Work At Height Risk Assessment Template

Department / Premises / Location
The activity/operation
Describe the work at height activity, operation or task being assessed:
What are the foreseeable consequences of a fall? For example, no injury, minor injury, moderate injury, severe injury or fatality.
Assessment factor: Put a cross in either the ‘Yes’ or ‘No’ or ‘N/A’ column / Yes / No / N/A / Comments
Can the activity/operation be done in a way that avoids work at height?
Can the work be carried out from a suitable existing place of work?
Does the existing workplace provide a means of preventing falls?
Does the existing workplace have suitable safe access and egress?
Does the work require the use of two hands?
Does the work require pushing or pulling?
Is the job repetitive in nature?
Is the job of short duration - between 15 and 30 minutes?
Will the job be supervised?
Does the task require the use of more than one person?
Does the task require equipment to be raised to the place of work?
Will the work take place where falling objects could injure passers-by?
Are the ground conditions suitable for a scaffold?
Are there any power cables or other overhead restrictions?
Are there suitable anchorage points for a ladder?
Can the risk of falling be eliminated?
Can the distance of fall be minimised?
Can the consequence of a fall from height be minimised?
Will inclement weather affect the safety of the job - high wind, rain, snow?
What is the distance of fall - in metres?
If the activity is just access or egress, such as getting onto a raised storage area, what is the distance to be travelled - in metres?
Access Equipment
Using the information above, select the equipment that should be used for the activity, operation or task being assessed.
Type of Equipment / Briefly explain why this equipment has been selected:
MEWP
Independent scaffold
Tower scaffold
Easidec
Ladder
Stepladder
Podium step
Fall arrest system
Work position equipment
Other - specify opposite
Assessment Factor / Yes / No / N/A
Is the equipment adequate for the foreseeable loading of people, equipment and materials?
If you answer ‘no’, you must reconsider the equipment selection for the activity or task
Instruction, training and inspection procedures
Assessment Factor / Yes / No / N/A
Have employees been trained or instructed in the use of the selected equipment?
If fall arrest equipment is to be used, are there emergency/rescue procedures in place?
Does the selected equipment require formal inspection periodically and before use?
Who will carry out the above inspection? Provide name, job title and contact number.
If you answer ‘no’ to training and emergency procedures, reconsider the equipment selection or put additional measures in place
Summary and further/remedial actions
With the above control measures in place,this activity/operation is considered to be: / High Risk / Medium Risk / Low Risk
Remedial actions or additional control measures required if medium or high risk / Date for completion of these
Assessor’s Name (Print below) / Assessor’s Signature / Date
Manager must sign below to accept the assessment and make sure that remedial actions are implemented
Manger’s Name (Print below) / Manager’s Signature / Date
Review Date (insert below) / Reviewed by / Comments