FORM

JDN.SF.08.35.E
VERIFICATION WORKING AT HEIGHT REVISION 01

General info
Project / Date & Time:
Vessel name:
Job location: PTW ref no.:

Verification of Control Measures (*) Yes No NA

1. All personnel is adequately trained and competent to perform work at heights.
2. The access to and from the elevated work location is considered safe.
3. Ladders are in good condition and are as far as practicable securely fixed (top / bottom).
4. Guard rails are available wherever there is a risk of falling more than 2m.
5. If item 4. is not practicable, all personnel are provided with a suitable Personal Fall Arrest
System.
6. Openings through which a person may fall are covered or guarded with effective barriers.
7. Fall prevention equipment is adequate and in good condition.
8. Anchorage points to attach Personal Fall Arrest Systems are available / in good condition.
9. Lifelines and/or lanyards are protected from contact with sharp edges / objects.
10. The area below to job site is barricaded to protect against Dropped Objects.
11. Scaffolds are erected by competent scaffolders and scaff-tags are used.
12. (if applicable) Special consideration is given to specific hazards related to working over the
side.
13. A rescue plan and equipment is in place to rescue persons suspended at height.
14. A JHA / SWP for the task is available, up-to-date and signed off by all persons involved.
15. Good housekeeping is practised to prevent falls due to tripping hazards, and against
Dropped Objects.
16. Others / Remarks:

(*) if ‘No’, then additional control measures shall be defined in 16. and these shall be put in place to reduce the risk to ALARP.

Declaration the info provided is accurate and the control measures listed above have been effectively
implemented at the time of the verification.
Name: Signature:
Function: Date:

JDN.SF.08.28.E 1/1