Fall Protection Checklist

• Audit Title

• Squadron

• Conducted on

  Date

• Inspector

• Location
  Address

• Supervisor

13.1.1 Fall Protection Checklist

• Are workers provided fall protection when exposed to falls of four (4) feet or more? AFI 91-203 para. 13.2.2

  Yes

  No

  N/A

• Are active and passive means of fall protection considered before using procedural controls? AFI 91-203 para. 13.3.1.3

  Yes

  No

  N/A

• Has a JSA been performed and coordinated with the installation safety office prior to the use of procedural controls for protecting workers from falls? AFI 91-203 para. 13.3.1.3

  Yes

  No

  N/A

• Are all PFAS components marked to indicate compliance with ANSI Z359.1.? AFI 91-203 para.13.4.6.2

  Yes

  No

  N/A

• Are wire rope, rope covered wire lanyards, plastics (such as nylon) and wet lanyards prohibited where an electrical hazard may be present? AFI 91-203 para. 13.4.6.5

  Yes

  No

  N/A

• Can anchorage connectors withstand a 5000 pound load for each PFAS connected? AFI 91-203 para. 13.4.6.7

  Yes

  No

  N/A

• Do workers inspect their PFAS prior to each use for mildew, wear, damage and other deterioration? AFI 91-203 para. 13.4.6.10.2

  Yes

  No

  N/A

• Does the supervisor ensure all PFAS components receive a thorough inspection at least quarterly and keep the record of inspection for at least one year? AFI 91-203 para. 13.4.6.10.3

  Yes

  No

  N/A

• Are PFAS components subjected to impact loading immediately removed from service and not be used again until inspected and determined by a competent person to be undamaged and suitable for reuse? AFI 91-203 para. 13.4.6.11.8

  Yes

  No

  N/A

• Are workers/competent persons trained and evaluated on the fall protection/fall arrest system prior to use? AFI 91-203 para. 13.6

  Yes

  No

  N/A

• Is recurring fall protection training conducted annually, when work conditions change or when new fall protection/fall arrest systems are procured? AFI 91-203 para. 13.6

  Yes

  No

  N/A

• Is a rescue plan included in each fall protection plan to assure prompt rescue of fallen workers? AFI 91-203 para. 13.7

  Yes

  No

  N/A

• Report Routing

• Supervisor Signature:

  Sign

• Notification

  N/A

  Action

  Info

• Superintendent Signature:

  Sign

• Notification

  N/A

  Action

  Info

• Commander Signature:

  Sign

• Notification

  N/A

  Action

  Info

• Safety Office Signature:

  Sign

• Notification

  N/A

  Action

  Info

• Wing Commander Signature:

  Sign

• Notification

  N/A

  Action

  Info