Stop the Drop observation card
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Project #
*
Project Name
*
Observers Company
*
If you choose other, enter the observers company here:
Company Observed
*
If you choose other, enter the company observed here:
Location
*
Has a PSI been completed and adequate for the task?
*
Yes
No
Are materials secured against a fall from heights
*
Yes
No
N/A
Are tools secured against a fall from heights? Tool retention in place?
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Yes
No
N/A
If rigging is involved, has it been approved and installed as required?
*
Yes
No
N/A
Are openings/gaps in the area covered and secured?
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Yes
No
N/A
Have workers coordinated and communicated with workers below them?
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Yes
No
N/A
Has a control zone been established in the area and maintained?
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Yes
No
N/A
Are toe boards and debris netting in place where required?
*
Yes
No
N/A
Have loose items been cleared from the edge/ not within the leading edge control zone?
*
Yes
No
N/A
Is fall protection being used properly where required?
*
Yes
No
N/A
Corrective action required
*
No action needed
Remove loose items from person/edge
Set up/adjust control zone
Review/adjust JHA/procedure
Update/review PSI
Secure loose materials
Establish/adjust leading edge control zone
Adjust fall protection
Cover holes/openings
Place toeboards/Debris netting
Tool retention needed
WORKERS INSTRUCTED TO STOP WORK
Other
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