Fortysouth | Latchway Certification

• Site conducted

• Conducted on

  Date

• Prepared by

• Permit to Work Number

• Have you reviewed the access instructions and hazards from the RFA provided?

  Yes

  No

• Are the access instructions correct?

  Yes

  No

• Please advise changes required

• Are the hazards correct?

  Yes

  No

• Please advise changes required

• Are all personnel qualified to complete this task?

  Yes

  No

• Have all adequate and appropriate hazard controls been put in place?

  Yes

  No

• Are all personnel wearing appropriate PPE?

  Yes

  No

• Is all PPE current and certified?

  Yes

  No

• Are all appropriate signs put in place (Emergency, traffic flow, restricted area)

  Yes

  No

• Are you escorting any visitors

  Yes

  No

• Name of visitors

• Photo ladder from ground view

  Media

• Photos of latchway from all angles

  Media

• Did the latchway pass or fail?

  Pass

  Fail

• Reason for failure

• Please provide photo of updated latchway plate with new expiry date

  Media

• Please provide copy of completed latchway certification

  Media

H&S

• Were there any incidents while on site today?

  Yes

  No

• Please describe the incident

• Has the main contractor been notified?

  Yes

  No

• If the incident was a notifiable even, has WorkSafe been notified?

  Yes

  No

• Please confirm site was left in a safe state with no new or significant hazards to the next visitor

  Yes

  No

• Please provide information

Site

• Was all work completed?

  Yes

  No

• Is a further site visit required?

  Yes

  No