Person

al
Prote
ctive
Equip
ment
Inspe
ction
to
worki
ng at
heigh
ts &
work
at
night
s
Crew #/Ref ID
Inspected by:

AOM#01
Johann Sookdeo

Vehicle Reg #
Date:
Crew Lead 1
Crew Member 2

Andreas Springer
Omar Robinson

Crew Member 3 Makesi Flament

Crew Member 4
The personal protective equipment check must also be
performed daily before use

Equip/Tools

Condition / Failure to be reviewed

Crew ID:

Helmet without a visor (dielectric E class)

Support chinstrap is in good condition (and not broken or damaged)

Yes
Yes

Crew
member 2

Helmet

Crew
member 1

Personal Protective Equipment

Gloves suitable for climbing, in good condition and good fit

Yes

Goggles in good condition

Yes

Safety boots with toe cap, dielectric and in good condition

Yes

High Viz Vest Suitable for use in daytime and low light conditions, and in good condition

Yes

Gloves
Goggles
Safety boots

Fall Arrest Equipment

Harness Code

H3515231WMD

05

Date of Manufacture

Safety
Harness

Positioning
Lanyard

Shock
Absorbing
Lanyard

Is in good condition (breakage , cutting, tearing, etc.)

No

Abrasion especially in areas of contact with accessories

No

Overstretching

No

Damage contact with heat, corrosive substances or solvents

No

Carabiners / Beckles are free from deformation or damage

Seams show no sign of being cut, worn, damaged or weakened due to
heat, corrosion or mildew
They are in perfect condition (rusted , broken , heat damage)

Yes

No

Yes

Wear on pins or insurance

No

Broken springs , worn or out of place

No

Deformation or physical harm

No

Check overload indications

Yes

Protector of the shock absorber in good condition

Yes

The impact absorber is activated and / or is outside of its home position.

No

Damage or weakness seams due to contact with heat , corrosive or mildew

No

Work at Night Equipment

Halogen Flood
Light

LED Head
Lamps
Other
Fire
Extinguisher

H3515

Is it present on the crew's vehicle

When was the last date of inspection ( or identify if brand new)

Caution Tape Is it present on the crew's vehicle

Safety Cones Are minimum 4 cones present per crew's vehicle, and in good shape
Are sufficent copies of JSA/JSSP stored on vehicle

Daily
Documents

Are sufficent copies of vehicle inspection checklist stored on vehicle

Based on the above inspection checklist, are the

crew members valid to perform work on the project.
Name and signature of crew leader at work:

SIGNATURE

Name and signature of person using protective equipment:

Member 1
Member 2
Member 3
Member 4