Rooftop Falls Safety Inspection
Site
Date/Time
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
24-Hour Time Minutes
Safety Inspector
First Name
Last Name
Foreman/Lead
First Name
Last Name
Rooftop Fall Prevention and Protection
Job Safety Briefing performed for the crew?
Acceptable
Marginal
Unacceptable
N/A
N/O
Job Hazard Analysis performed?
Acceptable
Marginal
Unacceptable
N/A
N/O
Does the JHA Process Form match the work?
Acceptable
Marginal
Unacceptable
N/A
N/O
Is the JHA Form complete and with hazards and mitigation?
Acceptable
Marginal
Unacceptable
N/A
N/O
Stair tower walkway has staircase to landing area?
Acceptable
Marginal
Unacceptable
N/A
N/O
Guardrails present for fall prevention?
Acceptable
Marginal
Unacceptable
N/A
N/O
Delineators and flaglines at least 15 feet from roof edge?
Acceptable
Marginal
Unacceptable
N/A
N/O
Anchor points (permanent) for edge fall prevention (if equipped)?
Acceptable
Marginal
Unacceptable
N/A
N/O
Raptor used as temporary fall prevention (if present) or fall protection as part of a PFAS?
Acceptable
Marginal
Unacceptable
N/A
N/O
Fall prevention properly used (kept away from edge)?
Acceptable
Marginal
Unacceptable
N/A
N/O
Fall protection properly used on roof (complete PFAS)?
Acceptable
Marginal
Unacceptable
N/A
N/O
Anchor points pass inspection?
Acceptable
Marginal
Unacceptable
N/A
N/O
PFAS pass inspection?
Acceptable
Marginal
Unacceptable
N/A
N/O
Fall prevention ropes/grabs pass inspection?
Acceptable
Marginal
Unacceptable
N/A
N/O
Skylights have fall prevention in place?
Acceptable
Marginal
Unacceptable
N/A
N/O
Personnel have the appropriate PPE?
Acceptable
Marginal
Unacceptable
N/A
N/O
Personnel are properly using the PPE?
Acceptable
Marginal
Unacceptable
N/A
N/O
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