Fall Hazard Assessment Form
Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________
| Field | Value |
|---|---|
| Category | Fall Protection |
| Recommended Industry | All |
| Document Type | Form |
| Access Level | Starter |
| Last Reviewed | 2026-06-29 |
| Last Updated | 2026-06-29 |
How to Use This Template
Complete the fields as fully and accurately as possible at the time of the task or event. Route the completed document per your internal process and retain it with your records.
Template Body
Assess fall hazards before work and select controls.
Area / task: [] Location: [] Date: [DATE] Assessed by: [NAME]
| Fall Hazard | Present? | Height | Exposed Workers | Control Measure |
|---|---|---|---|---|
| Unprotected edge/side | ☐ | [__] | ||
| Floor/roof hole or opening | ☐ | [__] | ||
| Leading edge | ☐ | [__] | ||
| Skylight/fragile surface | ☐ | [__] | ||
| Ladder/elevated work | ☐ | [__] | ||
| Excavation/wall opening | ☐ | [__] |