Fatal Risk Critical Control Verification - Falling from heights

• Prepared by:

• Location:

• Date:

  Date

• Brief Description of Task/Activity

• Document Number:

• Make sure you know which Fatal Risks are present in your work area!

  

• If any fatal risk controls are not effectively implemented or maintained the task/activity should be stopped immediately and the related risks needs to be re assessed by a competent person.

Falling from heights

• These CRITICAL CONTROLS need to be in place when working at height.

  

• Does the activity present falling from height risks.

  Yes

  No

Work Area Setup

• Have you completed a risk assessment prior to starting the working at heights job?

  Yes

  No

  N/A

• Has the Fall from Heights permit been completed, signed off, and implemented correctly for non-routine tasks? Person(s) working at heights shall wear safety helmets (hardhat) that are secured by using a chinstrap.

  Yes

  No

  N/A

• Are all objects, tools and equipment secured with an approved tether device to prevent them from falling?

  Yes

  No

  N/A

• If required, are exclusion zones established (i.e., barricades, barriers, guards) on lower levels to prevent individuals from being struck by a falling object?

  Yes

  No

  N/A

• Is there a physical barrier or barricade with signage in place that will mitigate the risk of falling over an edge or open hole?

  Yes

  No

  N/A

• Is anyone working alone?

  Yes

  No

  N/A

Fall Protection System

• Has the worker been trained and authorized, and understands the components of fall protection?

  Yes

  No

  N/A

• Have the key components been maintained and inspected by the worker prior to use? (i.e., anchor points, harness, lanyard, etc.)

  Yes

  No

  N/A

• Was the clearance fall distance calculated prior to starting work?

  Yes

  No

  N/A

• Is the proper fall protection system being used for the task? (i.e., prevention, restraint, arrest, full body harness, proper length shock-absorbing lanyard, and trauma straps)

  Yes

  No

  N/A

• While using a Fall Restraint System, is the anchor point capable of withstanding the expected force?

  Yes

  No

  N/A

• Are Fall Arrest Systems attached to the harness D-ring in the middle of the back and the tie off able to withstand 22.5kN or 5,000 pounds of force?

  Yes

  No

  N/A

• Where the work method requires persons to detach and re-attach at height, is a dual fall arrest system or dual fall restraint system being used to ensure that at least one connection point is always maintained?

  Yes

  No

  N/A

Work Platform

• Are work platforms tagged correctly, inspected, certified, maintained, and in proper working condition suitable for the task?

  Yes

  No

  N/A

• Is the aerial lift, scissor lift, or other elevated work platform equipped with secured floors, guardrails, and toe-boards to prevent items from falling to lower surfaces?

  Yes

  No

  N/A

• Are workers on the mobile work platform properly protected with a fall prevention or fall arrest system?

  Yes

  No

  N/A

• Are weather and terrain conditions acceptable to keep the working platform stable?

  Yes

  No

  N/A

• Do work platforms look to be free from signs of overloading and in good working order?

  Yes

  No

  N/A

• Has the ladder been inspected prior to use and is it the correct height and material for the job?

  Yes

  No

  N/A

• Is the worker ascending/descending and working from the ladder correctly?

  Yes

  No

  N/A

Emergency Response

• Do employees have means to summon help or self-rescue while using fall protection?

  Yes

  No

  N/A

• Is more than one employee working on the task while using fall protection? Are any employees working alone?

  Yes

  No

  N/A

• Is a fall protection plan and a rescue plan in place and communicated to all affected personnel? Do employees know what to do if a rescue is required?

  Yes

  No

  N/A

Sign off

• Person Conducted Fatal Risk Critical Control Verification.

  Sign