QUALIFIED PERSON - ROPE ACCESS

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PPE

• Do you have full body harness?

  Safe

  At Risk

  N/A

• Is descent device operational?

  Yes

  No

  N/A

• Is mobile fall arrester operational?

  Yes

  No

  N/A

• Is shock absorbing lanyard free of any defects?

  Yes

  No

  N/A

• Is boatswain chair free of defects?

  Yes

  No

  N/A

• Is bucket free of defects?

  Yes

  No

  N/A

Job site hazard anaylisis

• Tie back anchors available?

  Yes

  No

  N/A

• Are you using parapet hooks?

  Yes

  No

  N/A

• Are you using safety cones/caution tape?

  Yes

  No

  N/A

• Is a ground monitor needed (1-3 yes 4-10 no)

Ropes and Hooks

• Hooks free of defects?

  Yes

  No

  N/A

• Rope Condition (3 or below, schedule replacement order)

Are all safety precautions in place for rope access to be operational?

• Signature of QP

  Sign

• Add signature

  Sign

• Add signature

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