Fall Protection-VDC

• Client / Site

• Conducted on

  Date
• Location
  Address

• Prepared by

• Could the task be changed from fall arrest to a fall restraint situation?

  Safe

  At Risk

  N/A

• Is there a swing fall hazard?

  Safe

  At Risk

  N/A

• Are the tie off points appropriate and approved?

  Yes

  No

  N/A

• Yes

  No

  N/A

Interview

• Does the worker have current fall protection training?

  Yes

  No

  N/A

• Has the fall distance and fall clearance been considered?

  Yes

  No

  N/A

• Has the worker inspected their fall protection equipment?

  Yes

  No

  N/A