PENTEL DRYWALL, INC / FALL PROTECTION SAFETY CHECK LIST

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Fall protection

• 1. Is each employee who might be exposed to fall hazards trained by a competent person qualified in the following areas, in the safe use of access ways and fall protection systems and the recognition of hazards related to their use? (21.A.16a)

  Yes

  No

  N/A

• a. The nature of access and fall hazards in the work area

  Yes

  No

  N/A

• b. the correct procedure of constructing, erecting, maintaining, using and dismantling access ways and fall protection systems.

  Yes

  No

  N/A

• c. The maximum intended load-carrying capacities of access ways and fall protection systems

  Yes

  No

  N/A

• d. All applicable requirements for EM-385 Section16

  Yes

  No

  N/A

• e. The limitations on the use of mechanical equipment during the performance of roofing work on low-sloped roofs

  Yes

  No

  N/A

• 2. Has retraining been provided as necessary for employees to maintain an understanding on these subjects?

  Yes

  No

  N/A

• 3. Is rescue equipment available and procedures known?

  Yes

  No

  N/A

• 4. Has employer verified employees training by a written certification record that identifies the employee trained, the dates of the training and the signature of the trainer?

  Yes

  No

  N/A

• 5. Are he manufacture's recommendations followed in the fitting, adjustment, use, inspection, testing and care of personal fall protection equipment? (21.C.06)

  Yes

  No

  N/A

• 6. Is personal fall protection protection equipment inspected by the worker before use each day to determine that it is in safe working condition? ) 21.C.07

  Yes

  No

  N/A

• 7. Are body belts prohibited from use ( except in positioning and restraining systems ) ? ( 05.F.01b ) ?

  Yes

  No

  N/A

• 8. Are ropes and straps ( webbing ) used in lanyards, lifelines and strength components of body belts and body harnesses made from synthetic fibers? ( 05.F.03d )

  Yes

  No

  N/A

• 9. When vertical lifelines are use, is each employee attached to a separate lifeline? ( 21.C.09a )

  Yes

  No

  N/A

• 10. Are anchorages used for attachment of personal fall arrest equipment independent of any anchorage used to support or suspend platforms and are hey capable of supporting at least 2,270 kg ( 5,000 lb ) per employee attached ? ( 21.C.10a )

  Yes

  No

  N/A

• 11. Are safety nets in place and tested before operations requiring safety net protection are undertaken ? ( 21.C.11c )

  Yes

  No

  N/A

• 12. Prior to commencing any activity which requires work in elevated areas, have all provisions for access and fall protection been delineated in the AHA and accepted by the designated authority ? ( 22.A.03 )

  Yes

  No

  N/A

• 13. Is each person supported by a suspended scaffold protected by a Type I body belt or body harness system ? ( 22.E.15a )

  Yes

  No

  N/A

• 14. Are workers provided fall protection whenever they are exposed to falls of 1.8 m ( 6 ft ) or more? ( 21.A.02b )

  Yes

  No

  N/A

• Comments:

• This check list is based on EM 385-1-1, dated November 3, 2003. Use of this check list is optional.

• Competent Person.

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