michelle mckinnell

Topek Ltd - Unite Students - Mansafe Review Site Survey

A Mansafe Survey checklist to identify existing roof access systems to plan for areas requiring any future access to roof area and ensure adequate safety measures have been assessed prior to attendance on site.

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Information

Building Location (Name & City/Area)
Conducted on
Building Elevation - North or South
- North
- South
Prepared by

Mansafe Site Survey

Total Number of Roofs

Roof Access Systems Present

Type of Mansafe System Present? (e.g. horizontal, vertical and overhead)
Type of Fall Protection System? (e.g. guardrail systems, safety net systems, or personal fall arrest systems)

Photo Evidence

Photo
Photo
Photo
Photo
Photo
Photo

Items Present on Roof Requiring Future Access

Details
Photo
Photo
Details
Photo
Photo

Please briefly outline any recommendations or details that may be relevant to prepare for future access to areas identified (if applicable)

Details

Sign Off

Name & Signature of Inspector

michelle mckinnell

Topek Ltd - Unite Students - Mansafe Review Site Survey

Use this Template

Print as PDF

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