Fall Prevention Plan

Sample Fall Protection Plan
Taken from OSHA's website.

FLS recommends using the following only as an example. Most sites will be more specific; the customer's safety
representative should develop a detailed plan
6.1 BC Construction Industry Health & Safety Council Site Specific Fall Protection Plan
6.1.1 Employer Responsibilities
Ensure a written worksite specific fall protection plan is in place.

Ensure that a fall Protection System is being used.
Ensure that guardrails are used when practicable.
Ensure a Fall Restraint system is in place when applicable.
If a Fall Restraint cannot be used, ensure a Fall Arrest system is in place.
Provide appropriate Control Zone procedures if the above are not appropriate.
Ensure supervisors and workers are trained.
Ensure all equipment is safe, maintained, inspected and used correctly.
Investigate any anomalies in the system to make recommendations so that such anomalies will not happen again.
Update the program as needed.
Follow up on our program.
6.1.2 Supervisor Responsibilities

Ensure the program is prepared for each site.
Ensure the program is being implemented.
Inspect the program as it is used.
Review the program
Investigate any anomalies and make recommendations to prevent reoccurrence.
Investigate all workers reports of anomalies to the system.
Keep a log of all workers trained for the fall protection program and topics that were covered before they work in the
fall protected area.
Ensure all workers have a copy of the fall protection program.
Inspect, maintain, and use the equipment in the recommended methods.
Ensure that all workers are provided with the appropriate equipment.
Observe workers, work practices and site operations and correct when necessary.
6.1.3 Worker Responsibilities
Know the fall protection plan.

Follow the procedures, as trained.
Inspect equipment.
Maintain equipment.
Report any anomalies to the supervisors.
Ensure the equipment is used as the manufacturer recommends.
To inspect the program.
It is a condition of employment that all managers, supervisors, and workers comply with the company safety policy and
safety programs.
6.1.4 Company Policy Statement

Company Name and Address:
We at ______________ believe that our employees are very important to us. Fall Protection is an important aspect of ou
program to insure that people who work for us can continue to live safe and healthy lives. We at ______________ requir
all employees who work at heights above 10 feet and over to be protected from falling. In some cases we will also
implement fall protection at a lesser height if there is a danger or hazard in the area below. A written fall protection pla
will be developed and implemented when a fall hazard of 25 feet or more exists or when a safety monitor and control
zone is required. The intent of the plan is to:
Help prevent falls
Assist workers and supervisors to identify the fall hazards of the site before work begins at heights.
Assist in the selection of an appropriate fall protection system(s)
Assist in rescue procedures for someone if a fall should occur.
It is our company policy that all managers, supervisors and workers comply with the fall protection guidelines we have
established. We have several checklists to help our supervisors and workers in identifying problem areas on the site. The
checklists will be of much help when our supervisors are developing the site-specific program. We have outlined some
specific responsibilities for ourselves (the employer), our supervisors and our workers as follows:
Signature of Management and Date.
6.1.5 Site specific Fall Protection Work Program

Company: _______________________________________________________
Address: ________________________________________________________
Phone: __________________________________________________________
Date: ___________________________________________________________
Project: _________________________________________________________
Location: ________________________________________________________
Phone: __________________________________________________________
Date: ___________________________________________________________
Supervisor: ______________________________________________________
Site Safety Representative: __________________________________________
Job Description and Type of Work:

New: Alterations: Demolition: Maintenance: Repair:
Specific Work Area:_______________________________________________
A brief description of the type of work being done:
Control Zone
Is a control zone used: Yes: No:
If Yes where: _____________________________________________________
Is the control zone marked: Yes: No:
How: ___________________________________________________________
What is the set-back distance of the control zone area: Metres: Feet:
The Safety Monitor
Name of Safety Monitor: ___________________________________________
Safety Monitor Training: ___________________________________________
Date Trained: ____________________________________________________
Number of workers to be monitored: __________________________________
Journeyman: _____________________________________________________
Apprentices: _____________________________________________________
All the following Workers have been trained in the Safety monitor system:
Date: ___________________________________________________________
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
8. __________________________________________________________
Describe the type of work being done:
List the Fall Hazards:
Draw a diagram of the control zone:

Describe the type of Fall Protection System to be used:
Other considerations:
Describe the type of work being done in other Fall Hazard areas:
List the Fall Hazards:
Draw a diagram if necessary:

Describe the type of fall protection system to be used:
Other considerations:
Describe in detail the procedure to be followed if someone is to be rescued after a fall occurs:
Other concerns or considerations:
Hazard Identification
Name of Hazard Yes No
Scaffold Work. .
Lock Out. .
Walls. .
Floor Openings. .
Edge of Slab. .
Electrical Hazards. .
Other Trades. .
Manholes. .
Shafts. .
Doors. .
Tripping Hazards. .
Drop Off Points. .
Fly forms. .
Swing Stages. .
Excavations. .
Crane Operations. .
Work Access Above.
Walkways Above.
Type of Fall Protection Name .
Guardrails .
Toe Boards .
Horizontal Lifelines .
Vertical Lifelines .
Harness and Lanyard .
Belt and Lanyard .
Warning Lines .
Cover Over Holes .
Wire Rope Lifeline .
Fiber Rope Lifeline .
Robe Grab .
Fall Arrest Block .
Tie Backs .
Safety Nets .
Canopies
Describe in detail all work procedures including hazard identification, assembly, maintenance, use, disassembly, and
inspection of the equipment, system and / or area. Ensure all required equipment is provided, identified, inspected, and
put in a log book before use.
Equipment Log
Equipment Name. Equipment # Date Inspected Date Removed
Safety Belts
Harnesses Safety Lines
Lanyards
Horizontal Life
Lines
Nets
Platforms
Rebar Guards
Guardrails. . .
All workers who will be exposed to fall hazards are informed of those hazards, and are instructed in the fall protection
system to be used and the procedures to be followed. All contents of this program have been conveyed to the workers. A
necessary equipment has been provided.
Site Superintendent: ____________________________________________________
Signature: ____________________________________________________________
Print Name: ___________________________________________________________
Date: ________________________________________________________________
Site Safety Representative: _______________________________________________
Signature: ____________________________________________________________
Print Name: ___________________________________________________________
Date: ________________________________________________________________

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Sample Fall Protection Plan

Taken from OSHA's website.

Ensure a written worksite specific fall protection plan is in place.

6.1.2 Supervisor Responsibilities

Know the fall protection plan.

6.1.4 Company Policy Statement

Signature of Management and Date.

6.1.5 Site specific Fall Protection Work Program

Job Description and Type of Work:

Describe the type of work being done:

List the Fall Hazards:

Draw a diagram of the control zone:

List the Fall Hazards:

Draw a diagram if necessary:

Other concerns or considerations:

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