Fall protection and ladder practical checkoff
The worker below completed the online portion of fall protection and ladder training on LifeSafetyWiki. OSHA expects training to fit the actual site and equipment. Complete Parts 1 and 2 with the worker before they are exposed to fall hazards, then sign Part 3. Keep this form with your training records.
Part 1 — Your site (filled in by the employer)
| Fall hazards on this siteEdges, holes, skylights, roofs, wall openings, excavations | |
|---|---|
| Fall protection systems used hereGuardrails, nets, personal fall arrest, warning lines, safety monitor, controlled access zones | |
| Approved anchoragesWhere to tie off — and what is NOT an anchorage | |
| Rescue planWho responds, with what equipment, how fast (1926.502(d)(20)) | |
| Ladders and stairways in useTypes, where they are, who inspects them | |
| Fall protection plan in effect?Only for leading edge, precast or residential work (1926.502(k)) |
Part 2 — Hands-on check (by the competent or qualified person)
| The employee showed they can | OK | Not yet |
|---|---|---|
| Inspect a full body harness, lanyard and connectors and reject a defective one1926.502(d)(21) | ☐ | ☐ |
| Put on and adjust the harness so it fitsManufacturer instructions | ☐ | ☐ |
| Connect to an approved anchorage and explain the clearance below1926.502(d)(15)-(16) | ☐ | ☐ |
| Point out guardrails, covers and other systems on site and what to do if one is missing1926.502(b), (i) | ☐ | ☐ |
| Inspect a ladder, tag a defective one, set up at 1:4 with 3 feet above the landing1926.1053(b) | ☐ | ☐ |
| Climb facing the ladder with at least one hand on it, carrying nothing that upsets balance1926.1053(b)(20)-(22) | ☐ | ☐ |
| Describe the rescue plan and the signs of suspension trauma1926.502(d)(20) | ☐ | ☐ |
Part 3 — Certification
I certify that the worker named above received fall protection training from a competent person covering the topics in 29 CFR 1926.503(a)(2), and ladder and stairway training under 1926.1060, as it applies to this site.
29 CFR 1926.503(b) requires a written certification record with the employee’s name, the date(s) of training and the signature of the trainer or employer. Keep the latest one. This form does not replace the employer’s own program, and LifeSafetyWiki does not certify competence. Not an OSHA Outreach (10/30-hour) card.