Plant/ Equipment/ Tools/ Workbenches are not situated within the Drop Zone as per CPM Barricading/ Delineation Procedure Section 9.1? (Where Practicable)

  Yes

  No

  N/A

Working at Heights - EWP Compliance

• EWP basket condition

  Safe

  At Risk

  N/A

• Slew area controlled/barricaded?

  Yes

  No

  N/A

• Spotter in place and focused on task?

  Yes

  No

  N/A

• Does the Spotter have positive communication with the EWP operator?

  Yes

  No

  N/A

• Safety critical devices are working and unobstructed? (Audible Alarms / Beacons)

  Yes

  No

  N/A

Working at Heights - Scaffold Compliance

• Scaffold condition

  Safe

  At Risk

  N/A

• Scaffold Tag present/in date?

  Yes

  No

  N/A

• Open penetrations on scaffold deck?

  Yes

  No

  N/A

• Is the scaffold is built to code? (Hand Rails / Kick Boards / Access / Egress)

  Yes

  No

  N/A

• Scaffold Access/Egress suitable for intended works?

  Yes

  No

  N/A

• Appropriate encapsulation around Access/Egress?

  Yes

  No

  N/A

• Comments

• Auditor Name & Signature

  Sign