Title Page

  • Conducted on

  • Prepared by

  • Full Name

  • Signed

  • Location

  • Picture of the work area

Risk Assessment

Hazards and Controls

  • Select any applicable answers (These are considered Medium Risk Activities)

  • What Controls have/will be put in place? (Elimination)

  • What Controls have/will be put in place? (Passive Fall Protection) Can measures be put in place to isolate the risk of falling?

  • Can measures be put in place to minimise the consequences of a fall?

  • Stop the task until you have approval

  • Select any applicable answers (These are considered High-Risk Activities)

  • What Controls have/will be put in place? (Elimination)

  • What Controls have/will be put in place? (Passive Fall Protection) Can measures be put in place to isolate the risk of falling?

  • Can measures be put in place to minimise the consequences of a fall?

  • Stop the task until you have approval

  • Select any applicable answers (These are considered Extreme Risk Activities)

  • What Controls have/will be put in place? (Elimination)

  • What Controls have/will be put in place? (Passive Fall Protection) Can measures be put in place to isolate the risk of falling?

  • Can measures be put in place to minimise the consequences of a fall?

  • Stop the task until you have approval

  •  Does the task need to be done?  Is there another way to do the task that removes the extreme level of risk?  Use equipment designed for the task.

Follow Up Questions

  • Are workers provided with appropriate fall protection equipment?

  • Why does the task not require fall protection?

  • Provide evidence that fall protection has been provided or not required (e.g. worker will remain in Scissor Lift)

  • How would you rate the housekeeping practices in the areas where working at heights is performed?

  • Is the fall protection equipment inspection tag in date?

  • Is there a designated competent person (Trained in Working at Heights) responsible for overseeing working at heights activities?

  • Stop task until a trained person can supervise

  • Provide an example of proper anchorage points for fall protection systems.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.