Information
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Date / Start Time
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Permit Required (check if YES)
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Observer
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Work Group
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Job Description
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Work Area / Location
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Equipment
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Is there a Permit to Work for the job?
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Do you have an SOP for the Job task?
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Did you share the SOP with the crew prior to performing the job task?
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Has the crew performed this task within the last 6 months?
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% of SSE
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Result
Section 1
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A) When should you use personal fall protection equipment, i.e. fall arrest and/or fall restraint systems?
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* Personal fall protection equipment is used when a worker is working at an unprotected height of 6’ or more without an engineered fall prevention system in place. This includes:
* Manlifts
* Scaffolding
* As needed when the fall hazard is below grade (Excavations, augured holes, hillsides, etc.) -
B) What is the difference between a fall restraint lanyard and a fall arrest lanyard? What is the proper Fall Protection equipment for this job?
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* Fall restraint lanyards must be short enough to prevent the user from being in a position where a fall is possible and do not include a shock absorbing component.
* Fall arrest lanyards must have a shock absorbing component and are generally used at heights greater than 17’ where a fall is possible.
* A self-retracting lifeline may be used for fall arrest but may not be used for fall restraint. -
C) Do you understand the anchorage point strength requirements for fall arrest versus fall restraint?
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* Fall arrest = must be capable of supporting, without failure, 5,000 pounds.
* Fall restraint = must be capable of supporting 4x the intended load (i.e. 200 lb man requires 800 lbs anchorage). -
D) How do you know the anchorage points being used for fall arrest meet these requirements?
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* A label or stamp that states the anchorage point is properly rated.
* A competent person has inspected and signed off on the anchorage point. -
E) How do you determine that anchorage points are positioned in such a way that they will prevent contact with objects/surfaces during or after a fall?
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* The anchorage point must ensure that, in the event of a fall, the path below will be free of obstacles or other hazards, and the worker will neither swing nor touch the ground.
* If at all possible, anchorage points should be positioned overhead. -
F) How do you ensure that your fall protection equipment is properly inspected?
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Fall arrest/restraint and positioning equipment:
* D ring and metal hardware must not be cracked or deformed.
* No cracking, cuts, burns, tears, discoloration, or abrasions on the webbing or stitching.
* Webbing is not chemical or oil soaked.
* Labels are present and legible.
* Equipment is not used beyond the date on the label, if the label is dated.
* Lanyards, lifelines, connecting equipment, and anchorages must also be inspected for damage.
* Damaged equipment must not be used.
* Scaffolding must be inspected and approved by a Scaffolding Competent Person and a green or yellow scaffolding tag must be affixed to the scaffolding prior to use.
Remember ABCD-Attachment, Body Harness, Connecting Device, D-ring. -
G) How do you know that personal fall arrest systems are donned properly when in use?
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* Chest and thigh straps must be snug.
* Workers must know what size harness they wear and that the harness being used is the proper size.
* D ring sits between the shoulder blades. -
H) How do you know that personal fall arrest equipment is used only as a last resort?
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* Consider viable alternatives such as use of a manlift with fall restraint system or green-tagged scaffolding.
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I) If personal fall arrest equipment is being used, is a rescue plan in place?
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* Must be documented.
* Must be workable and rescue must occur in a timely manner.
Section 2
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1) Is the PLW knowledgeable in the permit requirements of the relevant MSW Standards?
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2) Does the PLW know the difference between fall restraint and fall arrest?
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3) Are all work-at-grade alternatives exhausted before beginning work at heights?
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4) Are hazards associated with working at heights identified and mitigated prior to beginning work?
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5) Are fall hazards including inadequate structural integrity, holes, voids and hatches identified and are personnel protected by fall prevention or fall protection systems?
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6) Are persons working at heights trained in the proper use of the equipment being used?
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7) Are measures taken to protect personnel below from falling objects?
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8) Is scaffolding designed, erected, inspected, labeled, and dismantled by trained persons?
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9) Are visual inspections of scaffolding performed daily?
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10) Do persons wearing fall-arrest systems not work alone and use 100% tie off?
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11) Are rescue personnel trained and able to perform their responsibilities?
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13) Was site hazard identification/recognition discussed with the crew?
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Hazards discussed/identified with crew
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Comments/Nuggets
