LSR-Fall Protection Audit

Life Saving Rules - Fall Protection Verification

🪜 FALL PROTECTION AUDIT

👤 Auditor Information

Name of Auditor *

Date *

Company *

Location *

🏗️ Work Platforms & Scaffolds

Life Saving Rule: Falls are a leading cause of fatalities. 100% fall protection is required when working at heights greater than 6 feet.

Possible to use fixed or mobile work platform? *

YesNoNeeds ImprovementN/A

Scaffold Tag Inspection within past 24-hours? *

YesNoNeeds ImprovementN/A

Platform >4' - are there guardrails in place? *

YesNoNeeds ImprovementN/A

⚠️ Fall Protection Requirements

>6' fall potential - 100% continuous fall protection? *

YesNoNeeds ImprovementN/A

Workers aware of all hazards & mitigation? *

YesNoNeeds ImprovementN/A

Roofs with >/< 4/12 pitch w/ edges >6' have guardrails? *

YesNoNeeds ImprovementN/A

🦺 Harness & Equipment

Harnesses in good condition & worn correctly? *

YesNoNeeds ImprovementN/A

Snap hooks & D-Rings rated at 5,000lbs? *

YesNoNeeds ImprovementN/A

All Snap hooks Double-Action Self-Locking? *

YesNoNeeds ImprovementN/A

⚓ Anchor Points

Anchor Points Rated at 5,000lbs & evaluated? *

YesNoNeeds ImprovementN/A

Process Piping Anchors Approved by Engineer? *

YesNoNeeds ImprovementN/A

No guardrails, conduit, or scaffold used as anchorage? *

YesNoNeeds ImprovementN/A

Fall Protection system limits free fall to less than 6'? *

YesNoNeeds ImprovementN/A

🪜 Ladder Safety

Extension/Straight ladders being used at 4:1 ratio? *

YesNoNeeds ImprovementN/A

Ladders extend 3-5 rungs above landing surface? *

YesNoNeeds ImprovementN/A

Workers not leaning out past ladder rails? *

YesNoNeeds ImprovementN/A

📦 Dropped Object Prevention

Dropped object prevention accounted for? *

YesNoNeeds ImprovementN/A

💡 Opportunities for Improvement

Describe any opportunities for improvement

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