Work at Height Inspection Form
Complete this form to document safety checks and compliance for work at height activities.
Site Name / Location
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector's Full Name
*
First Name
Last Name
Contact Email
*
example@example.com
Work at Height Task Description
*
Type of Access Equipment Used
*
Ladders
Scaffolding
Mobile Elevated Work Platform (MEWP)
Rope Access
Other
Personal Protective Equipment (PPE) Inspected and in Good Condition?
*
Yes, all PPE is present and in good condition
Some PPE is missing or damaged
No PPE available
Hazards Identified
Unprotected edges
Falling objects
Weather conditions
Inadequate lighting
Other
Inspection Checklist
*
Rows
Pass
Fail
N/A
Access equipment is secure and stable
1
2
3
Fall protection measures in place
4
5
6
Area below is cordoned off
7
8
9
Emergency procedures communicated
10
11
12
Weather conditions checked
13
14
15
Corrective Actions Required
Additional Comments
Inspector's Signature
*
Submit Inspection
Submit Inspection
Should be Empty: