C/M or P/M Michael Rhoads

Reviewed:
CONSTRUCTION ACTIVITY HAZARDS ANALYSIS
Aerial / Scissor Lifts
B239 Rev: 2015
Building & Room(s): Contractor/Subcontractor Name: DMS

Project: Date:
B239 RENOVATION

Scope of Work: Removal of existing light fixtures and fire sprinklers and installation of new fixtures and fire sprinklers.
Tasks being Performed Potential Safety Risks/Hazards Safety Controls / Mitigations

Scissors Lifts,
Aerial Lifts
Make: SUNBELT_____
Model:GS-2646______
Serial#:_1022478____
Risk of personnel Injury due to
working at elevations &
exposed to a fall
All employees shall be trained and instructed in the safe use and operation of equipment.
Pre-shift inspections of all equipment shall occur prior to the start of work or shift by the
subcontractor's competent person / user.
Fall protection is required when operating any Aerial / Scissor lift.
A fall protection matrix is required when using fall protection equipment.
Two (2) certified operators must be present at all times during operations of the lift.
One as a lift operator and the other as a spotter.

Be aware of your surroundings.

Identify overhead and ground obstructions.

Lifts placed in passageways, doorways or any location where other activities are being
conducted, barricades or delineation need to be in place.

Employee Signatures: Date: Employee Signatures: Date: Employee Signatures: Date:

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