Working at height

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site / Location:-

• Site Manager / Supervisor:-

• Signed:-

  Sign

• Date:-

  Date

Requirement

• Confirm awareness that “working at height” applies to any work undertaken above and/or below ground level e.g. excavations

  Yes

  No

  N/A

• Confirm that the task/work cannot be undertaken other than working at height

  Yes

  No

  N/A

• Undertake a risk assessment for the work and provide suitable safe methods of working e.g. method statements, permit to work system, toolbox talks, emergency rescue/retrieval plans, etc

  Yes

  No

  N/A

• Provide appropriate access and safety equipment and confirm it is maintained, tested and used as instructed and intended

  Yes

  No

  N/A

• Provide suitable protection to prevent falls from open edges of buildings, gangways, etc

  Yes

  No

  N/A

• Provide suitable protection to prevent falls through fragile surfaces or into holes or openings

  Yes

  No

  N/A

• Confirm the access and safety equipment provided is safe to use and has been installed correctly by a competent person

  Yes

  No

  N/A

• Confirm that workers are adequately trained, instructed and that they have been given sufficient information regarding the work

  Yes

  No

  N/A

• Provide adequate supervision

  Yes

  No

  N/A

Corrective Action

• Action required

• By whom

• Date

  Date