Scaffolding Task Analysis

This form is designed to assist you in setting up safely for the work you are about to undertake and provides a list of hazards that may be present on your worksite.
You should always Eliminate (E) the risk of a hazard causing death, injury, or illness if you can. Where this is not possible, you must Minimise (M) the risk. There may be occasions where multiple controls are appropriate.
Enter your work method in the space provided below then use this checklist to identify any associated hazard/s. Brief everyone involved in the work being undertaken, ensure the appropriate controls are in place to control the risk/s, sign the form and submit as part of your job documentation.
Please contact HazardCo on 0800 555 339 if you require any assistance to identify hazards or implement the required controls. / Company:
TA Completed By:
Contact Cell Ph:
Site Address/Ref:
Date:
WorkSafe Notification Ref:
Ref Document: / Best Practice Guidelines for Scaffolding in New ZealandPublishedSept 2002by the Scaffolding, Access & Rigging New Zealand

Job Start Checklist – to be completed prior to the commencement of any work

At Base / Yes / No / At Site / Yes / No
  1. HazardCo Team Pack is in vehicle.
/ ❑ / ❑ /
  1. Park in a safe place.
/ ❑ / ❑
  1. Vehicle has a current WOF/COF, lights and tyres in working condition.
/ ❑ / ❑ /
  1. Ensure you wear your PPE/PPC and it is in good condition and appropriate for the work to be undertaken i.e. overalls, boots, mask, gloves, eye, hearing and dust protection.
/ ❑ / ❑
  1. Minimum PPE/PPC available and in good condition.
/ ❑ / ❑ /
  1. HazardCo Hazard Board set up in the vicinity of where work is being undertaken.
/ ❑ / ❑
  1. All emergency equipment and materials required for the work being undertaken loaded and secured.
/ ❑ / ❑ /
  1. Ensure you are inducted onto site - liaise with any Site Manager/Contractor/Client present to establish exactly what they are doing on site and any hazards associated with their work. Conduct your own induction if alone on site. Ensure the Hazard Board is updated and Emergency Plan is complete.
/ ❑ / ❑
  1. All work documents for job in vehicle.
/ ❑ / ❑ /
  1. Explain to Site Manager/Contractor/Client any hazards you are bringing to site or that may be present as a result of your work (use HazardCo Client Induction Cards where appropriate).
/ ❑ / ❑

Work Method Statement

Describe how you plan to carry out the work, using the example shown in the left hand column as a guide. Write your own method in the Work Method column on the right.

Work Method Example / Our Work Method
  1. Ensure WorkSafe notification has been made if scaffolding is to be greater than 5m

  1. Correctly load up vehicle at base

  1. On Arrival complete job Start Checklist on Task Analysis

  1. Complete / Review Task Analysis questionnaire and brief all workers on hazards and required risk controls – sign off form.

  1. Warning and safety signage in place

  1. Check for overhead services, and other site hazards

  1. Set up barriers around work area

  1. Unload equipment and all required materials

  1. Check all equipment is in good working order and safe for use

  1. Ensure personal fall protection system is in place and has been inspected prior to use

  1. Erect/Dismantle scaffold in accordance with the best practice guidelines

  1. Inspect and certify scaffold upon completion

  1. Advise client of any hazards created by the scaffold

  1. Arrange a time to come back and inspect scaffold

  1. Tidy up / depart site

Hazard Identification & Risk Management (E & M) – General Hazards

Answer the following questions relevant to the task you are doing (Tick “Yes” or “No”) / Yes / No / Hazard Identified / The following Risk Controls will be used for the identified hazards (tick the risk controls you will be using)
  1. Will you use any subcontractors?
/ ❑ / ❑ / Visitors/Contractors / All Contractors to be inducted to site (M);
Visitors to be escorted (M).
  1. Is the job in a residential area or near a school ?
/ ❑ / ❑ / Injury to public / Site to be fenced off (M);
Hazard Boards and warning signage used(M);
All visitors to be inducted to site (M).
  1. Will a toilet be available and is there running water on site?
/ ❑ / ❑ / Illness/Disease / Toilets are available (M);
Running water is available on site (M);
Good hygiene practices to be maintained (M).
  1. Will there be any vehicles coming on to site?
/ ❑ / ❑ / Moving vehicles / Keep clear off all designated roadways (M);
Hi-vis clothing to be worn (M);
Speed limit to be enforced on site (M);
Traffic management plan in place (M);
Designated areas for vehicle parking and deliveries (M).
  1. Are any electrical appliances to be used?
/ ❑ / ❑ / Electricity in use / RCDs to be used (M);
Leads and appliances to be in good condition and checked before use (M);
RCDs, leads and appliances to be tagged and tested (M).
  1. Are hand and power tools to be used?
/ ❑ / ❑ / Hand and Power tools / All workers using tools to be competent or supervised by a competent person (M);
Tools to be checked in good condition before use, with guards in place and leads tagged (M);
Equipment to be serviced regularly (M);
Workers to keep clear of any moving parts (M);
Appropriate PPE to be used (M);
Tools to be used correctly (M).
  1. Will there be any overhead work?
/ ❑ / ❑ / Overhead work / Tools are to be secured from falling (E);
Visitors to be kept clear of any overhead work (M);
The area under the work area to be isolated from workers (M).

Hazard Identification & Risk Management (E & M) – General Hazards

Answer the following questions relevant to the task you are doing (Tick “Yes” or “No”) / Yes / No / Hazard Identified / The following Risk Controls will be used for the identified hazards. (tick the risk controls you will be using)
  1. Will there be any use of equipment near overhead power lines?
/ ❑ / ❑ / High Voltage / Lines company to de-energise high voltage lines prior to comencing work (E);
Lines company to Isolate high voltage lines using “tiger tails” or similar (M):
All equipment to be kept a minimum of 4M clear of high voltage lines unless authorised by lines company (M):
Spotter to be used while moving equipment (M);
Moved by competent operator only (M).
  1. Will you require a delivery area?
/ ❑ / ❑ / Moving vehicles and machinery / Access to areas around the delivery area to be restricted using barricades, safety mesh or danger tape (M);
Safety zone to be set up around delivery area (M);
Adequate lighting to be provided for work in low light or at night (M);
Appropriate warning signage to be put in place (M);
A clear area for deliverytrucks is to be established (M);
  1. Will you be working at night or in poor lighting?
/ ❑ / ❑ / Poor Lighting/Visability / Artificial lighting to be provided where there is insufficient natural light (M);
No lone work at night (M);
Clear communication procedures in place (M).
  1. Is there likely to be trip or slip hazards on site?
/ ❑ / ❑ / Slips and Trips / Keep access ways clear of debris M);
Keep worksite clean & tidy (M):
Use appropriate lighting (M):
Rubbish bins to be used (M).
  1. Will there be any hazardous substances on site? e.g gas, paint e.t.c.
/ ❑ / ❑ / Hazardous substances / Correct storage, handling and disposal techniques (M);
Licensed handlers used(M);
Required PPE to be used (M);
Hazardous Substance Register and Safety Data Sheets (SDS) to be available on site(M).

Hazard Identification & Risk Management (E & M) – Scaffolding Hazards

Answer the following questions relevant to the task you are doing (Tick “Yes” or “No”) / Yes / No / Hazard Identified / The following Risk Controls will be used for the identified hazards. (tick the risk controls you will be using)
  1. Will there be a risk of fall from height?
/ ❑ / ❑ / Fall from heights / Fall restraint equipment to be used (M)
All staff to be trained to US23229 (M)
Ladders to be used as a last resort and for short periods only (M).
  1. Will the work being undertaken involve repetitive lifting, bending, twisting or other types of manual handling?
/ ❑ / ❑ / Manual handling / Use mechanical aids (E);
Manual handling training (M);
Use correct lifting techniques (M).
  1. Will work be affected by high winds?
/ ❑ / ❑ / Fall from height
High winds
Falling objects / Postpone working at heights (E);
Secure tools, materials and equipment (M);
Use appropriate fall protection and PPE (M);
Use the correct footwear for the job (M).
  1. Will materials be lifted by crane/forklift or similar?
/ ❑ / ❑ / Overhead loads / Competent/Trained staff only to operate crane/forklift
Exclusion zone set up (M);
Safety oserver to be used (M);
All non-essential workers and visitors kept clear while lifting occurs (M).
  1. Will you be using harness and lanyard systems
/ ❑ / ❑ / Fall from heights / Competent/Trained staff only to use harneses ( As per working at heights best practice guidelines) (M);
Daily safety checks to be done (M);
Resue plan in place (M);
  1. Will there be any work of ladders?
/ ❑ / ❑ / Ladders / Don’t use as a working platform (M);
Only commercial grade ladders in good condition (M):
Use correctly e.g. 1 in 4 method (M):
Use for access to the work area only (M);
Regular maintenance checks (M);
Ladders to be used as a last resort and for short duration only (M).

Any additional hazards you identify for the work to be undertaken that are not listed, should be written in the “Additional Site Information” box.

Please contact HazardCo on 0800 555 339 if you have an accident on the worksite.

Additional Site Information / Hazards

PPE Required / Signage
Required
Safety Briefing Completed By: / Date: / Signed:

Competencies of Workers Carrying Out Task

Name / Certificate of Competence level / Trained to US 23229 / Trained to US 15757

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WorkersReceiving Safety Briefing:

Name: / Name:

Scaffolding Checklist

Weekly Pre-use Inspection (Note: Scaffold must be inspected before use once a week as a minimum. It must also be inspected after every extended period of non-use e.g. after a weekend off and after a period of bad weather. All defects identified during your inspection MUST be rectified before the scaffold can be used.)

Weekly Pre-use Inspection
Is item ok? (tick as appropriate) / N/A / Yes / No / Is item ok? (tick as appropriate) / N/A / Yes / No
Has the scaffold been erected by a competent person? /  /  /  / Are all braces, clamps and ladders secured appropriately? /  /  / 
 /  /  / Is the leading edge of the working platform less than 300mm from the workface? /  /  / 
Are the guardrails and toe boards in place on all sides? /  /  /  / Are all toe boards a minimum of 150mm High? /  /  / 
Is the footing sound and rigid (not on soft ground, soft timber etc.)? /  /  /  / Is the scaffold more than one bay long? /  /  / 
Are the wheels locked in place (mobile scaffold)? /  /  /  / If so does each bay have it’s own access or is there clear access between each bay? /  /  / 
Is the platform fully completed, no gaps front to back and fully secured? /  /  /  / If Being left up over night is the access secured from unauthorized people gaining access? /  /  / 
Is the scaffold level? /  /  /  / Is the scaffold 4m clear of any electrical power lines/equipment? /  /  / 
Are all structural parts free from cracks and damage? /  /  /  / Is screening required to protect the public/vehicles? /  /  / 
Is there a safe way to get on/off the scaffold? /  /  /  / Is the screening secured adequately to the scaffold? /  /  / 
Are people working under the scaffold? /  /  /  / Is the scaffold over 5m? /  /  / 
Is there sufficient protection from falling debris/tools for people working under the scaffold? /  /  /  / Has Worksafe been notified? /  /  / 
Is the correct fall protection being worn? /  /  /  / If greater than 5m has scaffold been erected and certified by a trained scaffolder? /  /  / 
Date of Inspection: / Inspection Carried Out By:
Defects Listed Below:

Fall Protection System Checklist

Daily Pre use inspection

Pre-use Equipment Inspection. Fall Protection System Being Used:
Is the following ok? (tick as appropriate) / N/A / Yes / No / Is item ok? (tick as appropriate) / N/A / Yes / No
Has the harness been certified in the last 6 months by a competent person? /  /  /  / Is there a rescue plan in place? /  /  / 
Is the Harness tagged as safe to use? /  /  /  / Are all workers aware of the rescue plan? /  /  / 
Has the lanyard/Inertia Reel/Pole strap been certified in the last 6 months by a competent person?? /  /  /  / Is there rescue equipment available? /  /  / 
Is the Lanyard/Inertia Reel/Pole strap tagged as safe to use? /  /  /  / Are all workers trained in the use of rescue equipment? /  /  / 
Are all the clips, hooks, carabineers and D-shackles free from damage and rust? /  /  /  / Is there a minimum of 2 people available while working at height? /  /  / 
Are all straps and stitching in good condition? /  /  /  / Are all workers, working with a harness trained to Unit Standard 23229 as a minimum? /  /  / 
Is the harness clean from oil, grease, paint, and markings? /  /  /  / Are there sufficient correctly rated anchor points above head height of workers? /  /  / 
Are all moving parts free from cracks and damage? /  /  /  / Are all workers/supervisors installing fall arrest systems and anchor points trained to Unit Standard 15757? /  /  / 
Is there a manufacturers label clear and legible? /  /  /  / Is there an exclusion zone set up to protect people from the overhead works? /  /  / 
Is the harness older than 2 years? /  /  /  / Is the work over 5m from the ground ? /  /  / 
If above Q is answered yes remove harness from use? /  /  /  / If you answer yes to the above has Worksafe been notified? /  /  / 
If the correct Harness being used Fall Protection Vs. Fall Arrest? (see info on page 2) /  /  /  /  /  / 
Date of Inspection: / Inspection Carried Out By:
Defects Listed Below:

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