• Document No.

  • Sudent Name

  • Client / Site

  • Conducted on

  • Prepared by

Site Setup

  • Student chooses correct sign and puts them in place prior to work

  • correct barricades are assembled and positioned

  • Equipment is checked for date and compliance

  • Understands documentation required for the task


  • Does the student choose the correct PPE

  • Can the student put the PPE on correctly

  • Can the student remove PPE correctly

Tools and Equipment

  • Chooses the correct Working at heights equipment

  • Identifies isolation procedures

  • checks tools for defects in accordance with policies

  • Shows correct use of equipment

  • Wears harness correctly


  • Work area is made safe

  • Removal of waste and damaged equipment is done in accordance with the Company Policy

  • All tools are cleaned and put away

  • Equipment is checked after use and tagged for service


  • I declare that the information included in this report is true and I have witnessed the student participate in the process of Working at Heights in accordance with the Legal requirements.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.