Information
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Document No.
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Client / Site
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Conducted on
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Assessor:
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Location of Assessment:
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Course Participant:
Prior to working at heights the participant:
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Inspected the work area and complete a Take 5 or JSA for a task involving working at heights.
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Reviewed any relevant Height Safety procedures, Legislation to ensure proposed work is compliant.
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Signage and barrier tape erected in work area?
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Recognised & Described an understanding of the use of tool lanyards and edge protection toe-boards.
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Recognised & Described the use of a Fall-arrest system.
Knot Tying: (participant correctly tied the following knots at least three times.
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Figure 8 stop knot.
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Figure 8 on the bight.
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Figure 8 follow through.
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Alpine Butterfly.
Practical Sign-off
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Personally inspected a Working at Heights safety equipment.
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Donned Harness in accordance with the manufacturer's requirements.
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Setup and used a 'Total Restraint' system.
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Setup and used a 'Temporary Ladder Safety' system.
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Used proper manual handling techniques
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Conducted periodic safety checks / reassessed task as required.
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Dismantled all systems, put away equipment and return work area to normal operating conditions.
Sign-off
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Unit Status:
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Assessor's Comments:
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Participant Comments:
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Participant's Signature
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Date/Time Assessment Completed:
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Assessor's Name and Signature:
