FALL PROTECTION WORK
PLAN – SAMPLE
INSTRUCTIONS
A written fall protection work plan must be
implemented by each employer on a job site where
a fall hazard of 10 feet or greater exists, in accordance with OSHA
Standards.
The plan must be specific for each work site.
THIS WORK PLAN WILL BE AVAILABLE ON THE JOB
SITE FOR INSPECTION.
Attached is a sample of a model fall protection work
plan that may be filled out by each employer who has employees exposed
above 10 feet. The following steps will help you fill out your plan.
1.
Fill out the specific job information.
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Company Name:
___________________________________________________________ |
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Job Name:
_________________________________________ |
Date:
_______________ |
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Job Address:
___________________________________ |
City:
_____________________ |
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Job Foreman:
___________________________________ |
Jobsite Phone:
_____________________ |
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2. FALL HAZARDS IN THE WORK
AREA
INCLUDE
LOCATIONS AND DIMENSIONS FOR HAZARDS
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Elevator shaft:
_____________________________ |
Stairwell:
______________________________ |
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Leading edge:
_____________________________ |
Window opening:
______________________________ |
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Outside static
line: _____________________________ |
Roof eave height:
______________________________ |
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Perimeter edge:
_____________________________ |
Roof perimeter
dimensions: ______________________________ |
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Other fall
hazards in the work area:
____________________________________________________________ |
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____________________________________________________________ |
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____________________________________________________________ |
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____________________________________________________________ |
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____________________________________________________________ |
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____________________________________________________________ |
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____________________________________________________________ |
3.
METHOD OF FALL ARREST OR FALL RESTRAINT
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(For fall protection equipment include
details, such as manufacturer etc.)
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Full body
harness:
_____________________________ |
Body belt
(Restraint only):
______________________________ |
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Lanyard:
_____________________________ |
Dropline:
______________________________ |
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Lifeline:
_____________________________ |
Restraint line:
______________________________ |
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Horizontal
lifeline:
_____________________________ |
Rope grab:
______________________________ |
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Deceleration
device:
_____________________________ |
Shock absorbing
lanyard:
______________________________ |
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Locking snap
hooks:
_____________________________ |
Safety nets:
______________________________ |
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Guard rails:
_____________________________ |
Anchorage points:
______________________________ |
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Catch platform:
______________________________ |
Scaffolding
platform:
______________________________ |
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Safety monitor:
______________________________ |
Name of monitor,
if used:
______________________________ |
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Other:
[LIST]
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4.
ASSEMBLY, MAINTENANCE,
INSPECTION, DISASSEMBLY PROCEDURE
Assembly and disassembly of all equipment
will be done according to manufacturers’ recommended procedures. (Include
copies of manufacturer’s data for each specific type of equipment used.)
Specific types of
equipment on the job are:
[LIST]
A visual inspection
of all safety equipment will be done daily or before each use, as stated
in the Employee Training Packet. Any defective equipment will be tagged
and removed from use immediately. The manufacturer’s recommendations for
maintenance and inspection will be followed.
5.
HANDLING, STORAGE &
SECURING OF TOOLS AND MATERIAL
Toe boards will be
installed on all scaffolding to prevent tools and equipment from falling
from scaffolding.
Other specific
handling, storage and securing is as follows:
[LIST]
6.
OVERHEAD PROTECTION
Hard hats are
required on all job sites with the exception of those that have no
exposure to overhead hazards. Warning signs will be posted to caution of
existing hazards whenever they are present. In some cases, debris nets
may be used if a condition warrants additional protection.
Additional overhead
protection will include:
[LIST]
Toe boards (at least
4 inches in height) will be installed along the edge of scaffolding and
walking surfaces for a distance sufficient to protect employees below.
Where tools, equipment or materials are piled higher than the top of the
toe board, paneling or screening will be erected to protect employees
below.
7.
INJURED WORKER REMOVAL
Normal first aid
procedures should be performed as the situation arises. If the area is
safe for entry, the first aid should be done by a foreman or other
certified individual.
Initiate Emergency Services – Dial 911 (where
available)
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Phone location:
_________________________________ |
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First aid
location: ________________________________ |
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Elevator
location: ________________________________ |
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Crane location:
__________________________________ |
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Other:
__________________ Location: ________________________
Rescue
considerations. When personal fall arrest systems are used, the
employer must assure that employees can be promptly rescued or can
rescue themselves should a fall occur. The availability of rescue
personnel, ladders, or other rescue equipment should be evaluated. In
some situations, equipment that allows employees to rescue themselves
after the fall has been arrested may be desirable, such as devices
that have descent capability. |
Describe methods to
be used for the removal of the injured worker(s):
[LIST]
8.
TRAINING AND INSTRUCTION PROGRAM
All new employees
will be given instructions on the proper use of fall protection devices
before they begin work. They will sign a form stating they have been
given this information. This form becomes part of the employee’s
personnel file.
The written fall
protection work plan will be reviewed before work begins on the job site.
Those employees attending will sign below. The fall protection equipment
use will be reviewed regularly at the weekly safety meetings.
Date:
_________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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_____________________________ |
_____________________________
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Foreman or Job Superintendent:
___________________________________________
Prior to permitting employees into areas where fall
hazards exist, all employees must be trained regarding fall protection
work plan requirements. Inspection of fall protection devices/systems
must be made to ensure compliance with OSHA Standards.
Fall Protection Work Plan Sample Two - Instructions
Why do I need a fall
protection work plan?
- Falls from elevation are a major cause of injuries
in the construction industry.
- OSHA Regulations require you to evaluate your
worksite to identify fall hazards.
- You must then eliminate or control the fall
hazards you identify.
- If fall hazards of 10 feet or more exist, you must
provide a written plan which identifies:
- All fall hazards in the work area
- The methods you and your employees will use to
eliminate and control them
- Correct procedures for assembly, maintenance,
inspection, and disassembly of fall protection systems used
- Correct procedures for handling, storage, and
securing of tools and materials
- The method of providing overhead protection
- The method for prompt, safe removal of injured
workers
- Training methods for the employees working on
the jobsite
·
The fall protection work plan must be specific to the work site
·
The fall protection work plan must be available on the work site for
review
·
The documentation of training must be available on the work site for
review
How do
I write the plan?
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Use the attached template to assist you
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Have a “competent employee” complete the template
to make it work site specific
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Customize the template as needed by adding
missing information and/or
deleting
unnecessary information
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NOTE: The plan form and individual site plans
must accurately describe the conditions at your worksite and
the methods you will use. A compliance officer will, in addition to
ensuring that your plan contains all the required elements, determine
if it describes what you actually do. If it does not, you may be
subject to citation and monetary penalty! |
Fall Protection Work Plan
Fall Hazard Identification and
Protection Selection Worksheet
On the table below,
identify each fall hazard of 10 feet or more that exists or will exist
during this construction project and then select the protection method
from the options identified below the table.
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Hazard Type
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General Location(s) |
Fall Protection Method |
Overhead Protection Method |
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Roof > 4/12 Pitch
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Roof < 4/12 Pitch
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Skylight Openings
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Roof Openings
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Floor Openings
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Window Openings
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Open-sided Floors
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Decks
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Balconies
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Leading Edge Work
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Mobile Lift Work
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Excavation Edges
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Grade Drop-Offs
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Other
_____________
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Fall Protection
Methods: Select a fall
protection method from the list below for each hazard identified above.
Assembly and implementation instructions for the method(s) used are
located elsewhere in this document.
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Standard Guardrails |
Fall Arrest Harness |
Fall Restraint Harness/Belt |
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Warning Line System |
Safety Net |
Cover or Hatch |
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Warning Line & Safety Monitor |
Positioning Belt |
Other: __________________ |
Overhead Hazard
Protection Methods: For each
overhead hazard identified, specify the method(s) of protection for
workers below. Refer to the “Overhead Protection” Section of this plan
for any special installation instructions.
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Hard Hats Required |
Screens on Guardrails |
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Overhead Hazard Signs |
Barricade to Control Access to Area |
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Debris Nets |
Other: _______________________________ |
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Toe Boards on Guardrails |
Other: _______________________________ |
Fall Protection Work Plan
Fall Protection
System Assembly and Maintenance
Fall protection
systems will be assembled and maintained according to manufacturer’s
instructions when using a manufactured system. A copy of those
instructions is available on-site for reference. Assembly and
maintenance instructions unique to this worksite such as components,
placement of systems, anchor points, areas where systems are particularly
subject to damage, etc., are specified below.
Standard
Guardrails must:
- be 39” to 45”
above the work surface at top rail with midrail and toe board.
- be able to
withstand 200 pounds of pressure on the top rail in any direction.
- not have
significant deflection.
- be inspected
regularly for damaged or missing components.
Note: A guardrail
does not protect a person standing on a ladder, box, or other surface
above the work surface.
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Post Material:
_________________________
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Rail Material:
__________________________ |
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Post Spacing (8’
max): __________________
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Anchor Method:
________________________ |
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Other
Instructions:
_____________________________________________________________ |
Fall Arrest
Harness:
- Must have anchor
points capable of withstanding a 5000 pound shock unless a deceleration
device in use limits fall to 2 feet, in which case a 3000 pound anchor
point may be used.
- Free fall may not
exceed 6’.
- A lower level may
not be contacted during a fall.
- Lifelines must be
placed or protected to prevent abrasion damage.
- Snap hooks may not
be connected to each other, or to loops in webbing.
- Inspect components
for deformation, wear, and mildew.
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System Component
List: ________________________________________________________
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Anchor Point at
this worksite: ____________________________________________________
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Configuration and
placement sketch attached? Yes __________ No
_________
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Other
Instructions:
_____________________________________________________________ |
Positioning
Belt:
- Employees must not
be able to fall more than 2 feet.
- The anchorage must
be able to sustain 4 times the intended load.
- Snap hooks must
not be connected to each other, or to loops in webbing.
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System Component
List: ________________________________________________________
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Anchor Point at
this worksite: ____________________________________________________
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Other
Instructions:
_____________________________________________________________ |
Fall Protection Work Plan
Fall Restraint
Harness/Belt:
Anchor points:
- must withstand 4
times the intended load.
- must always
prevent a free fall from the work surface. (Several alternate
anchor points may be necessary to
