Fatal Risk - Fall From Heights

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Is a contractor being audited?

  YES

  NO

• Which contractor company?

  Select

• Foundational aspects applicable to all Fatal Risks that address: housekeeping, workplace exams, FLRA, training confirmation, and emergency protocols.

• Is the work area housekeeping in good order? (i.e., clear walkways and organized tools/materials)

  YES

  NO

• Has a workplace exam been conducted?

  Yes

  No

  N/A

• Have all hazards been identified, corrected, or communicated?

  YES

  NO

• Has the employee conducted a Field Level Risk Assessment (FLRA) or Team Risk Assessment (TRA)?

  YES

  NO

• Has the employee received training? (i.e., task training, procedure or guidelines)

  YES

  NO

• Can the employee explain the proper emergency shut down, summoning for help and evacuation procedures? 

  YES

  NO

• Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.
  
  Instructions: For each critical control, select Controlled, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

Work Area Setup

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

  Controlled

  At Risk

  N/A

• Has the Fall from Heights permit been completed, signed off, and implemented correctly for non-routine tasks?

  Controlled

  At Risk

  N/A

• Are person(s) working at heights wearing safety helmets (hardhat) that are secured by using a chinstrap?

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  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?

  Controlled

  At Risk

  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?

  Controlled

  At Risk

  N/A

• Is anyone working alone?

  Controlled

  At Risk

  N/A

Fall Protection System

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

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  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)

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  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?

  Controlled

  At Risk

  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?

  Controlled

  At Risk

  N/A

Work Platform

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

  Controlled

  At Risk

  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?

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  N/A

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

  Controlled

  At Risk

  N/A

Emergency Response

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

  Controlled

  At Risk

  N/A

• Is more than one employee working on the task while using fall protection?

  Controlled

  At Risk

  N/A

• Are any employees working alone?

  Controlled

  At Risk

  N/A

• Is a fall protection plan and a rescue plan in place and communicated to all affected personnel?

  Controlled

  At Risk

  N/A

• Do employees know what to do if a rescue is required?

  Controlled

  At Risk

  N/A

• CONTROLLED The presence of this control is verified and effective

• ATRISK This control is missing or ineffective

• NA / NO Not Applicable to this exposure situation or Not Observed