Fall Hazard-Rescue Plan Example
Fall Arrest Rescue Plan
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|Date: Job Description: |
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|Location: |
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|Contacts |Rescue Equipment |Critical Rescue Factors |
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|Rescuer(s) |□ Ladder □ Block & Tackle |Anchor Point |
| |□ Rescue Pole □ First Aid Kit | |
| |□ Rescue Rope □ Life Ring | |
|Competent |□ Spider □ Work Vest | |
|Person |□ Scaffold □ (Cutting Device) |Landing Area |
| |□ Stokes Litter | |
|Emergency |□ Alternative Lifting & Lowering Device | |
|Contact | | |
| | |Rescue Obstructions/Hazards: |
|Method of Contact: |Location of Equipment: | |
|□ PA □ Verbal/Face to face |□ Job Site □ Gang Box | |
|□ Radio Channel: |□ Tool House □ ____________ | |
|□ Phone Number: | | |
|□ Other | | |
|Check for Yes |Comment |
|□ Have alternatives to using fall arrest equipment been considered? | |
|□ Has rescue equipment been inspected and found in good shape? | |
|□ Is equipment adequate for the rescue plan (weight ratings, length, connection type, etc.)? | |
|□ Have communication devices been identified, located, & tested? | |
|□ Are all rescuers familiar with the use of the rescue equipment? | |
|□ If working over water, is there a boat available? | |
|Pre Work Tasks: |Response Procedure: |
|1) |Notify Emergency Contact. |
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|2) |Make medical assessment of person. |
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|3) |3) |
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|4) |4) |
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|5) |5) |
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|6) |6) |
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