Aerial Project Safety Assessment

Aerial Project Safety Assessment
Please complete this form to ensure all safety protocols and risks are evaluated for your aerial project.
Project Name
Project Location (Site Address)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Assessment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Aerial Activity
Weather Conditions at Time of Assessment
Risk Factor Assessment
Rows Low Medium High
Proximity to Power Lines
Nearby Structures
Weather Impact
Equipment Condition
Personnel Training
Are all required safety equipment and PPE (Personal Protective Equipment) available and in use?
Is there a site-specific safety plan in place?
Rate the overall level of compliance with safety regulations
Have any incidents or near-misses occurred on this project site in the past 12 months?
If any incidents or near-misses occurred, please provide details
Additional Comments or Recommendations
Assessor's Full Name
First NameLast Name
Assessor's Email Address
example@example.com
Should be Empty:

Select theme: