MHS -Rev003

• Report number / Job Number

• Site:

• Audit must have site details

Tempeture

• What are weather conditions like

  Select Sunny Raining Windy Hot Cold Other

  • Sunny
  • Raining
  • Windy
  • Hot
  • Cold
  • Other

• Client:

• What type of structure is being audited

  Select Warehouse School Shops Apartments Treatment Plant Water holding tank Shopping Centre Other Service Station Warehouse with attached office / Showroom Car Dealership

  • Warehouse
  • School
  • Shops
  • Apartments
  • Treatment Plant
  • Water holding tank
  • Shopping Centre
  • Other
  • Service Station
  • Warehouse with attached office / Showroom
  • Car Dealership

• New or existing building

• Conducted on

  Date

• Prepared by

• Location
  Address

• Other Personnel onsite

• How Is Access Gained To Systems

  Select Fold Down Access Ladder Fixed Access Ladder Fixed Ladder Support Bracket EWP Rope Access Other No current access point

  • Fold Down Access Ladder
  • Fixed Access Ladder
  • Fixed Ladder Support Bracket
  • EWP
  • Rope Access
  • Other
  • No current access point

• Name access

Data Plate

• How many

• Is data plate legible?

  Yes

  No

  N/A

• Is all required information on the plate?

  Yes

  No

  N/A

• Date of last inspection

  Date

• Installation date of system

  Date

• Installed by

• Manufactured by

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• Persons per system

• System load rating

  Select 15kN 12kN 1 x 136kg 2 x 136kg 3 x 136kg 4 x 136kg 150kg hoisting load

  • 15kN
  • 12kN
  • 1 x 136kg
  • 2 x 136kg
  • 3 x 136kg
  • 4 x 136kg
  • 150kg hoisting load

• System ID number

• Were any new data plates installed

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Photos

  Media
Fixed Ladders

• How many?

• Vertical or pitched

• Manufacture of ladder

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• Is the ladder secured appropriately?

  Safe

  At Risk

  N/A

• Ladder must be removed or tagged out of service

• Can ladder be accessed safely using correct PPE

  Safe

  At Risk

  N/A

• Are all fixings in place as per Manufacturers installation instructions

  Yes

  No

  N/A

• Is there any visible damage to the ladder?

  Yes

  No

  N/A

• Is there a fall arrest line on the ladder?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If fall arrest line present include in static line section of this report

• Does the line have a shock absorber?

  Yes

  No

  N/A

• If shock absorber present record details in associated equipment register

• Is the line installed in a compliant manner?

  Yes

  No

  N/A

• Is there a cage on the ladder?

  Yes

  No

  N/A

• If no lifeline or cage is present would one be recommended?

  Yes

  No

  N/A

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

  Safe

  At Risk

  N/A
Ladder Brackets

• How many?

• Photos

  Media

• Is the bracket installed as per the manufactures specifications?

  Yes

  No

  N/A

• Have any modifications been made to the bracket or parent structure?

  Yes

  No

  N/A

• What brand of bracket is installed

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• With the appropriate ladder can the bracket be used to access the required area safely?

  Safe

  At Risk

  N/A
Walkways

• Do they comply to AS1657:2018?

  Yes

  No

  N/A

• What type

  Select Stainless Steel Galvanised Steel Alumimium Timber Fiberglass other

  • Stainless Steel
  • Galvanised Steel
  • Alumimium
  • Timber
  • Fiberglass
  • other

• What brand in known

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• Platforms present

  Yes

  No

  N/A

• Are platforms installed correctly

  Select Safe At Risk N/A

  • Safe
  • At Risk
  • N/A

• Is current layout safe to use

  Select Safe for use clean and re inspect repairs needed unserviceable other

  • Safe for use
  • clean and re inspect
  • repairs needed
  • unserviceable
  • other

• What is required to platform / walkway to make compliant

Are there handrails on-site

• Do they comply to AS1657:2018?

  Yes

  No

  N/A

• What are they 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

• What brand in known

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• Is current layout safe to use

  Safe

  At Risk

  N/A

• What is required to make compliant

Lanyards / Strops

• How many?

• Photo

  Media

• Has the lanyard/wire rope been damaged or modified in any way?

  Yes

  No

  N/A

• Is there any deterioration in the anchorage/parent structure?

  Yes

  No

  N/A

• Is the line the appropriate length for the designated task?

  Yes

  No

  N/A
Fixed Anchor Points

• Are all anchors individually tagged?

  Yes

  No

  N/A

• Photos of anchor tags

  Media

• Is a ID plate used at access point to identity anchors.

  Yes

  No

  N/A

• Abseil (15kN+)

• Are these anchors present onsite?

  Yes

  No

  N/A

• How many

• Types of anchor present

  Select Surface mount Purlin mount Concrete Clamp mount Tri Plate

  • Surface mount
  • Purlin mount
  • Concrete
  • Clamp mount
  • Tri Plate

• Is anchor a minimum 200mm from any edge

  Yes

  No

  N/A

• Fall Arrest (15kN+)

• Are these anchors present onsite?

  Yes

  No

  N/A

• How many

• Types of anchor present

  Select Surface mount Purlin mount Concrete Clamp mount Tri Plate

  • Surface mount
  • Purlin mount
  • Concrete
  • Clamp mount
  • Tri Plate

• Is anchor a minimum 200mm from any edge

  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

• Please advise

• If the anchor is fixed to concrete or bricks all anchors must be pull tested to 7.5Kn for 2 Minutes. If Tri Plate, please note if each fixing was tested. Tri plate anchors can be direct pulled as per single eyelet.

• What Adhesive was used to install anchors / rods

  Select Hilti HIT-HY 200-R Hilti HIT-RE 500 V3 ChemSet 801 XTREM XC2 OTHER

  • Hilti HIT-HY 200-R
  • Hilti HIT-RE 500 V3
  • ChemSet 801 XTREM XC2
  • OTHER

• Was reinforcing steel hit why drilling into concrete

  Yes

  No

  N/A

• Was a new hole drilled to avoid steel?

  Yes

  No

  N/A

• Was a testing device used?

  Yes

  No

  N/A

• If a testing device was used please provide make model and serial number

• Photo of testing device

  Media

• Any signs of deterioration in the anchor or parent structure?

  Yes

  No

  N/A

• Any corrosion or rust present in anchor or parent structure?

  Yes

  No

  N/A

• Is the anchor damaged or deformed from usage or loading?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is there any other factors that would prevent the anchor holding its intended load when required?

  Yes

  No

  N/A
Static Lines

• How many

• Types of lines present

  Select Vertical Horizontal Overhead Wall mounted Floor mounted Other

  • Vertical
  • Horizontal
  • Overhead
  • Wall mounted
  • Floor mounted
  • Other

• Brand

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• What are the lines 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

• Is anchor a minimum 200mm from any edge

  Yes

  No

  N/A

• If the line is fixed to concrete or bricks all anchors must be pull tested to 7.5Kn for 2 Minuets

• Was a testing device used?

  Yes

  No

  N/A

• If a testing device was used please provide make model and serial number

• Is the line tensioned appropriately?

  Yes

  No

  N/A

• Are all bolts, rivets, screws and fastenings secure?

  Yes

  No

  N/A

• Any corrosion or rust present in system or parent structure?

  Yes

  No

  N/A

• Any corrosion or rust present in travel/attachment device?

  Yes

  No

  N/A

• Is there any brittleness or fraying in the steel cable?

  Yes

  No

  N/A

• Does the travel device operate smoothly along the entire system?

  Yes

  No

  N/A

• Does the system have a shock absorbing device?

  Yes

  No

  N/A

• Has the shock absorber been deployed or damaged in any way?

  Yes

  No

  N/A

• Does the line have a working tension indicator?

  Yes

  No

  N/A

• Are all joints and swages secure?

  Yes

  No

  N/A

• Photo of swage

  Media

• Is there any visible cuts or dents in the system?

  Yes

  No

  N/A

• Is there any other visible damages or modifications that may cause the system to fail?

  Yes

  No

  N/A

• Load rating per system

  Select 15kN 12kN 1 x 136kg 2 x 136kg 3 x 136kg 4 x 136kg 150kg hoisting load

  • 15kN
  • 12kN
  • 1 x 136kg
  • 2 x 136kg
  • 3 x 136kg
  • 4 x 136kg
  • 150kg hoisting load

• Load rating per span

  Select 15kN 12kN 1 x 136kg 2 x 136kg 3 x 136kg 4 x 136kg 150kg hoisting load

  • 15kN
  • 12kN
  • 1 x 136kg
  • 2 x 136kg
  • 3 x 136kg
  • 4 x 136kg
  • 150kg hoisting load
Fixed (RopeAccess) Rail Systems?

• How many

• Load rating per system

  Select 15kN 12kN 1 x 136kg 2 x 136kg 3 x 136kg 4 x 136kg 150kg hoisting load

  • 15kN
  • 12kN
  • 1 x 136kg
  • 2 x 136kg
  • 3 x 136kg
  • 4 x 136kg
  • 150kg hoisting load

• Load rating per span

  Select 15kN 12kN 1 x 136kg 2 x 136kg 3 x 136kg 4 x 136kg 150kg hoisting load

  • 15kN
  • 12kN
  • 1 x 136kg
  • 2 x 136kg
  • 3 x 136kg
  • 4 x 136kg
  • 150kg hoisting load

• Types of rails present

  Select Stainless Steel Galvanised Steel Alumimium Timber Fiberglass other

  • Stainless Steel
  • Galvanised Steel
  • Alumimium
  • Timber
  • Fiberglass
  • other

• Brand of rail

  Select Sayfa Safetylink 3M BTS RIS other

  • Sayfa
  • Safetylink
  • 3M
  • BTS
  • RIS
  • other

• What are the rails 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

• Is anchor a minimum 200mm from any edge

  Yes

  No

  N/A

• If the rail is fixed to concrete or bricks all anchors must be pull tested to 7.5Kn for 2 Minuets

• Was a testing device used?

  Yes

  No

  N/A

• If a testing device was used please provide make model and serial number

• Are all bolts, rivets, screws and fastenings secure?

  Yes

  No

  N/A

• Are all joints under the maximum allowable distance of 4mm

  Yes

  No

  N/A

• Is the rail mounted as per the manufactures specifications?

  Yes

  No

  N/A

• Are any bolts or connectors missing?

  Yes

  No

  N/A

• Any corrosion or rust present in system or parent structure?

  Yes

  No

  N/A

• Is the rail free from any contaminants?

  Yes

  No

  N/A

• Is the rail free from dents, cracks, splitting and other damages?

  Yes

  No

  N/A

• Any corrosion or deterioration present in travel/attachment device?

  Yes

  No

  N/A

• Does the shuttle/travel device operate smoothly along the entire system?

  Yes

  No

  N/A

• Is there any other visible damages or modifications that may cause the system to fail?

  Yes

  No

  N/A
Other Structures for Anchoring (Davits)

• Are these present onsite.

  Yes

  No

  N/A

• What materials are they made from.

  Select Stainless Steel Galvanised Steel Alumimium Timber Fiberglass other

  • Stainless Steel
  • Galvanised Steel
  • Alumimium
  • Timber
  • Fiberglass
  • other

• Photos

  Media

• Is the structure a permanent support of the building?

  Yes

  No

  N/A

• Can it be accessed with ease?

  Safe

  At Risk

  N/A

• Is the structure free from dirt, grease, insects and other contaminants?

  Yes

  No

  N/A

• Does the structure have any sharp edges or burrs?

  Yes

  No

  N/A

• Will the structure hold a minimium 15+kN load?

  Yes

  No

  N/A

• Is anchor a minimum 200mm from any edge if mounted to concrete

  Yes

  No

  N/A

• What is the maximium WLL

  Select 15kN 12kN 1 x 136kg 2 x 136kg 3 x 136kg 4 x 136kg 150kg hoisting load

  • 15kN
  • 12kN
  • 1 x 136kg
  • 2 x 136kg
  • 3 x 136kg
  • 4 x 136kg
  • 150kg hoisting load

• Could slings or other rigging slip off?

  Yes

  No

  N/A

Final Appraisal

• What is the result of the inspection?

  Safe for use

  clean and re inspect

  repairs needed

  unserviceable

  other

• If anything besides safe for use was selected please give details

• Items to be addressed

• Photos

  Media

• Will a return visit be required? If yes provide details

  Yes

  No

  N/A

• Additional notes from technician

By Submitting this audit, the Technician has confirmed the site / systems are safe and comply to all relevent stardards uneless stated in above report.

• I Agree

  Sign

• Please add any extra detail you have regarding the project and systems being inspected.

• Is your housekeeping up todate on this project. All rubished removed leftover materials stacked neatly?

  Yes

  No

  N/A

• Do you agree?

  Yes

  No

  N/A