Roof Safety Pre-Access Checklist Form

• Site

• Employee Login

• Date and Time of Work

  Date

• Task Description

General Information

• IS A PERMIT IN PLACE FOR THE WORK?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• ARE WEATHER CONDITIONS ACCEPTABLE?

  Yes

  No

  N/A

• HAS THE WORKER UNDERGONE ROOF TRAINING?

  Yes

  No

  N/A

• HAS ALL REQURED PPE BEEN IDENTIFIED AND IS PROPERLY WORN BY WORKER?

  Yes

  No

  N/A

• IS THE WORKER FULLY AWARE OF THE TASK REQUIREMENTS?

  Yes

  No

  N/A

Access and Structure

• HOW WILL THE ROOF BE ACCESSED?

  Internally

  Externally

• ARE ANY STRUCTURAL DEFICIENCIES VISIBLE FROM THE ROOF UNDERSIDE?

  Yes

  No

  N/A

• ARE ALL ACCESS POINTS IN GOOD CONDITION AND SAFE TO USE?

  Yes

  No

  N/A

• ARE ANY MATERIALS OR TOOLS TRANSPORTED TO THE ROOF?

  Yes

  No

• Please comment HOW materials or tools will be transported to the roof

Walkways and Roof

• ARE WALKWAYS PRESENT ON THE ROOF?

  Yes

  No

  N/A

• ARE THERE ANY OBSTRUCTIONS ON THE ROOF?

  Yes

  No

  N/A

• ARE ALL ROOF EDGES PROTECTED/BARRIERED OFF?

  Yes

  No

  N/A

• ARE GUARD RAILS PRESENT?

  Yes

  No

  N/A

• ARE PRE-INSTALLED ANCHORAGES AVAILABLE?

  Yes

  No

  N/A

• ARE HARRNESSES/LANYARDS AVAILABLE AND INSPECTED BEFORE USE?

  Yes

  No

  N/A

Risk Assesment

• HAS A ONE MINUTE RISK ASSESSMENT FOR THE TASK BEEN COMPLETED?

  Yes

  No

  N/A

Competion

• COMPLETED AND ACKNOWLEDGED BY (SIGNATURE)

  Sign