Aerial Work Safety Assessment Form
Complete this assessment to verify aerial worksite and operator safety before starting the job.
Worksite or Job Location
*
Description of Work to be Performed
*
Type of Equipment or Platform Used
*
Please Select
Scissor Lift
Boom Lift
Suspended Scaffold
Ladder
Other
Equipment/Platform Condition
*
Inspected and in good condition
Minor issues (non-critical)
Unsafe—do not use
Weather and Environmental Conditions
*
Safe (clear, no wind/rain)
Marginal (light wind/rain)
Unsafe (storm, high wind, lightning)
Operator/Personnel Training and Readiness
*
Properly trained and ready
Training incomplete or unsure
Untrained—do not proceed
Fall Protection and PPE Check
*
All required PPE and fall protection in use
Some PPE/fall protection missing
No PPE/fall protection—stop work
Hazard Identification Checklist
*
Rows
Hazard Present?
Control Measures in Place?
Overhead obstructions
1
2
Nearby power lines
3
4
Unstable ground/surface
5
6
Pedestrian/vehicle traffic
7
8
Additional Hazards or Comments
Overall Safety Assessment (Go/No-Go)
*
GO: All safety checks passed, work may proceed
NO-GO: One or more critical safety issues identified
Submit Assessment
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