Work at Heights Safety Checklist
Complete this checklist before commencing any work at height to ensure all safety measures are in place.
Worker Name
*
First Name
Last Name
Supervisor Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Work Location / Site
*
Type of Work Being Performed
*
Please Select
Roof Work
Scaffold Work
Ladder Work
Platform Work
Other
Personal Protective Equipment (PPE) Check
*
Full Body Harness
Lanyard/Restraint
Helmet
Non-slip Footwear
Other
Are all harnesses and lanyards inspected and in good condition?
*
Yes
No
Not Applicable
Are anchor points secure and inspected?
*
Yes
No
Not Applicable
Environmental Conditions Assessment
*
Weather is suitable (no rain, strong wind, or lightning)
Surface is dry and stable
Area is clear of loose objects
Adequate lighting
Is a valid Work at Heights permit available?
*
Yes
No
Emergency rescue plan in place and communicated?
*
Yes
No
Additional Comments or Observations
I confirm that all above safety checks have been completed and work at heights will be conducted in accordance with safety protocols.
*
Submit Checklist
Submit Checklist
Should be Empty: