Title Page

  • Client/Site

  • Conducted on

  • Location
  • Prepared by

  • Task to be carried out

Identification of Work at Heights Activities

  • Are there activities associated with working at heights?

  • List activity

  • Are the employees / contractors / members of public at risk from work at height identified?

  • List their names here

  • Frequency of performing these activities

Identification of Hazards

  • Employee falling from height

  • Objects falling on employees / members of the public

  • Slipping / collapsing access equipment

  • Slips / trips on elevated access ways

Control Measures

PLANNING

  • Is working at heights avoided where possible?

  • Is work at heights properly planned and organised?

  • Has the work area been surveyed for hazards, eg overhead power lines, unsuitable ground conditions, moving machinery parts?

  • During work at height is there always a competent person present who can suspend work if conditions change, eg weather, traffic, scope of work?

  • Name of competent person

LADDERS/ACCESS EQUIPMENT

  • Are portable ladders, steps and all other access equipment regularly inspected?

  • Are ladders only used for light work of short duration?

  • Are work platforms with edge protection, such as tower scaffolds, cherry pickers, scaffolding always used?

  • Are work platforms sufficiently wide to walk on without risk of stumbling or losing balance?

  • Are work platforms capable of supporting workers, equipment, materials, the safe working loads indicated and inspected every six months?

  • Is there a log maintained for ensuring quality of these equipment?

OPEN EDGES

  • Are open vertical drops identified and properly guarded when open?

  • Are hand rails present on the open side of staircases?

  • Are measures always taken to prevent falling objects injuring others as a result of working at heights?

  • Is fixed edge protection provided to prevent falls where working at heights cannot be avoided?

RACKING

  • Is storage properly planned which discourages climbing racking or pallets to access goods?

  • Are adequate provisions in place to allow safe access to stored / displayed goods?

  • Are staff trained in safe working methods to access high level racking?

TRAINING

  • Have all workers who work at heights been assessed as competent or closely supervised by someone who is competent?

PROTECTIVE EQUIPMENT

  • Where the risk of falls cannot be eliminated are safety harnesses, fall arrest devices or safety nets used as required?

  • Are anchorage points for safety harnesses and ladders provided, used and regularly inspected?

  • Write down positive observations

Recommendations

  • List recommendations here

Completion

  • Full Name and Signature of Inspector

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