Conducted on
Date
Location
Address
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Inspected by:
Sign
Inspected by:
Sign
Inspected by:
Sign
Inspected by:
Sign
All fall prevention equipment recorded on register
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Current quarterly inspection tag fitted to all fall prevention equipment
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Equipment pin sound condition. No visible damage
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Range of equipment available is adequate for the work scope and is set up correctly
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Equipment inspected by competent person prior to use
TRA/s used in conjunction with high fall potential activity - i.e. TRA/s written for specific task
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Grid mesh permits in use for grid mesh removal and re-installation
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Personnel complying with safety requirements
Acceptable
Needs Improvement
Unacceptable
Not Assessed
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Personnel trained in use of equipment
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Fall arrest systems installed by competent person
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Anchor point/s compliant with safety requirements
Acceptable
Needs Improvement
Unacceptable
Not Assessed
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Safety harnesses stored correctly when not in use
Acceptable
Needs Improvement
Unacceptable
Not Assessed
Safety harnesses fitted correctly to personnel i.e. Not loose
Acceptable
Needs Improvement
Unacceptable
Not Assessed
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Fall arrest for all works >2m
Acceptable
Needs Improvement
Unacceptable
Not Assessed
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Step ladders maximum height 1.8m
Acceptable
Needs Improvement
Unacceptable
Not Assessed
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Required action:
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Derek Searle
LPI#5 Fall Prevention
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The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
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