Site Specific Fall Protection Plan version 3

Type: Form
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Creation details

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This QRsafety.com Smart Form is a series of questions that should be answered prior to working at heights. The questions may not identify every hazard for your task and location. The form is to be completed by a qualified person that can identify all hazards and add any that are missing.
This Smart Form has fields that will be hidden if they are not relevant to the work, as determined by your hazard assessment answers.
The completed Site Specific Fall Protection plan may be a part of the total solution however is not to be the only part of it. Users use it at their own risk.
This plan creators name Email Phone

Workplace location/ contact details

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Project/ Building name Prime Contactor/ Owner
Address of work
Supervisor(s) name - add rows for each Supervisor phone #

Work area details

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Hazards (basic) with standard controls

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Anything that could harm a worker or the public. Think of your work and location - what could happen to hurt workers or public
Steps/ actions taken to eliminate or decrease the risk of the hazards identified above. NOTE - best practice and regulations require controls to be chosen following a hierarchy with elimination being the first.

Choose the controls for dropped objects and access to work area

When there is potential for you to enter the limit of approach during the arresting of a fall and when there is potential for any of your tools or materials to enter the LOA - you will need an additional procedure created and followed.

Hazards (task Specific) with control checklist added when chosen

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Hazards (ladders and work platforms) with control checklist when chosen

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Controls - Personal Fall Protection system and administrative

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When you use a fall arrest system consider the hazards of swinging when your system stops you. Look at what you could swing into - best practice is to limit swing fall to less than 25 degrees

Equipment list and system step by step set up- will be empty when not applicable

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Based on the controls - the following components/ permits and/or tools will be part of your fall protection systems.
Do not proceed until you have reviewed and understand the manufacturer instructions. These step by step are in additional to them.

Exclusion zone items needed

Exclusion zone step by step

Fall Protection anchor item(s) needed

Harness options needed

To be in compliance, you will need to either have a rope grab with integral (permanently attached) 30" lanyard (CSA) or a separate lanyard max. 36" (ANSI)

Vertical lifeline step by step

Horizontal lifeline step by step

SRD step by step

Photos - add photos that will help users understand the hazards and controls

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Drawings - add any that will help users understand the hazards and controls

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Inspections

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The checked items will be inspected following the manufacturer instructions and at intervals checked to confirm set up is correct.

Rescue

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The following rescue techniques will be used in a hierarchy approach with self rescue being the first choice.
In a fall restraint system you cannot fall therefore rescue will not require work at heights. Follow standard injury/ first aid procedures.
Administrative controls do not allow a worker to get within 6.5' of a fall hazard. Rescue will be standard injury/ first aid procedures.
By choosing a scenario, the step by step instructions will be added to this plan.
Choose as many as needed.
They are listed in a hierarchy or difficulty.
a. Stay calm – let everyone know the system has worked and you are safe.
b. Look at yourself – are you injured. If so wait for help
c. Look at your system – has it been damaged? If so wait for help
d. If you can pull yourself back onto a work platform, floor, roof, structure without risking another fall – do so
e. Once back on the surface adjust your rope grab or your retractable device to remove any slack
f. Travel to a safe area
g. Disconnect system and notify your supervisor
h. Remove your entire fall protection system from service/ tag it
i. Notify owner of the anchor, if not your employer, and have it tagged/ removed from service
j. Participate in the incident investigation
a. Stay calm – let everyone know the system has worked and they are safe.
b. Notify your supervisor
c. Look at the fallen worker – are they injured. If so call first aid.
d. Look at the fallen workers fall protection system. Is it damaged from arresting the fall. If so, gather and deploy a back up fall protection system.
e. Make a note of the time the worker fell
f. If at anytime the worker gets groggy or becomes unconscious call your supervisor and 911
g. Prior to helping the fallen worker set yourself up in a fall protection system – restraint if possible
h. If you can reach out and grasp the fallen workers hand or harness, do so. Pull the worker into the structure
i. If needed have a rope and toss it to the fallen worker while the rescuer holds the other end – pull worker close when possible
j. In some cases you will need a short ladder or work platform for the worker to stand on and allow them to get slack on their rope grab or to reset their retractable. If this is required ensure the ladder/ work platform is tethered to structure, is held stable by the rescuer and the rescuer maintains hold of the fallen worker until they are able to stand on the surface.
k. Travel to a safe area
l. Disconnect system and notify your supervisor
m. Remove your entire fall protection system from service/ tag it
a. Stay calm – let everyone know the system has worked and they are safe.
b. Notify your supervisor and with their direction notify the Prime Contractor.
c. Look at the fallen worker – are they injured. If so call first aid.
d. Look at the fallen workers fall protection system. Is it damaged from arresting the fall. If so, gather and deploy a back up fall protection system.
e. Make a note of the time the worker fell
f. If at anytime the worker gets groggy or becomes unconscious call your supervisor and 911
g. Follow the direction of the Prime Contractor – or if you are the Prime Contractor follow your procedure for DEP box rescue.
h. Remove your entire fall protection system from service/ tag it
i. Notify owner of the anchor, if not your employer, and have it tagged/ removed from service
j. Participate in the incident investigation
NOTE - This plan requires a safe place to operate the MEWP that provides save access to the worker.
a. Stay calm – let everyone know the system has worked and they are safe.
b. Notify your supervisor and with their direction notify the Prime Contractor.
c. Look at the fallen worker – are they injured. If so call first aid.
d. Look at the fallen workers fall protection system. Is it damaged from arresting the fall. If so, gather and deploy a back up fall protection system.
e. Make a note of the time the worker fell
f. If at anytime the worker gets groggy or becomes unconscious call your supervisor and 911
g. Have qualified operator complete pre-use inspeciton of machine
h. Confirm the maximum load of the MEWP. Default to operator and the patient if you cannot confirm.
I. Place lift close to suspended worker. Using a second lanyard, connect to the workers back D ring.
J. Adjust MEWP location as required. When in best location connect the other end of fallen workers new lanyard onto the identified anchor of the MEWP.
K. Help worker gain access to the lift
L. When worker is in MEWP and connected to the MEWP - disconnect the fall pro system that stopped the fall.
M. Lower worker to safe area
h. Remove used fall protection system from service/ tag it
i. Notify owner of the anchor, if not your employer, and have it tagged/ removed from service
j. Participate in the incident investigation
a. Stay calm – let everyone know the system has worked and they are safe.
b. Notify your supervisor and with their direction notify the Prime Contractor.
c. Look at the fallen worker – are they injured. If so call first aid.
d. Look at the fallen workers fall protection system. Is it damaged from arresting the fall. If so, gather and deploy a back up fall protection system.
e. Make a note of the time the worker fell
f. If at anytime the worker gets groggy or becomes unconscious call your supervisor and 911
g. Follow your procedure for rescue using the specific rescue system
a. Stay calm – let everyone know the system has worked and they are safe.
b. Notify your supervisor and with their direction notify the Prime Contractor.
c. Call 911 and tell them you require a worker to be rescued from a fall
d. Take direction from 911 operator
NOTE 1– prior to considering emergency services your only rescue provider an assessment following requirements in WSBC Guidelines 14.3(1) must be completed and emergency services notified.
Note 2 - When doing short duration suspended work you should also consider the “Notice of Rescue Service for Short-term Work” found in section 4.13 of the WSBC guidelines - https://www.worksafebc.com/en/law-policy/occupational-health-safety/searchable-ohs-regulation/ohs-guidelines/guidelines-part-04#SectionNumber:G4.13_1

Notes from any section

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Workers sign off

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Supervisor signs to confirm it has been reviewed by workers - attach an additional sign off sheet if needed