Personal Protective Equipment Inspection

to working at heights & work at nights

Crew #/Ref ID
Vehicle Reg #

Inspected by:
Date:

Crew Lead 1
Crew Member 3

Crew Member 2
Crew Member 4
The personal protective equipment check must also be performed daily before use

Helmet without a visor (dielectric E class)

Helmet

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

Gloves

Gloves suitable for climbing, in good condition and good fit

Goggles

Goggles in good condition

Safety boots Safety boots with toe cap, dielectric and in good condition
High Viz Vest Suitable for use in daytime and low light conditions, and in good condition
Fall Arrest Equipment
Harness Code
Date of Manufacture
Is in good condition (breakage , cutting, tearing, etc.)
Abrasion especially in areas of contact with accessories

Safety
Harness

Overstretching
Damage contact with heat, corrosive substances or solvents
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)

Positioning
Lanyard

Wear on pins or insurance

Broken springs , worn or out of place
Deformation or physical harm
Check overload indications

Shock
Absorbing
Lanyard

Protector of the shock absorber in good condition

The impact absorber is activated and / or is outside of its home position.
Damage or weakness seams due to contact with heat , corrosive or mildew

Work at Night Equipment

Halogen Flood
Light

LED Head
Lamps
Other
Is it present on the crew's vehicle
Fire
Extinguisher
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
Daily
Documents

Are sufficent copies of JSA/JSSP stored on vehicle

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 person using protective equipment:

Name and signature of crew leader at work:

Member 1
Member 2
Member 3
SIGNATURE

Member 4

Crew
member 4

Personal Protective Equipment

Crew
member 3

Crew ID:
Crew
member 2

Condition / Failure to be reviewed

Crew
member 1

Equip/Tools