Job Number

Job Type

Select date

Operatives on site

Is this a Window cleaning task?

If it is not Window cleaning ?

The following information constitutes an on-site risk assessment for the job. A Method Statement is also required.

Access to height is via?

Via Velux window or rooflight Sky SAT procedures with roped access techniques in use.

Ladder. With minimum control measures ( sky's fall arrest systems, eye bolting ML and LM or equivalent from the Ladder Hierarchy.

Via dormer Sky SAT procedures as trained with roped access techniques in use.

Other means ( give details below ) Specify minimum control measures required.

Additions to or variations from standard control measures. Any other relevant information- Please specify clearly.

Which (if any) ladders are to be used? Select all required.
NOTE: All PPE and ladder hierarchy should be used as minimum control measure.

8 rung ladder

Single section

Double section

Triple section

DAT roof ladder

Combi ladder

If anchor points are needed for Roped Access are they:

Existing and Fixed ( and in date and granted permission to use?)

Temporary - e.g. 20mm eyebolt (primary & back up?)

Part of the building structure- Checked and verified by both Engineers?

On-site identified hazards.

Can the following Hazards identified be removed. If hazard is not present select N/A

Adverse weather

Third parties

Existing equipment

Garden Hazards

Ground Hazards

Any other Hazard ( give details below)

Additional Hazard information

Can Hazards be controlled or minimised?

If Hazards cannot be controlled or minimised then they must be escalated (give details below)

Method Statement.

A clear and detailed method for carrying out the work must be recorded here before the work commences. Items to be covered include site details, pre job preparation, roof type (flat/sloping(give apps angles)); rescue considerations (if standard rescue techniques say so, otherwise specify in detail). The method statement should have sufficient detail to allow another team to understand how they would carry out the work. Add photos/draw diagrams as necessary to illustrate.

Add media
Add drawing

Both Operatives must sign before work commences.

Operative leader 1
Operatitve 2
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.