NGM - Working at Heights - Ladders

• Site conducted

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• Conducted on

  Date

• Prepared by

• Location
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• 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

• Is an extension ladder following the 4:1 ratio (75 degrees)?

  Controlled

  At Risk

  N/A

• Is the extension ladder securely tied off?

  Controlled

  At Risk

  N/A

• Has the equipment been inspected (Fall protection, ladder, tie-off point)?

  Controlled

  At Risk

  N/A

• Is the extension ladder secured 3 feet from the top? (3 rungs)

  Controlled

  At Risk

  N/A

• Will 3 points of contact be maintained for task?

  Controlled

  At Risk

  N/A

• Does a harness/tie off need to be used when working off a ladder? (If the worker is working 5 feet or greater)

  Controlled

  At Risk

  N/A

Assessment

• CONTROLLED The presence of this control is verified and effective

• ATRISK This control is missing or ineffective

• NA Not Applicable to this exposure situation or not observed

Notes