TOTAL OIL INDIA PRIVATE LIMITED

WORKING AT HEIGHT INSPECTION CHECKLIST

Date: Location:
Inspector Name: Contractor Name:
Ite Description Y N
m
1 IS WORK AT HEIGHTS PROPERLY PLANNED AND ORGANIZED?
2 ARE ALL THE PERSONNEL SELECTED MEDICALLY FIT?
3 ARE ALL THE PERSONNEL UNDERGONE TRIANING FOR CANOPY CLEANING
ACTIVITY?
HAS JOB SAFETY ANALYSIS (JSA)/RISK ASSESSMENT (RA) CONDUCTED COVERS
4 ALL THE ACTIVITIES OF WORK AT HEIGHT?

5 ARE THE HAZARDS AND RISK CONTROL MEASURES COMMUNICATED TO ALL

STAFF?
6 IS PREVENTION PLAN SIGNED, VALIDATED AND COMMUNICATED TO ALL STAFF
7 IS WORK AUTHORIZATION AND WORK AT HEIGHT PERMIT ISSUED TO
AUTHORIZED PERSONS AND EXPLAINED TO ALL STAFF BEFORE START OF WORK
8 ARE ALL MATERILS OF THE SCAFFOLD ARE FREE FROM DAMAGES AND STORED
BARRICADED WITH WARNING SIGNAGE?
9 ARE ALL MATERILS OF THE SCAFFOLD ARE BARRICADED WITH WARNING
SIGNAGE?
10 ARE OSHA APPROVED SCAFFOLD MATERIAL WITH CERTIFICATE AVAIALABLE?
11 ARE OSHA APPROVED SCAFFOLDERS WITH VALID CERTIFICATE AVAILABLE?
12 IS OSHA APPROVED SCAFFOLD INSPECTOR VERIFIES THE SCAFFOLD AFTER
ERECTION?
13 IS ERECTED SCAFFOLD PROTECTED BY HARD BARRICATION WITH WARNING
SIGNAGE
DISPLAYED?
14 IS SCAFFOLD TAG SYSTEM IS MAINTAINED?
15 IS TOP RAIL(0.9M-1.10M), MID RAIL(0.45M- 0.60M) AND TOE BOARDS(0.1M) FROM
THE WORKING PLATFORM OF SCAFFOLD INSTALLED?
16 ARE OUTRIGGERS INSTALLED ON ALL THE FOUR SIDE TO ESTABLISH FORM
SUPPORT TO THE SCAFFOLD
17 ARE ALL WHEELS OF MOBILE SCAFFOLD ARE LOCKED AND ENSURED?
18 ARE PERSONAL WEARING PERSONAL PROTECTIVE EQUIPMENTS LIKE SAFETY
SHOES, GOGGLES, HAND GLOVES, NOSE MASK AND REFLECTIVE VEST OF ISI
MARK
19 IS FULL BODY HARNESS WITH DOUBLE LANYARD OF ISI MARK WITH VALID
CERTIFICATE AVAILABLE?
20 ARE THE FULL BODY HARNESSES USED BY STAFF INSPECTED AND PRE USE
CHECKLIST MAINTAIEND?
21 DOES THE FULL BODY HARNESS HAS SHOCK ABSORBER

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