Saline Water Desalination plant on the West Coast

WORK AT HEIGHT CHECKLIST

PTW Ref. No. Contractor Name: Date of Inspection:

Project Name Work Location:

Precaution require to complete the work safely Yes No N/A

Have the risk control/s been implemented? if yes state below
Fall Protection : Guard Rails system Safety Net Toe Board
Fall restraint : Life Line Retractable Harness
Fall arrest : Harness with Shock absorber & Double Hook With Normal Hook
Harness with Shock absorber & Double Hook With Big Hook
Has risk assessment (RA) been conducted and are safe work procedures (SWP) developed for the works?
Where hazardous work at height is carried out, is a permit-to-work (PTW) for hazardous work at height available and
implemented?
Have alternative ways of carrying out the work been considered?
Have all practical steps been taken to prevent falls?
Has it been assessed whether a fall will be arrested before hitting the ground/other structure?
Is there adequate supervision to ensure that safe work practices for working at heights are in place?
Are the hazards and risk control measures communicated to all workers?
Have proper access/egress been provided?
Is every ladder and step-ladder used of good construction, sound material and adequate strength for the purpose for which it is
used?
Where a ladder is used for access or as a working place, are adequate handholds provided to a height of at least one meter above
the place of landing of the highest rung to be reached by the feet of any person on the ladder?
Can three points of contact be maintained when using a ladder?
Does the ladder or step-ladder have level and firm footing?
Is the ladder or step-ladder secured so as to prevent undue swaying?
Are fall injury prevention systems required and in place?
In setting up a fall injury prevention systems is it inspected to ensure sharp edges, pinch points and sources of heat, which could
damage the system are identified and rectified?
Are the anchorage and anchorage line of the travel restraint system or fall arrest system inspected by a competent person before
use by the workers?
Are workers instructed on the proper method to wear and use the safety harness or restraint belt, as well as attach it to the lifeline
or anchorage point?
Is all fall protection equipment such as Full body harness with two shock absorbing lanyard being inspected and recorded in the
registry?
Is there a risk of falling objects striking people below? Are controls required?
Is a rescue plan required and in place?
Are the weather conditions appropriate for the work being carried out? Is it being monitored and recorded properly
Are the workers competent / trained for the task? Is there any proof of competency for the worker to assigned in work at heights
activity
Is the scaffold erected and inspected by Certified person? (if no do not proceed the activity)
Are all floor openings at any working platform adequately covered/ protected to prevent falling?
Are walkways in good condition and free from obstructions?
Are the scaffold, ladder, Arial lift inspected and recorded in a registry?
Name of Inspector: Date of Inspection:
Other (specify):
The following areas / items have been inspected by issuer and receiver
Danger/Warning Sign Scaffold Tag System Lighting Safety Barriers
Buddy System Rescue Material basket Other (specify:
PPE Required for the activity
Helmet Safety Shoes Safety Gloves Safety Ear Plugs/muff
Safety goggles Reflective Vest Dust Mask Coverall / Uniforms
Other (Specify):

INSPECTION RESULT: NOT APPROVED APPROVED

QHSSE/TBM03
 Saline Water Desalination plant on the West Coast
WORK AT HEIGHT CHECKLIST

PTW Ref. No. Contractor Name: Date of Inspection:

Project Name Work Location:

Remarks:

Inspected and attested by: Sub-Contractor Representative ASRF

Name:
Signature:
Date:

QHSSE/TBM03