Title Page
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Client/Site
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Conducted on
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Location
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Prepared by
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Task to be carried out
Identification of Work at Heights Activities
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Are there activities associated with working at heights?
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List activity
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Are the employees / contractors / members of public at risk from work at height identified?
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List their names here
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Frequency of performing these activities
Identification of Hazards
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Employee falling from height
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Objects falling on employees / members of the public
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Slipping / collapsing access equipment
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Slips / trips on elevated access ways
Control Measures
PLANNING
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Is working at heights avoided where possible?
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Is work at heights properly planned and organised?
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Has the work area been surveyed for hazards, eg overhead power lines, unsuitable ground conditions, moving machinery parts?
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During work at height is there always a competent person present who can suspend work if conditions change, eg weather, traffic, scope of work?
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Name of competent person
LADDERS/ACCESS EQUIPMENT
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Are portable ladders, steps and all other access equipment regularly inspected?
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Are ladders only used for light work of short duration?
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Are work platforms with edge protection, such as tower scaffolds, cherry pickers, scaffolding always used?
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Are work platforms sufficiently wide to walk on without risk of stumbling or losing balance?
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Are work platforms capable of supporting workers, equipment, materials, the safe working loads indicated and inspected every six months?
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Is there a log maintained for ensuring quality of these equipment?
OPEN EDGES
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Are open vertical drops identified and properly guarded when open?
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Are hand rails present on the open side of staircases?
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Are measures always taken to prevent falling objects injuring others as a result of working at heights?
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Is fixed edge protection provided to prevent falls where working at heights cannot be avoided?
RACKING
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Is storage properly planned which discourages climbing racking or pallets to access goods?
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Are adequate provisions in place to allow safe access to stored / displayed goods?
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Are staff trained in safe working methods to access high level racking?
TRAINING
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Have all workers who work at heights been assessed as competent or closely supervised by someone who is competent?
PROTECTIVE EQUIPMENT
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Where the risk of falls cannot be eliminated are safety harnesses, fall arrest devices or safety nets used as required?
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Are anchorage points for safety harnesses and ladders provided, used and regularly inspected?
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Write down positive observations
Recommendations
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List recommendations here
Completion
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Full Name and Signature of Inspector