Pre-Task Elevated Work Checklist for Perimeter Walls (Shotcrete & Pour in Place)

• Project Number

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Describe work to be done:

• Estimate date range required of work to be done:

• Are Mirror Drain/Waterproofing completed?

  Yes

  No

  N/A

• Is dowel protection in place?

  Yes

  No

  N/A

• Holes covered, secured and covered?

  Yes

  No

  N/A

• Type of ladder, scaffolding or man lift are they in compliance with known regulations?

  Yes

  No

  N/A

• Have you spoken with the formwork foreman or GC to ensure the deck is ready for access by our manpower and preloading of our reinforcing materials?

  Yes

  No

  N/A

• Name of the Foreman that you spoke with?

• Have you walked the perimeter area before accessing with the manpower or preloading materials in the area?

  Yes

  No

  N/A

• Were all questions or concerns addressed by GC & forming contractor?

  Yes

  No

  N/A

• Rescue plan reviewed with the GC? (man basket & crane, man lift, ramps or other)

  Yes

  No

  N/A

• Is climbing rebar curtains with fall protection required?

  Yes

  No

  N/A

• Are vertical work bracing plans required? review plan if required.

  Yes

  No

  N/A

• If form work is provided, have you reviewed with GC or form work if it has been braced to handle rebar and manpower loads?

  Yes

  No

  N/A

• Do you have your vertical work plans completed, approved and signed off?

  Yes

  No

  N/A

• If engineered tie-off points are requested and supplied, are they inspected and signed off?

  Yes

  No

  N/A

• Does work described above require a Fall Protection Plan?

  Yes

  No

  N/A

• Please review.

• Harness and Lanyard selection and inspection?

  Yes

  No

  N/A

• Lifeline or horizontal retractable line plan complete, retractables selected and inspected?

  Yes

  No

  N/A

• Rated for one person 5,000 lbs and two person 10,000 lbs

  Yes

  No

  N/A

• Fall protection plans are required for all vertical work, these are to be reviewed and signed off by a Superintendent or Safety Department. Site condition adjustment can and should be made by Foreman as necessary.

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• ***If you have questions or run into a scenario that your unsure about, contact you're Superintendent or Safety Department to discuss before accessing Elevated deck or vertical element.***