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Homepage |
Managed Fall Protection Program Evaluation
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 duties
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 persons having Fall Protection
duties
and responsibilities have the education and training to do perform
adequately? |
Yes __ No __ |
Check training
records and interview. |
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5.
Are performance reviews conducted with Authorized Persons
demonstrating 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 equipment currently used by Authorized Persons? |
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 practice 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 requirements in this standard? |
Yes __ No __ |
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13. Is the system for purchasing equipment and systems
followed? |
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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? |
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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 drills performed? |
Yes __ No __ |
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19. Are drills evaluated for success and program improvement? |
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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 as outlined in the
requirements? |
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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