Fall Protection Evaluation
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Date Evaluated: Person
Evaluating: Facility
Evaluated: |
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Comments
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1.
Does a written Fall
Protection policy exist? |
Yes __ No __ |
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2.
Does the written Fall Protection
policy apply to ALL fall hazards? |
Yes __ No __ |
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3.
Are the roles
and responsibilities for Fall Protection documented, assigned and clearly
understood? |
Yes __ No __ |
Assess all assigned roles
based on written roles and responsibilities and interviews with fall
protection program persons. |
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4.
Do the people with Fall Protection roles
and responsibilities have the education and training to do perform
adequately? |
Yes __ No __ |
Check training records and
interview. |
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5.
Do performance reviews include
demonstrations of the proper procedures and use of equipment? |
Yes __ No __ |
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6.
Does the Fall Protection training
program conform with the American National Standard
Z490.1-2001, Criteria for Accepted Practices in Safety, Health, and
Environmental Training? |
Yes __ No __ |
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7.
Does the Fall Protection training
program address known hazards and utilize the actual equipment currently
used? |
Yes __ No __ |
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8.
Are the existing fall
hazard survey reports current? |
Yes __ No __ |
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9.
Are new or modified fall protection
systems designed according to current design requirements? |
Yes __ No __ |
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10.
Are the selected fall hazard controls documented and meet the hierarchy
of controls? |
Yes __ No __ |
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11.
Do the anchorage systems meet the anchorage
design requirements? |
Yes __ No __ |
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12. Is there a written system to ensure that purchased equipment and
systems meet the standard requirements? |
Yes __ No __ |
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13.
Is the system followed? |
Yes __ No
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Fall Protection Program Evaluation, Page 2
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Comments |
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14.
Does the system to inspect, maintain,
store, and care for fall protection systems ensure that the equipment meets
this standard? |
Yes __ No __ |
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15.
Are there documented fall protection,
rescue, and evacuation procedures for all work with fall hazards? |
Yes __ No __ |
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16.
Are they complete, clear, and
available to all personnel? |
Yes __ No
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17.
Are insurance claims evaluated to
determine if procedures, work areas, or equipment have uncontrolled hazards? |
Yes __ No __ |
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18.
Are rescue and evacuation drills
performed? |
Yes __ No __ |
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19.
Are drills evaluated for success and
program improvement? |
Yes __ No __ |
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20.
Is Fall Protection and Prevention a
consideration for new buildings, facilities, and equipment? |
Yes __ No __ |
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21.
Are incident investigations reviewed? |
Yes __ No __ |
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22.
Is the Fall Protection Program
evaluated at least every two years, or when deficiencies are identified, or
when there are incidents involving personnel or property damage? |
Yes __ No __ |
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23.
Does each written program evaluation
identify the strengths, deficiencies, and recommendations for improvement? |
Yes __ No __ |
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24.
Is a documented plan of action
developed, identifying the changes, who is responsible, and when they will be
completed? |
Yes __ No __ |
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25.
Are program evaluations kept for at
least 5 years or longer if required by a legislative authority? |
Yes __ No __ |
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