Form 27 Risk Based Audit Checklist for Working at Height Checklist - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date
• Add location
  Address

• 

General

• Are hazards associated with working at height are specified in the Permit To Work (PTW) and Job Hazard Analysis (JHA)/Job Safety Analysis (JSA) / Hazard Identification, Risk Assessment & Risk Control (HIRARC) / Method Statement?

  Yes

  No

  N/A

• Are tools and equipment safely stored and secured to prevent fall from height or trip hazard?

  Yes

  No

  N/A

• Has working at height equipment (e.g. ladder, mobile scaffold) been inspected before use?

  Yes

  No

  N/A

• Is the ground area properly barricaded and warning signs displayed to protect personnel from falling objects

  Yes

  No

  N/A

• Has the work area been surveyed for harzard (eg: overhead power line, unsuitable ground condition moving machinery parts)

  Yes

  No

  N/A

• Does personnel use 100% tie-off (i.e. Y-lanyard or double lanyard) with full body harness when working at height with risk of fall e.g. working edge of platform, during installation/dismantling of scaffolding?

  Yes

  No

  N/A

• During working at height, there is competent person who can suspend work if the condition change (eg: weather, traffic, scope of work)

  Yes

  No

  N/A

• Have all workers who work at height have been trained by a competent person or closely supervised by someone who competent

  Yes

  No

  N/A

Body Harness and Lanyards

• Is ladder comply with approved standard as per FMA (eg : secured and properly supported)?

  Yes

  No

  N/A

• Does worker practice 3-point contacts while ascending/descending ladder?

  Yes

  No

  N/A

• Is ladder rested on level and stable ground?

  Yes

  No

  N/A

• Is ladder free from signs of corrosion, cracks, defects?

  Yes

  No

  N/A

• Is the locking mechanism for interlocking/extension ladder in working condition to prevent movement of the sections while in use?

  Yes

  No

  N/A

• Is the ladder used for electrical work has the rubber non-slip sheet?

  Yes

  No

  N/A

• Are portable ladder, steps and other equipment regularly inspected

  Yes

  No

  N/A

• Have workers been trained not to over reached on ladder

  Yes

  No

  N/A

Working on Roof

• Is scaffold used for roof access and egress?

  Yes

  No

  N/A

• Is 100% tie-off practiced and lifeline provided?

  Yes

  No

  N/A

• Are fragile roof identified, labelled especially where fragility is found

  Yes

  No

  N/A

• Are warning signed displayed on the approach to fragile roof

  Yes

  No

  N/A

Removal of Guardrail, Grating, Cover Plate

• Has risk of fall been assessed and control measures implemented?

  Yes

  No

  N/A

Open Edges

• Are open vertical drop identified and properly guarded or covered

  Yes

  No

  N/A

• Are handrails present on the open side of staircase

  Yes

  No

  N/A

• Is fixed edge protection provided to prevent fall where working at height can be avoided

  Yes

  No

  N/A

Other Observation

Completion

• Checked by

  Sign

• Acknowledged by

  Sign