Self-Assurance check list for Working at Height

• Audit Title

• Date of Assurance:

  Date

• Completed by:

• Site:
  Address

• Work description:

Above 1.8 meters

• Wast the work defied (description) in PTW?<br>(review at least 50% of issued PTW in last 3 months)

  Yes

  No

  N/A

• Was 'Working at Height' Task Sheet correctly filled in?<br>(review at least 50% task sheet for last 3 months)

  Yes

  No

  N/A

• Was Job Hazard Analysis (JHA) submitted for the required work?<br>(JHA must identify all the critical steps of the activity)

  Yes

  No

  N/A

• Is the equipment's (mobile platform, cherry picker, scaffold etc.) in good condition and maintained?<br>(check preventive maintenance record)

  Yes

  No

  N/A

• Is scaffold erected by competent (Authorized) person? And only authorized person use the equipment's?<br>(check competency certificate and authorization record)

  Yes

  No

  N/A

• Is there access ladder to climb on mobile platform?

  Yes

  No

  N/A

• Physical barriers and signage erected to prevent access to affected work area?

  Yes

  No

  N/A

• Is work carried out under full supervision?

  Yes

  No

  N/A

Working at Height below 1.8 meters

• Do site suing Step Platform Ladders or A frame ladders are maintained in good condition and tagged for safe use?

  Yes

  No

  N/A

• Have user attended the 'working at height' and 'Safe use of Ladder' training?

  Yes

  No

  N/A

• Are appropriate ladders used to reach to the required height?

  Yes

  No

  N/A

• Any other observation: