NGM - Working at Heights - Scaffold - Platforms

• 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

Critical Controls

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

  Controlled

  At Risk

  N/A

• Is the platform tagged and tied off?

  Controlled

  At Risk

  N/A

• Are barricades in place in the exclusion zone under the work area?

  Controlled

  At Risk

  N/A

• Are the physical barriers handrails, planks, kick plate all in place?

  Controlled

  At Risk

  N/A

• There is safe access and fall protection utilized to access the platform

  Controlled

  At Risk

  N/A

• Key components of Fall protection system inspected. (Harness)

  Controlled

  At Risk

  N/A

• Can 3 points of contact be maintained when descending and ascending the scaffold?

  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