Written site-specific fall protection plan

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					                                    WorkSafe Bulletin                                                                                      !

  Written site-specific fall protection plan
A written fall protection plan is required prior to using a personal fall protection system for work with a potential
fall hazard of 7.5 m (25 ft.) or more.
The written plan should address issues such as
• Potential fall hazards on the job
• Types of fall protection systems to be used
• Instructions to workers on how to safely use the equipment
• Instructions on how to rescue a worker who has fallen and can’t initiate self-rescue

              Fall protection plan
               Site                                                          Work area

               Describe tasks




               Fall hazards




               Special assembly/disassembly procedures




               Rescue procedures




               Workers who received training

               1.                                                            4.

               2.                                                            5.

               3.                                                            6.


               The contents of this work plan have been conveyed to all workers of

                                                                      and their sub-contractors exposed to fall hazards where the use of

               a fall protection system is required.

               Supervisor’s signature                                        Date




Page 1 of 2                                       Workers’ Compensation Board of B.C.
Project: ______________________________ Address: _______________________________________
Employer: ________________________________ Supervisor: __________________________________
Date: __________________ Time:____________ Shift: __________________________________
Number in crew: ______________________ Number attending: ______________________________

Other safety issues or suggestions made by crew members:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________


Record of those attending:
 Name: (please print)                                 Signature:                                   Company:
 1.
 2.
 3.
 4.
 5.
 6.
 7.
 8.
 9.
 10.
 11.
 12.
 13.
 14.
 15.


Manager’s remarks: _______________________________________________________________
________________________________________________________________________________
Manager: _____________________________ Supervisor: _________________________________
                           (signature)                                                              (signature)




Page 2 of 2             WorkSafeBC Prevention Information Line: 604 276-3100 or toll-free 1 888 621-SAFE (7233)   TG 06-48