Rope Access Skills Assessment Form
Evaluate and document the rope access skills, safety knowledge, and practical competencies of participants.
Participant Full Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Full Name
*
First Name
Last Name
Participant Email Address
*
example@example.com
Participant Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Rope Access Experience Level
*
Beginner
Intermediate
Advanced
Other
Certifications Held (select all that apply)
IRATA Level 1
IRATA Level 2
IRATA Level 3
SPRAT Level 1
SPRAT Level 2
SPRAT Level 3
Other
Assessment of Rope Access Skills
*
Rows
Needs Improvement
Fair
Good
Excellent
Equipment Inspection
1
2
3
4
Knots and Hitches
5
6
7
8
Rigging Techniques
9
10
11
12
Use of Fall Protection
13
14
15
16
Ascending and Descending
17
18
19
20
Rescue Procedures
21
22
23
24
Communication Skills
25
26
27
28
Overall Safety Awareness (1 = Poor, 5 = Excellent)
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Assessor Comments / Recommendations
Submit Assessment
Should be Empty: