Height Safety System Inspection and recertification

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Data Plate

• Is there a data plate at all access points to roof?

  Yes

  No

  N/A

• How many?

• Photos

  Media

• Is all required information on the plate?

  Yes

  No

  N/A

• Date of last know inspection?

• Installation date?

• Installed by?

• Manufactured by?

• Persons per system?

• System load rating?

• Safe working load?

• System ID number?

• Were any new data plates installed?

  Yes

  No

  N/A

• Photos

  Media

Fixed Ladders

• Are there any fixed ladders on site?

  Yes

  No

  N/A

• How many?

• Photos

  Media

• Is the ladder secured to the parent structure according to AS/NZS1891.4:2009?

  Yes

  No

  N/A

• visible damage to the ladder or signs of deterioration?

  Safe

  At Risk

  N/A

• Is there a cage or other fall protection on ladders greater than 3.5m?

  Yes

  No

  N/A

• Is there any other issues affecting the safe operation of the ladder?

  Safe

  At Risk

  N/A

Fixed Anchor Points

• is there a system providing adequate height safety on this site?

  Yes

  No

  N/A

• Are all anchors individually tagged?

  Yes

  No

  N/A

• Photos of anchor tags

  Media

• Abseil/Fall Restraint (12kN/15kN)

• do the anchors on sight provide adequate access and fall restraint to all applicable areas?

  Yes

  No

  N/A

• What are the anchors fixed to?

  Select Steel Purlin roof sheet & Purlin roof sheet concrete bricks bolt through multiple other

  • Steel Purlin
  • roof sheet & Purlin
  • roof sheet
  • concrete
  • bricks
  • bolt through
  • multiple
  • other

• Are ALL anchor points safe for use?

  Yes

  No

  N/A

• photo of defective anchor point.

  Media

• Was this problem rectified?

  Yes

  No

  N/A

• photo of repaired/ replaced anchor point.

  Media

• signs of deterioration in the anchor or parent structure?

  Safe

  At Risk

  N/A

• corrosion or rust present in anchor or parent structure?

  Safe

  At Risk

  N/A

• anchor points damaged or deformed from usage or loading?

  Safe

  At Risk

  N/A

• Has the anchor or parent structure been modified in any way since the original installation?

  Safe

  At Risk

  N/A

Final Appraisal

• What is the result of the inspection?

  system is compliant and safe for use

• Items to be addressed

• Photos

  Media

• Additional notes from technician

• Site representative

  Sign

• Technician

  Sign