Basic Overview

Height of the working platform

Work Duration

Time between equipment moves

Work Activity

Access Equipment
Equipment in use

Other (Specify)

Safe Working Load

SWL of access equipment (KG)

Maximum combined weight of operator(s), tools and materials (KG)


Can working at height be avoided?

Working at height should not be completed, working at height must be avoided where alternative methods are reasonably practical

Detailed Assessment of Task

Does the task involve:

Insufficient rest or recovery

Level of Risk

A work rate imposed by a process

Level of Risk

Working on or near fragile surfaces

Level of Risk

Strenuous pushing or pulling

Level of Risk

Working on or near fragile surfaces

Level of Risk


Level of Risk

Holding tools or materials away from trunk

Level of Risk

Task Comments and Control Measures

Detailed Assessment of Working Environment

The Working Environment- are there:

Constraints on posture

Level of Risk

Poor lighting conditions

Level of Risk

Poor floor conditions

Level of Risk

Uneven ground

Level of Risk

Overhead hazards

Level of Risk

Hot, cold or humid conditions

Level of Risk

Strong air movements

Level of Risk

Environment Comments and Control Measures

Detailed Assessment of Individual

The Individual – Does the job

Call for special information and/or training e.g. IPAF

Level of Risk

Individual Comments and Control Measures

Other Factors

Is movement or posture hindered by:


Level of Risk

Personnel Protective Equipment

Level of Risk

Other Factors Comments and Control Measures

Control Measures
Measures in place

Other Measures (Specify)

Additional Measures Required

Additional Measure



Date Due
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.