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HBI - Fall Protection Work Plan

HBI

Fall Protection Work Plan

Employees must review and adhere to the requirements of this fall protection work plan for the duration of work activities.

MM slash DD slash YYYY

Fall Hazards

Select all existing or potential hazards associated with work task(s) where a fall would exceed 4’.

Fall Protection System to Be Used

Select all components of the Personal Fall Arrest or Personal Fall Restraint System to be used.

Inspection & Maintenance of Fall Protection System

Assembly & Disassembly of Fall Protection System

Handling, Storage and Securing of Tools and Materials

Method(s) of Overhead Protection

Select all methods of overhead protection for workers who may be in or pass through the area below the worksite.

Fallen Worker Rescue Plan

In the event of a fall from height, the fallen worker will first attempt to perform self-rescue. The supervisor will immediately alert HBI rescue and first aid teams. If the rescue team cannot perform a rescue within 3 minutes the Jobsite Contact and Emergency Services are to be called immediately.

Rescue Equipment

Select all equipment that will be needed to assist in the aid and rescue of a fallen worker.

Communication or Method of Contact

Select all communication methods that will be used between the fallen worker and rescue team.

Rescue Procedures

Pre-Work Tasks:


  1. Identify rescue & first aid team(s).
  2. Inspect work area.
  3. Identify additional access / anchor points.
  4. Inspect and stage rescue equipment.
  5. Review rescue plan with crew.
  6. Coordinate rescue plan with jobsite contact.

Response Procedures:


  1. Make medical assessment of worker.
  2. If possible, have worker perform self-rescue.
  3. If unable, notify rescue & first aid team(s).
  4. Notify jobsite contact & call 911 or ________.
  5. Assist emergency responders.
  6. Notify Hudson Bay Insulation safety team.

Special Cosideration & Coordination

Employee Acknowledgment of Fall Protection Training

All employees are to adhere to the Fall Protection procedures that are set forth in the HBIC Safety & Risk Management Plan. All employees shall have been trained by a qualified competent person; the training shall consist of a review of the fall protection work plan and the proper use of fall protection equipment before work is to begin. Copies of this form are to be turned into the HBIC Safety Department and maintained at the jobsite.
Name:
Name:
Name:

Approvals

Fall Protection Work Plan Completed By:
Submitted To:
MM slash DD slash YYYY
Approved By:
MM slash DD slash YYYY

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