IRATA Third Party Audit

• Document No.

IRATA Log

• IRATA Registation No. (If applicable)

• Current level of certification (multiple selection)

  Select Probationary Trainer Probationary Operator Full Trainer Full Operator Group Member New Applicant

  • Probationary Trainer
  • Probationary Operator
  • Full Trainer
  • Full Operator
  • Group Member
  • New Applicant

• Membership status

  Valid

  Suspended

  New applicant

Audit details

• Audit conducted on

  Date

• Auditor

• Level of audit

  Select Probationaty Trainer Probationary Operator Full Trainer Full Operator Re-certification Trainer Re-certification Operator Group Internal

  • Probationaty Trainer
  • Probationary Operator
  • Full Trainer
  • Full Operator
  • Re-certification Trainer
  • Re-certification Operator
  • Group
  • Internal

• IRATA PO No

• Audit location
  Address

Company's Details

• Company's name

• Address

• City & Postcode

• Country

• Email

• Phone

• Fax

• Web

Personnel

• Manager

• Email

• Phone

• Admin

• Email

• Phone

• Technical authority

• Email

• Phone

Various

• Other certifications held (incl. accreditation body and expiry)

• About shortcuts used in the audit form:
  
  (T) = Trainer, (O) = Operator, (OT) = Trainer & Operator
  
  C = Compliance, RFI = Request for Improvement, N/C = Non-Conformance, N/A = Non-Applicable, N/V = Non-Verifiable
  
  Add a comment: tap anywhere in the active field (question, etc) to start editing.

Opening meeting

• Audit plan submitted to the audited company?

  No

  Yes

• Audit scope

• Audit objectives

• Personnel attending

• Time frame

• Logistic

• Documentation

Section A Quality Control, Management & Planning

• (OT) - A1 - DOCUMENT & RECORD CONTROL

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4, 1.4.3.2, 1.4.3.12
  General Requirements references: 6.2
  Bye-Laws references: N/A

• Does the Company have a document control procedure?

  Yes

  No

  N/A

  N/V

• Does the document control procedure specify...

• the storage?

  Yes

  No

  N/A

  N/V

• the approval?

  Yes

  No

  N/A

  N/V

• the numbering (issue No., version No.)?

  Yes

  No

  N/A

  N/V

• the dispatching?

  Yes

  No

  N/A

  N/V

• how to deal with previous versions? (VOID documents)

  Yes

  No

  N/A

  N/V

• the withdrawal of documents?

  Yes

  No

  N/A

  N/V

• Does the Company have a control of record procedure?

  Yes

  No

  N/A

  N/V

• Does the control of record procedure describe...

• the storage?

  Yes

  No

  N/A

  N/V

• the retention period?

  Yes

  No

  N/A

  N/V

• the withdrawal of records?

  Yes

  No

  N/A

  N/V

• Is the control of documents / records efficient and appropriate?

  Yes

  No

  N/A

  N/V

• (OT) - A2 - MANAGEMENT RESPONSABILITIES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.1.1, 1.4.3.1, 2.2.2(a)
  General Requirements references: 6.3
  Bye-Laws references: N/A

• Does the Company have an up-to-date organigram?

  Yes

  No

  N/A

  N/V

• Is the level of responsability defined for rope access training and operations, health & safety, appointment of personnel, equipment selection & purchase and inspection etc

  Yes

  No

  N/A

  N/V

• Does the Company issue a quality policy?

  Yes

  No

  N/A

  N/V

• Does the management set and review quality objectives?

  Yes

  No

  N/A

  N/V

• Does the Company issue a safety policy?

  Yes

  No

  N/A

  N/V

• Does the management set and review safety objectives?

  Yes

  No

  N/A

  N/V

• Does the Company issue job description?

  Yes

  No

  N/A

  N/V

• (OT) - A3 - MANAGEMENT & SUPERVISORY EXPERTISE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.1.1, 1.4.2.3.1, 1.4.2.4.1, 1.4.3.1, 2.1.4, 2.6.1, 2.6.3.3
  General Requirements references: 8.2.4
  Bye-Laws references: 4.1.7

• Does the Company have a nominated technical authority?

  Yes

  No

  N/A

  N/V

• Is the level of competence of the technical authority appropriate?

  Yes

  No

  N/A

  N/V

• (OT) - A4 - IRATA SAFETY RECORDS & INCIDENT RECORDING

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.1.1(f)(i), 1.4.3.9, 2.2.6(f), 2.11.12
  General Requirements references: N/A
  Bye-Laws references: 4.1.6, 4.1.7

• Does the Company have a procedure for recording hours worked?

  Yes

  No

  N/A

  N/V

• Does the Company have a procedure for recording and investigating accidents, incidents and dangerous occurrences?<br><br>

  Yes

  No

  N/A

  N/V

• Does the Company have a nominated person to record hours worked and incidents (including IRATA quarterly ‘work and safety statistics’ return and IRATA ‘incident record’ [form 021R])?

  Yes

  No

  N/A

  N/V

• (OT) - A5 - IRATA QUARTERLY SAFETY RECORDS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.9, 2.11.12
  General Requirements references: N/A
  Bye-Laws references: 4.1.6

• Are IRATA quarterly satety records up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - A6 - INCIDENT OCCURENCE & REPORTING

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.9, 2.11.12
  General Requirements references: N/A
  Bye-Laws references: N/A

• Have reportable incidents or dangerous occurrences occurred?

  Yes

  No

  N/A

  N/V

• Have reportable incidents or dangerous occurrences been reported to the authorities and IRATA?

  Yes

  No

  N/A

  N/V

• Are incident records / reports available?

  Yes

  No

  N/A

  N/V

• (OT) - A7 - INCIDENT OR DANGEROUS OCCURENCE INVESTIGATION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.6(f), 2.10.1.6, 2.11.12
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure for investigating dangerous occurences?

  Yes

  No

  N/A

  N/V

• Does the Company have a procedure for investigating incidents?

  Yes

  No

  N/A

  N/V

• Does the Company treat incidents and dangerous occurences as non-conformances?

  Yes

  No

  N/A

  N/V

• Are investigation records available?

  Yes

  No

  N/A

  N/V

• (OT) - A8 - IRATA INTERNAL AUDIT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.2, 2.2.2(b)
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure for IRATA internal audit?

  Yes

  No

  N/A

  N/V

• Are the results of internal audits reviewed by the management?

  Yes

  No

  N/A

  N/V

• Are internal audit records up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - A9 - ANNUAL DECLARATION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: N/A
  Bye-Laws references: 4.1.8

• Does the Company have a procedure for IRATA annual renewal and declaration?

  Yes

  No

  N/A

  N/V

• Are annual declaration records up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - A10 - SAFETY BULLETINS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.10
  General Requirements references: N/A
  Bye-Laws references: 4.1.9

• Does the Company have a procedure for downloading and circulating safety bulletins?

  Yes

  No

  N/A

  N/V

• Are safety bulletins made available to the whole rope access staff?

  Yes

  No

  N/A

  N/V

• Are safety bulletins up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - A11 - DOCUMENTATION LICENSE OR OWNERSHIP

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: N/A
  Bye-Laws references: 4.1.10

• Does the Company have ownership to use all procedures, manuals and documents?

  Yes

  No

  N/A

  N/V

• Does the Company have a valid license to use all procedures, manuals and documents?

  Yes

  No

  N/A

  N/V

• Does the Company use any management software?

  Yes

  No

  N/A

  N/V

• Does the Company have a valid license to use the management software?

  Yes

  No

  N/A

  N/V

• (OT) - A12 - MEETING ATTENDANCE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.14
  General Requirements references: N/A
  Bye-Laws references: 4.1.3, 4.1.7

• Does the Company have a procedure stating the attendance at minimum one IRATA meeting yearly?

  Yes

  No

  N/A

  N/V

• Does the Company have a nominated person for attending IRATA meetings?

  Yes

  No

  N/A

  N/V

• Are meeting attendance records up-to-date?

  Yes

  No

  N/A

  N/V

• (O) - A13 - ROPE ACCESS SUITABILITY

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.1.1, 1.4.2.1.2(a), 2.2.3, 2.6.1.1
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating that rope access suitability should be assessed prior to work start?

  Yes

  No

  N/A

  N/V

• Is potential work systematically assessed to ensure it is suitable for rope access?

  Yes

  No

  N/A

  N/V

• Are the assessment findings recorded?

  Yes

  No

  N/A

  N/V

• Are records available?

  Yes

  No

  N/A

  N/V

• (O) - A14 - RISK MANAGEMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.1(i), 1.4.2.1, 1.4.2.7, 2.2, 2.11.11, 2.11.11.5, Annex A, Annex B
  General Requirements references: 8.5.1, 9.2.1
  Bye-Laws references: N/A

• Does the Company have a procedure for risk management?

  Yes

  No

  N/A

  N/V

• Does the Company systematically carry out risk assessment / inventory of hazards?

  Yes

  No

  N/A

  N/V

• Are appropriate measures for risk management in place?

  Yes

  No

  N/A

  N/V

• Are risk assessment records available?

  Yes

  No

  N/A

  N/V

• (T) - A15 - TRAINING VENUE RISK MANAGEMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.4, 2.2.4.4-6
  General Requirements references: 8.5.1, 9.21
  Bye-Laws references: N/A

• Does the Company have a procedure for training venue risk management?

  Yes

  No

  N/A

  N/V

• Does the Company systematically carry out risk assessment / inventory of hazards for external venue(s)?

  Yes

  No

  N/A

  N/V

• Are appropriate measures for training venue risk management in place?

  Yes

  No

  N/A

  N/V

• Are risk assessments for training venues available?

  Yes

  No

  N/A

  N/V

• (OT) - A16 - RESCUE PLAN

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.1.1(i), 1.4.2.7, 1.4.3.11, 2.2.5.2, 2.2.6(h)(i), 2.11.11, 2.11.11.6, Annex B 2.2
  General Requirements references: 8.5.7, 22.6
  Bye-Laws references: N/A

• Does the Company have a procedure for rescue planning?

  Yes

  No

  N/A

  N/V

• Are resources required for the emergency response systematically identified?

  Yes

  No

  N/A

  N/V

• Is the rescue plan part of the toolbox talk briefing?

  Yes

  No

  N/A

  N/V

• Are records available?

  Yes

  No

  N/A

  N/V

• (O) - A17 - SUPERVISOR & TECHNICIAN BRIEFING BY MANAGEMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.2(f), 2.2.4.5, 2.2.6(h)(i), 2.6.2.8, 2.11.6.6, 2.11.7.2
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure for supervisor and technician briefing by management?

  Yes

  No

  N/A

  N/V

• Does the Company record the briefings?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific form for the briefings?

  Yes

  No

  N/A

  N/V

• Are records available?

  Yes

  No

  N/A

  N/V

• (O) - A18 - SUPERVISION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.3, 1.4.3.6-7, 2.5.2.1, 2.11.6.4
  General Requirements references: N/A
  Bye-Laws references: 4.1

• Does the Company have a procedure stating that all rope access operations must be supervised by an in-date IRATA Level 3?

  Yes

  No

  N/A

  N/V

• Are evidences from toolbox talk records available?

  Yes

  No

  N/A

  N/V

• (OT) - A19 - LEVEL 3 COMPETENCE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.2, 2.1.6(b), 2.3.2.2-4, 2.4, 2.5.1.2, 2.6, 2.6.2.6, 2.11.6.4
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure for evaluating L3 competence?

  Yes

  No

  N/A

  N/V

• Does the Company record the evaluations?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific form for the evaluations?

  Yes

  No

  N/A

  N/V

• Is the form appropriate and does it meet the requirements of both IRATA and the Company?

  Yes

  No

  N/A

  N/V

• Are records available?

  Yes

  No

  N/A

  N/V

• (O) - A20 - MANAGEMENT OF COMPETENCE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.3.2.2, 2.6, Annex M 1.1
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure for evaluating technician competence?

  Yes

  No

  N/A

  N/V

• Is the evaluation part of the toolbox talk briefing?

  Yes

  No

  N/A

  N/V

• Are records available?

  Yes

  No

  N/A

  N/V

• (OT) - A21 - TEAM SIZE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.5.9, 1.4.3.7, 2.2.6(b), 2.11.6
  General Requirements references: N/A
  Bye-Laws references: N/A

• (T) Does the Company have a procedure stating the trainer/trainee ratio?

  Yes

  No

  N/A

  N/V

• (T) Are training records available?

  Yes

  No

  N/A

  N/V

• (O) Does the Company have a procedure stating the minimum team size?

  Yes

  No

  N/A

  N/V

• (O) Are operation records available?

  Yes

  No

  N/A

  N/V

• (T) - A22 - FORM 006

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• References: IRATA Form 006

• Does the Company have a procedure stating that the [form 006] must be completed and posted at each training venue?

  Yes

  No

  N/A

  N/V

• Are records available? Is information up-to-date?

  Yes

  No

  N/A

  N/V

• Are the posted [Form 006] signed by assessor(s)?

  Yes

  No

  N/A

  N/V

• (OT) - A23 - CUSTOMER SATISFACTION (optional, no score)

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a customer feedback procedure?

  Yes

  No

  N/A

  N/V

• Does the procedure state that feedback records should be assessed and used for continuous improvement?

  Yes

  No

  N/A

  N/V

• Does the procedure state that negative feedback records should be treated as non-conformance or request for improvement?

  Yes

  No

  N/A

  N/V

• Does the Company use paper forms for feedback purpose?

  Yes

  No

  N/A

  N/V

• Does the Company use electronic forms (email, monky survey, etc) for feedback purpose?

  Yes

  No

  N/A

  N/V

• Are the feedback statistics reviewed by the management?

  Yes

  No

  N/A

  N/V

• (T) Are training feedback records available?

  Yes

  No

  N/A

  N/V

• (T) Are training feedback statistics records available?

  Yes

  No

  N/A

  N/V

• (O) Are operation feedback records available?

  Yes

  No

  N/A

  N/V

• (O) Are operation feedback statistics records available?

  Yes

  No

  N/A

  N/V

• (OT) Are preventive/corrective actions following negative customer feedback available?

  Yes

  No

  N/A

  N/V

• Overall attainment for the Section A (0 = system breakdown / 10 = excellent)

• Comments

Section B Human Resource Management & Training

• (OT) - B1 - IRATA CERTIFIED PERSONNEL

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.5, 1.4.3.7, 2.2.6, 2.5.2.1
  General Requirements references: 6.2, 10.5, 13.1.1
  Bye-Laws references: 4.1.5

• Does the Company have a procedure stating that only IRATA certified personnel shall be used for operations / training?

  Yes

  No

  N/A

  N/V

• Does the Company have an electronic system for monitoring expiry?

  Yes

  No

  N/A

  N/V

• Does the Company have a manual system for monitoring expiry?

  Yes

  No

  N/A

  N/V

• Are records available and up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - B2 - FIRST AID FOR LEVEL 3

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.8, 2.5.2(c), 2.5.3.2.4(n)
  General Requirements references: 4.5, 8.5.7, 9.3.5, 10.5, 17.1
  Bye-Laws references: 4.1.4, 4.1.5

• Does the Company have a procedure stating that Level 3s shall have a valid first aid certificate?

  Yes

  No

  N/A

  N/V

• Does the Company have an electronic system for monitoring expiry?

  Yes

  No

  N/A

  N/V

• Does the Company have a manual system for monitoring expiry?

  Yes

  No

  N/A

  N/V

• Are records available and up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - B3 - FITNESS LEVEL

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.2(b), 2.3.1.3
  General Requirements references: 8.1.1, 9.3.5(a)
  Bye-Laws references: N/A
  IRATA Form 014

• (T) Does the Company have a procedure stating that students should be physically and medically fit?

  Yes

  No

  N/A

  N/V

• (T) Does the Company use the [014 form] for self-certification?

  Yes

  No

  N/A

  N/V

• (T) Are medical statement records available?

  Yes

  No

  N/A

  N/V

• (O) Does the Company have a procedure stating that technicians should be physically and medically fit?

  Yes

  No

  N/A

  N/V

• (O) Does the Company comply with national regulations in terms of medical certification?

  Yes

  No

  N/A

  N/V

• (O) Does the Company have a system for monitoring medical certificate expiry?

  Yes

  No

  N/A

  N/V

• (O) Are medical records available and up-to-date?

  Yes

  No

  N/A

  N/V

• (T) - B4 - TRAINING RECORDS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 6.2, 13.1.4
  Bye-Laws references: N/A
  IRATA Form 014

• Does the Company have a procedure for monitoring of training data?

  Yes

  No

  N/A

  N/V

• Does the procedure state which documents should be kept by the Company, and for how long?

  Yes

  No

  N/A

  N/V

• Are training records available and up-to-date?

  Yes

  No

  N/A

  N/V

• (T) - B5 - MANAGEMENT OF TRAINING

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2
  General Requirements references: 6.2, section 8, 8.1.3
  Bye-Laws references: N/A

• Does the Company have a procedure for training management?

  Yes

  No

  N/A

  N/V

• Does the training management procedure include methods of deliverry?

  Yes

  No

  N/A

  N/V

• Does the training management procedure include course content?

  Yes

  No

  N/A

  N/V

• Does the training management procedure include rescue training?

  Yes

  No

  N/A

  N/V

• Does the rescue section of the procedure include specific controls for two person loading and live casualty?

  Yes

  No

  N/A

  N/V

• Are specific controls for rescue in place?

  Yes

  No

  N/A

  N/V

• (T) - B6 - MANAGEMENT OF TRAINING PERSONNEL COMPETENCE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.2, 2.3.2.2, 2.5.3.2.4
  General Requirements references: 8.2.4
  Bye-Laws references: N/A

• Does the Company have a procedure for trainer competence evaluation?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific form for competence evaluation?

  Yes

  No

  N/A

  N/V

• Are the trainier evaluations kept in personnel files?

  Yes

  No

  N/A

  N/V

• Are records of evaluation available?

  Yes

  No

  N/A

  N/V

• (T) - B7 - TRAINING PERSONNEL QUALIFICATION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.5, 2.5.3.2.5, 2.5.3.2.7
  General Requirements references: 3.2, 6.2, 8.1.3, 8.2.4
  Bye-Laws references: 4.1.5

• Does the Company have a procedure stating that only IRATA certified personnel shall assist in training course?

  Yes

  No

  N/A

  N/V

• Are training records, showing evidence of trainer qualification, available?

  Yes

  No

  N/A

  N/V

• (T) - B8 - TRAINING PERSONNEL INDUCTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.7, 2.2.6, 2.5.3.2.3-6, 2.6.1.2, 2.6.2
  General Requirements references: 8.1.6
  Bye-Laws references: N/A

• Does the Company have an induction procedure for training personnel?

  Yes

  No

  N/A

  N/V

• Is the induction for trainer up-to-date, and does it cover risk assessment, written procedures, equipment, venue constraints, etc.?

  Yes

  No

  N/A

  N/V

• Are trainer induction records available?

  Yes

  No

  N/A

  N/V

• (T) - B9 - PRE-REQUISITES FOR APPLICANTS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: Sections 5, 7 & 8, 9.3, 15.2, 16.2, 17.2
  Bye-Laws references: N/A

• Does the Company have a pre-requisite procedure for applicants?

  Yes

  No

  N/A

  N/V

• Does the Company communicate the pre-requisites on the web?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific document stating the pre-requisites?

  Yes

  No

  N/A

  N/V

• (O) - B10 - INDUCTION FOR OPERATIVES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.6
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have an induction procedure for rope access personnel?

  Yes

  No

  N/A

  N/V

• Is the induction for rope access up-to-date, and does it cover risk assessment, written operating procedures, equipment, current IRATA Code of Practice, etc?

  Yes

  No

  N/A

  N/V

• Are rope access personnel induction records available?

  Yes

  No

  N/A

  N/V

• (T) - B11 - TRAINEE INDUCTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.5.1, 9.2.1
  Bye-Laws references: N/A

• Does the Company have an induction procedure for trainees?

  Yes

  No

  N/A

  N/V

• Is the induction for trainee up-to-date, and does it cover risk assessment, rescue plan, equipment, venue constraints, IRATA Code of Practice & General Requirements, etc?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific form for the trainee induction?

  Yes

  No

  N/A

  N/V

• Are trainee induction records available?

  Yes

  No

  N/A

  N/V

• (T) - B12 - TRAINING MANUAL

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.4.3, 2.5.3.2.3
  General Requirements references: 8.1.4, 15.3.1(a), 17.1(b), 22.2.4.4
  Bye-Laws references: N/A

• Does the Company provide a training manual?

  Yes

  No

  N/A

  N/V

• Does the training manual cover the entire and current IRATA syllabus?

  Yes

  No

  N/A

  N/V

• Does the training manual cover national legislation?

  Yes

  No

  N/A

  N/V

• Is the training manual reviewed and up-to-date?

  Yes

  No

  N/A

  N/V

• (T) - B13 - TRAINER FILE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.1.6
  Bye-Laws references: N/A

• Does the Company have a procedure stating that trainers should have access to IRATA trainer file?

  Yes

  No

  N/A

  N/V

• Does the procedure describe the downloading and dispatching processes?

  Yes

  No

  N/A

  N/V

• Does the company have a nominated person in charge of IRATA trainer file, this includes monitoring and dispatching.

  Yes

  No

  N/A

  N/V

• Are IRATA trainer files available?

  Yes

  No

  N/A

  N/V

• (O) - B14 - REFRESHER TRAINING

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.5.2.8
  General Requirements references: 8.4.3, 10.6
  Bye-Laws references: N/A

• Does the Company have a procedure for refresher training?

  Yes

  No

  N/A

  N/V

• Are refresher trainings carried out in house?

  Yes

  No

  N/A

  N/V

• Are refresher trainings recorded in IRATA logbook?

  Yes

  No

  N/A

  N/V

• Are refresher trainings recorded in personnel file?

  Yes

  No

  N/A

  N/V

• Are refresher training records available?

  Yes

  No

  N/A

  N/V

• (O) - B15 - CLOSE MONITORING SUPERVISION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.5.2.3, 2.5.2.4
  General Requirements references: 8.4.2, 8.4.3
  Bye-Laws references: N/A

• Does the Company have a procedure for close monitoring supervision for new qualified technicians?

  Yes

  No

  N/A

  N/V

• Is close supervision recorded in technician's IRATA logbook?

  Yes

  No

  N/A

  N/V

• Is close supervision recorded in personnel file?

  Yes

  No

  N/A

  N/V

• Are close supervision records available?

  Yes

  No

  N/A

  N/V

• Overall attainment for the Section B (0 = system breakdown / 10 = excellent)

• Comments

Section C Equipment & Facilities

• (OT) - C1 - PURCHASE OF EQUIPMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.1.1, 1.4.2.4, 1.2.4.4.5-6, 2.10
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a purchase procedure?

  Yes

  No

  N/A

  N/V

• Is the documentation of the purchasing process appropriate and up-to-date?

  Yes

  No

  N/A

  N/V

• Does the Company provide an appropriate induction to personnel involved in purchasing?

  Yes

  No

  N/A

  N/V

• Are purchasing records available?

  Yes

  No

  N/A

  N/V

• (OT) - C2 - SELECTION OF EQUIPMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.4.1, 1.4.2.8, 2.2.2(k), 2.7.1.1, 2.7.5, 2.7.7
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating that the selection and the purchase of equipment should be approved by the technical authority?

  Yes

  No

  N/A

  N/V

• Is the level of competence of the technical authority, related to selection of equipment, appropriate?

  Yes

  No

  N/A

  N/V

• Are purchasing records, showing evidence of approval by technical authority, available?

  Yes

  No

  N/A

  N/V

• (OT) - C3 - STORAGE OF EQUIPMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.10.7
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure considering the storage of equipment...

• in equipment store?

  Yes

  No

  N/A

  N/V

• at training venue?

  Yes

  No

  N/A

  N/V

• at work site?

  Yes

  No

  N/A

  N/V

• Are quarantine areas available...

• in equipment store?

  Yes

  No

  N/A

  N/V

• at training venue?

  Yes

  No

  N/A

  N/V

• at work site?

  Yes

  No

  N/A

  N/V

• Is the equipment stored securely?

  Yes

  No

  N/A

  N/V

• Does the company produce an equipment manifest for equipment shipped on work site(s)?

  Yes

  No

  N/A

  N/V

• Is the transportation included in the equipment storage procedure?

  Yes

  No

  N/A

  N/V

• (OT) - C4 - SCHEDULE OF INSPECTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.10, 2.10.1.2, 2.10.1.5-6, 2.10.1.4.2, Annex I
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure scheduling the inspection of equipment by competent person?

  Yes

  No

  N/A

  N/V

• Does the Company have a nominated and competent person to carry out equipment inspections?

  Yes

  No

  N/A

  N/V

• Is the level of competence of the nominated person, related to inspection of equipment, appropriate?

  Yes

  No

  N/A

  N/V

• Is the certificate of competence of the nominated person available?

  Yes

  No

  N/A

  N/V

• Is the scheduling appropriately monitored?

  Yes

  No

  N/A

  N/V

• (OT) - C5 - METHOD OF INSPECTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.12, 2,9, 2.10, Annex H, Annex I
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating the method of equipment inspection?

  Yes

  No

  N/A

  N/V

• Are the PASS / FAIL criteria described in procedure?

  Yes

  No

  N/A

  N/V

• Does the Company keep the certificates of conformity?

  Yes

  No

  N/A

  N/V

• Are certificates of conformity available?

  Yes

  No

  N/A

  N/V

• (OT) - C6 - INSPECTION RECORDS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.3.12, 2,9, 2.10, Annex H, Annex I
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure for the monitoring of equipment inspection?

  Yes

  No

  N/A

  N/V

• Does the database include relevant information related to the products?

  Yes

  No

  N/A

  N/V

• If individually marked by the Company, is the equipment linked to manufacturer's batch number?

  Yes

  No

  N/A

  N/V

• Are inspection records available and up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - C7 - MARKING & TRACEABILITY

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.8, Annex H
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a marking procedure for equipment?

  Yes

  No

  N/A

  N/V

• If individually marked by the Company, is the equipment linked to manufacturer's batch number?

  Yes

  No

  N/A

  N/V

• Are inspection records available and up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - C8 - MANUFACTURER'S INSTRUCTIONS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.6(f), 2.7.1.7, 2.9.1(g), 2.10.1.1
  General Requirements references: 8.1.4
  Bye-Laws references: N/A

• Does the Company have a procedure considering the accessibility of manufacturer's instructions to technicians, trainers and trainees...

• in store?

  Yes

  No

  N/A

  N/V

• at training venue?

  Yes

  No

  N/A

  N/V

• at work site?

  Yes

  No

  N/A

  N/V

• Are manufacturer's instructions available...

• in store?

  Yes

  No

  N/A

  N/V

• at training venue?

  Yes

  No

  N/A

  N/V

• at work site?

  Yes

  No

  N/A

  N/V

• Are manufacturer's instructions up-to-date?

  Yes

  No

  N/A

  N/V

• (OT) - C9 - WORN, DAMAGED & QUARANTINED EQUIPMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.6.2.5(h), 2.10.1.3, 2.10.1.5-6
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure considering arrangements for worn, damaged or quarantined equipment?

  Yes

  No

  N/A

  N/V

• Does the Company consider worn, damaged or quarantined equipment to be treated as a non-conformance?

  Yes

  No

  N/A

  N/V

• Are worn, damaged or quarantined equipment investigated and does the Company produce corrective or preventive action?

  Yes

  No

  N/A

  N/V

• Are records of corrective or preventive actions available and implemented?

  Yes

  No

  N/A

  N/V

• (OT) - C10 - SAFE TO USE EQUIPMENT

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.4, 2.10.1.3
  General Requirements references: 6.2, 9.2.1
  Bye-Laws references: N/A

• Is the equipment safe to use...

• in store?

  Yes

  No

  N/A

  N/V

• at training venue?

  Yes

  No

  N/A

  N/V

• at work site?

  Yes

  No

  N/A

  N/V

• (OT) - C11 to C21 - SELECTION CRITERIA

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.7.2 to 2.7.8, 22.7.10, 2.11.3.1, Annex E, Annex L
  General Requirements references: 22.5.1-3, 22.5.3, 22.5.3.3,
  Bye-Laws references: N/A

• Does the Company have a procedure describing selection criteria for equipment...

• (T) For training

  Yes

  No

  N/A

  N/V

• (O) For operations

  Yes

  No

  N/A

  N/V

• Does the Company have an equipment risk assessment or an assessment of equipment suitabily and foreseeable misuse?

  Yes

  No

  N/A

  N/V

• Does equipment conform to national and international standards?

  Yes

  No

  N/A

  N/V

• (T) - C22 - TRAINING VENUE SUITABILITY

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.6.1
  Bye-Laws references: N/A
  IRATA Form 006

• Does the training facility allow the current IRATA to be trained?

  Yes

  No

  N/A

  N/V

• Is the recommended height of at least 7 meters available?

  Yes

  No

  N/A

  N/V

• Is a calculation note provided by an engineer available?

  Yes

  No

  N/A

  N/V

• If applicable, are structural inspection records available?

  Yes

  No

  N/A

  N/V

• Does the training venue fulfill the requirements of the [006 form]?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C23 - INDOOR SESSIONS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.5.4
  Bye-Laws references: N/A

• Is provision for indoor theory/examination sessions made?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C24 - WELFARE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.11.10
  General Requirements references: 8.5.5
  Bye-Laws references: N/A

• Are welfare facilities available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C25 - SIGNAGE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.5.8-9
  Bye-Laws references: N/A

• Do training structures display loading capacity and loading direction?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• Do anchors display loading capacity and loading direction?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• Are anchor inspection records available?

  Yes

  No

  N/A

  N/V

• Are any other inspection records available?

  Yes

  No

  N/A

  N/V

• (T) - C26 - BASIC ROPE MANOEUVRES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.6.1
  Bye-Laws references: N/A

• Are locations to ascend, descend, pass obstructions, re-anchors, rope-to-rope transfers available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C27 - DEVIATIONS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.11.3.1.5, fig. 2.8
  General Requirements references: 8.6.1
  Bye-Laws references: N/A

• Are locations requiring deviations to re-direct ropes for both positioning and protection purposes available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C28 - EDGE OBSTRUCTION AT TOP

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.7.10, 2.11.3.1-2, Annex P
  General Requirements references: 8.6.2, 22.3.10
  Bye-Laws references: N/A

• Is a location where the ropes pass through 90 degrees between the anchors and the ground available?

  Yes

  No

  N/A

  N/V

• Is the rope protection over the edge accordingly demonstrated?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C29 - MID-ROPE PROTECTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.7.10, 2.11.3.1-2, Annex P
  General Requirements references: 8.6.1
  Bye-Laws references: N/A

• Is a location to ascend/descend past mid-rope obstructions using appropriate rope protection devices available?

  Yes

  No

  N/A

  N/V

• Is a procedure dealing with rope protection devices available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C30 - AID CLIMBING (FIXED POINTS)

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.6.3, 22.5.2
  Bye-Laws references: N/A

• Is a structure providing anchorages for horizontal aid climbing using fixed points available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• Is a structure providing anchorages for vertical aid climbing using fixed points available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C31 - AID CLIMBING (MOVEABLE POINTS)

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.6.3, 22.5.2
  Bye-Laws references: N/A

• Is a structure providing anchorages for horizontal aid climbing using moveable points available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C32 - CLIMBING WITH FALL ARREST LANYARDS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.6.4, 22.5.3
  Bye-Laws references: N/A

• Is a structure that allows climbing using Y or V-shaped fall arrest lanyards available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C33 - ANCHORS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.6.5, 8.6.6
  Bye-Laws references: N/A

• Are suitable anchors to allow horizontal rescue and rigging exercises available?

  Yes

  No

  N/A

  N/V

• Are suitable anchors to allow vertical rescue and rigging exercises available?

  Yes

  No

  N/A

  N/V

• Are suitable anchors to allow three-dimensional rescue and rigging exercises available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• (T) - C34 - MANIKIN

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: N/A
  General Requirements references: 8.5.3
  Bye-Laws references: N/A

• Is a manikin/weight of at least 70kg for hauling and rescue exercises available?

  Yes

  No

  N/A

  N/V

• Photo

  Media

• Overall attainment for the Section C (0 = system breakdown / 10 = excellent)

• Comments

Section D Method of Work / Training

• (O) - D1 - DOCUMENT AVAILIBILITY

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.6, Annex N
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating that following documents should be available?

• Relevant Company procedures?

  Yes

  No

  N/A

  N/V

• IRATA Code of Practice?

  Yes

  No

  N/A

  N/V

• Equipment user's instructions?

  Yes

  No

  N/A

  N/V

• Are the relevant documents available...

• in store?

  Yes

  No

  N/A

  N/V

• at work place?

  Yes

  No

  N/A

  N/V

• in office?

  Yes

  No

  N/A

  N/V

• (O) - D2 - MIXED TEAMS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.2(f)
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating that a prior agreement of operating procedures is required if technicians from another company work in the same team?

  Yes

  No

  N/A

  N/V

• Are the agreements recorded?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific agreement form?

  Yes

  No

  N/A

  N/V

• Are agreement records available?

  Yes

  No

  N/A

  N/V

• (O) - D3 - TOOLBOX TALK BRIEFING

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.7, 2.2.2(e), 2.2.6, 2.6.2.8, 2.11.6.6, 2.11.7.2
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating that all team members shall receive a task specific briefing at the start of each day?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include rigging discussions?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include rescue plan discussions?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include rope protection discussions?

  Yes

  No

  N/A

  N/V

• Are the toolbox talk briefings recorded?

  Yes

  No

  N/A

  N/V

• Does the Company use a specific toolbox talk form?

  Yes

  No

  N/A

  N/V

• Are toolbox talk records signed?

  Yes

  No

  N/A

  N/V

• Are toolbox talk records available?

  Yes

  No

  N/A

  N/V

• (OT) - D4 - RIGGIGNG FOR RESCUE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.3(e), 2.2.5.2, 2.2.6(h)(i), 2.7.9.7, 2.11.2.22. 2.11.4(i)(ii), 2.11.11.3
  General Requirements references: 8.5.7
  Bye-Laws references: N/A

• Does the Company have a procedure stating that operational planning should consider rigging for rescue and other non-rope access rescue methods?

  Yes

  No

  N/A

  N/V

• Are method statements showing evidence of rigging for rescue available?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include rigging for rescue?

  Yes

  No

  N/A

  N/V

• Are toolbox talk records showing evidence of rigging for rescue available?

  Yes

  No

  N/A

  N/V

• (T) Is rigging for rescue demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D5 - ANCHOR SYSTEMS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.7.9, 2.11.2, 2.11.2.6, Annex F
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating that anchor systems must provide independent security for both working and back-up rope?

  Yes

  No

  N/A

  N/V

• (T) Is this practice demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D6 - RIGGING HIERARCHY

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: Annex P
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure demonstrating rigging and protection hierarchy?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include rigging hierarchy discussions?

  Yes

  No

  N/A

  N/V

• Are toolbox talk records, showing evidence of rigging and protection hierarchy, available?

  Yes

  No

  N/A

  N/V

• (T) Is rigging hierarchy demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D7 - ROPE PROTECTION DEVICES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.7.10, 2.11.3.1, 2.11.3.2, Annex P
  General Requirements references: 22.3.10
  Bye-Laws references: N/A

• Does the Company have a procedure stating the use of rope protection devices?

  Yes

  No

  N/A

  N/V

• Does the procedure state that the edge radius should be increased to greather than 5mm?

  Yes

  No

  N/A

  N/V

• Does the procedure deal with heat associated hazards?

  Yes

  No

  N/A

  N/V

• Does the procedure deal with abrasion associated hazards?

  Yes

  No

  N/A

  N/V

• (T) Is the use of rope protection devices demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D8 - WORKING & BACK-UP LINES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.5.1, 2.11.1.2, 2.11.2.2
  General Requirements references: 22.3.5.3
  Bye-Laws references: N/A

• Does the Company have a procedure specifying that the working and back-up lines should each have own separate anchors?

  Yes

  No

  N/A

  N/V

• (T) Is this practice demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D9 - LIMITS OF RIGGING & RE-DIRECTION ANGLES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.7.8.3.2, fig. 2.4, fig. 2.8, 2.11.2.10, 2.11.2.11, 2.11.2.19, 2.11.2.21, 2.11.3.1.5, 2.11.4
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure specifying the limits of rigging angles, angle of re-direction of ropes and pendulum?

  Yes

  No

  N/A

  N/V

• (T) Are these practices demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D10 - SEPARATE HARNESS ATTACHEMENTS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.5.3, 2.11.1.3
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure specifying separate attachments from harness to working rope and to back-up rope or other anchor?

  Yes

  No

  N/A

  N/V

• (T) Is this practice demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D11 - COMFORT SEATS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.5.4, 2.7.3.5(e), 2.7.11, Annex G 2.1
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure stating the use of comfort seat?

  Yes

  No

  N/A

  N/V

• (T) Is the use of work seats demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D12 - THIRD PARTY PROTECTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.1.1(f/ii)(f/iv), 1.4.2.6, 2.2.4.3(b), 2.2.6(j), 2.11.8.2, Annex M
  General Requirements references: 8.5.6, 8.5.10
  Bye-Laws references: N/A

• Is the protection of third parties part of the operational planning?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include the protection of third parties and exclusion area?

  Yes

  No

  N/A

  N/V

• Are toolbox talk records, showing the evidence of third party protection, available?

  Yes

  No

  N/A

  N/V

• (OT) - D13 - ANCHOR PROTECTION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.11.8.1.2, 2.11.8.2.3, 2.11.8.3
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure considering the protection of anchor area from interference?

  Yes

  No

  N/A

  N/V

• Does the toolbox talk briefing include the protection of anchor area from interference?

  Yes

  No

  N/A

  N/V

• Are toolbox talk records, showing the evidence of anchor area protection, available?

  Yes

  No

  N/A

  N/V

• (OT) - D14 - BUDDY CHECK

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.11.7.4, 2.11.7.5
  General Requirements references: 15.3.2(b), 22.3.2
  Bye-Laws references: N/A

• Does the Company have a procedure stating the pre-use check of all rigged and personal equipment [buddy check]?

  Yes

  No

  N/A

  N/V

• Does the Company have a procedure stating the pre each use function check?

  Yes

  No

  N/A

  N/V

• Are buddy checks recorded in the toolbox talk briefings?

  Yes

  No

  N/A

  N/V

• Are records showing evidence of buddy checks available?

  Yes

  No

  N/A

  N/V

• (OT) - D15 - COMMUNICATION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.5.6, 2.11.9
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure specifying the appropriate type of communication, depending on the environment?

  Yes

  No

  N/A

  N/V

• Is communication on site recorded in the toolbox talk briefings?

  Yes

  No

  N/A

  N/V

• Are records showing evidence of appropriate communication?

  Yes

  No

  N/A

  N/V

• (O) - D16 - LEAD CLIMBING

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.2.5.8, 1.4.2.8, 2.11.15, Annex L, Annex Q
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure describing lead climbing?

  Yes

  No

  N/A

  N/V

• Does the Company have a specific risk assessment for lead climbing?

  Yes

  No

  N/A

  N/V

• (T) Is lead climbing demonstrated in the Company's training manual?

  Yes

  No

  N/A

  N/V

• (OT) - D17 - RESPONSABILITIES

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.4, 2.5.2, 2.6.2
  General Requirements references: 6.3, sections 15, 16 & 17
  Bye-Laws references: N/A

• Does the Company have a procedure defining the responsability of rope access technicians?

  Yes

  No

  N/A

  N/V

• Does the induction procedure include the responsability of rope access technicians

  Yes

  No

  N/A

  N/V

• (OT) - D18 - USE OF SMALL TOOLS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.11.8.2.2, Annex M section 2
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure describing the use of small tools?

  Yes

  No

  N/A

  N/V

• Does the procedure specify the use of containers and/or lanyards?

  Yes

  No

  N/A

  N/V

• Is the use of small tools recorded in the toolbox talk briefings?

  Yes

  No

  N/A

  N/V

• Are records showing evidence of correct use of small tools available?

  Yes

  No

  N/A

  N/V

• (OT) - D19 - HEAVY EQUIPMENT & WORK PLATFORMS

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.11.1.4, 2.11.2.23, Annex M sections 1.3 & 4
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have a procedure describing the suspension of heavy equipment?

  Yes

  No

  N/A

  N/V

• Does the Company have a procedure describing the suspension of work platforms?

  Yes

  No

  N/A

  N/V

• Does the procedure specify the strength of the attachment points?

  Yes

  No

  N/A

  N/V

• Is the suspension of heavy equipment and work platforms recorded in the toolbox talk briefings?

  Yes

  No

  N/A

  N/V

• Are records showing evidence of correct suspension of work platforms / heavy tools available?

  Yes

  No

  N/A

  N/V

• (OT) - D20 - TYPES OF WORK

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 1.4.1.1(f), 2.2, 2.2.2(m), 2.7.14, 2.11.6, Annex M
  General Requirements references: N/A
  Bye-Laws references: N/A

• Does the Company have appropriate procedures for types of work?

  Yes

  No

  N/A

  N/V

• Hot work?

  Yes

  No

  N/A

  N/V

• Burning?

  Yes

  No

  N/A

  N/V

• Electrical and powered tools?

  Yes

  No

  N/A

  N/V

• Blasting?

  Yes

  No

  N/A

  N/V

• Painting?

  Yes

  No

  N/A

  N/V

• Inspections?

  Yes

  No

  N/A

  N/V

• Cleaning?

  Yes

  No

  N/A

  N/V

• Work carried out over water?

  Yes

  No

  N/A

  N/V

• Heavy lifting?

  Yes

  No

  N/A

  N/V

• Else?

  Yes

  No

  N/A

  N/V

• Overall attainment for the Section D (0 = system breakdown / 10 = excellent)

• Comments

Section E General / Legislation

• (OT) - E1 - INSURANCE

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: 2.2.2(c), Annex N
  General Requirements references: 9.2.2
  Bye-Laws references: N/A

• Is the insurance of correct scope...

• (T) for training?

  Yes

  No

  N/A

  N/V

• (O) for operations?

  Yes

  No

  N/A

  N/V

• Is the insurance currently valid...

• (T) for training?

  Yes

  No

  N/A

  N/V

• (O) for operations?

  Yes

  No

  N/A

  N/V

• If applicable, insurance expiry date...

• (T) for training?

  Date

• (O) for operations?

  Date

• (OT) - E2 - NATIONAL H&S LEGISLATION

  Select Compliance Request for Improvement Minor Non-Conformance Major Non-Conformance Non-Applicable Non-Verifiable

  • Compliance
  • Request for Improvement
  • Minor Non-Conformance
  • Major Non-Conformance
  • Non-Applicable
  • Non-Verifiable

• ICOP references: Annex C sections 4 & 4.3
  General Requirements references: N/A
  Bye-Laws references: N/A

• Are copies of relevant national H&S legislation available?

  Yes

  No

  N/A

  N/V

• Are copies of relevant national COPs available?

  Yes

  No

  N/A

  N/V

• Does the company comply with national H&S legislation?

  Yes

  No

  N/A

  N/V

• Overall attainment for the Section E (0 = system breakdown / 10 = excellent)

• Comments

Closing meeting

• Overall attainment (0 = system breakdown / 10 = excellent)

• Number of Major Non-Conformances

• Number of Minor Non-Conformances

• Number of Request for Improvement

• Number of Non-Verifiable items

• Auditor's conclusion

• Signed by auditor

  Sign

• Signed for auditee

  Sign

Corrective & Preventive Actions

• Corrective Action Request (CAR)?

  Yes

  No

• Details of Non-Conformances

• Proposed preventive and/or corrective actions

• Proposed date for implementation of preventive and/or corrective actions

  Date

Follow-up

• Follow up audit

  Surveillance

  Full member

  Re-certification

• Proposed date for follow-up audit

  Date

• Approved and signed by a Member of the Management

  Sign

Executive Committe Record

• Ballot result per Article 2.1.5

• For

• Against

• Overall committee decision

  PASS

  FAIL

• Any conclusions, recommendations or conditions

• Signed on behalf of the committee

  Sign