Ref.

#: CMO-F-058
Rev. #: 0
Rev. Date: 01 July 2015

Contractors Logo
WORKING ON HEIGHTS CHECKLIST
(Above 2 meters)

Project name: ______________________________ Contractor: ____________________________

Type of work activity: ________________________ Const. Supervisor: _______________________

Insp.
Description YES NO REMARKS
point
Is a suitable protective working platform being
1
used?
Is the lifeline installed on rigid structure? Is 100%
2
tie off implemented? (when using FBH)
Is the correct ladder in use for the right work
3
activity? Is the person not standing on last 2 rungs?
4 Are people protected from falling objects?
5 Is the area isolated? (install barricade, signage)
6 Are ladders the right means of access for the job?
Are ladders in good working conditions?
7
(aluminum ladder required)
Are ladders secured from slipping sideways or
8
outwards? (tied on rigid structure)
9 Are the ladders inspected prior to use?
Do ladders have sufficient heights (at least 3rungs)
10
above their landing place of activity?
Are ladders positioned so that users don’t have to
11
stretch or climb over obstacle works?
Do ladders rest against a solid surface and not on
12
fragile or unsecured materials or structure?
13 Is buddy system implemented when using a ladder?
Are workers using the required basic PPE while
14
working on height? (significantly FBH)
15 OTHERS
I/We hereby commit to check/inspect daily in accordance with the above checklist and adhere to implement
standards policies and procedures, relating OSH Standards.

INSPECTED BY: __________________________________________ NOTED BY: _____________________________________

Designation/ Print name/signed Designation/ Print name/signed

DATE OF INSPECTION: ___________________________________ DATE: _________________________________________