Kallam Darby

Fall protection assessment

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Use this Template

Title Page

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

X=Non applicable
0=Non compliance
1=Insufficient
2=Acceptable
3Excellent
Guardrail is sound (will withstand 200 lbs. in any direction at top-rail).
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Too-rail will deflect downward to no less than 39" high.
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No materials stacked higher than toe-boards.
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Cable top-rails flagged (bright material-spacing 6' or less).
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Cable too-rails are properly secured by cable clamps/clips.
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Workers demonstrate understanding of the 100% tie-off procedure.
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Workers are using fall arrest system correctly.
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Fall arrest equipment is in good condition.
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Kallam Darby

Fall protection assessment

Use this Template

Print as PDF

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