NGM - Working at Heights - Aerial Lifts

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.
  
  Instructions: For each critical control, select Controlled, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

• Critical Controls

• Have you completed a Team Risk Assessment prior to starting the job?

  Controlled

  At Risk

  N/A

• Elevated work platforms are equipped with secured floors, guardrails and toe boards?

  Controlled

  At Risk

  N/A

• Lifting equipment have fall protection (Tramming/movement, check valves, limiting device, etc.)?

  Controlled

  At Risk

  N/A

• Is proper fall protection being utilized and is it anchored correctly?

  Controlled

  At Risk

  N/A

• Work Platform is positioned for stability, the rolling risk is mitigated. (Jacks, level, weather acceptable)?

  Controlled

  At Risk

  N/A

• Did the worker do a pre-operational check? (brake test, check fluids, safety devices, outriggers, etc.)

  Controlled

  At Risk

  N/A

Assessment

• CONTROLLED The presence of this control is verified and effective

• AT RISK This control is missing or ineffective

• NA / NO Not Applicable to this exposure situation or Not Observed