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Fall Protection Plan Sample
Fall Protection Plan Sample
Safety
Marine Industrial Electro Solutions reference
4.2 4.2
SHE Management System Clause:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 1 of 12
Approved By: Chris Bosch Signature:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 2 of 12
Approved By: Chris Bosch Signature:
Employees must review & sign this fall protection work plan prior to starting work in an area where a hazard of falling
exists. Employees must understand this plan & be trained in fall protection, the systems & equipment that will be used.
This plan must be posted at the worksite for the duration of the work activities. This plan must be used in conjunction
with a comprehensive & effective fall protection program.
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 3 of 12
Approved By: Chris Bosch Signature:
5. Identify the Method of Protection for Employees who may be in or pass through the area
below the Overhead Work Activity
Barricading Toe Boards/ Screens on Scaffolds
Hard Hats Required Toe Boards/ Covers on Floor Openings
Catch Net Other (Identify)
Warning Signs Other (Identify)
6. Identify the method for Prompt, Safe Removal of Injured Workers
Written Agreement with: Self-rescue (Training Documentation)
(ex. Identify Fire Department & attach agreement)
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 4 of 12
Approved By: Chris Bosch Signature:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 5 of 12
Approved By: Chris Bosch Signature:
15. Describe the Procedures for the Assembly, Maintenance, Inspection & Disassembly
of the Fall Protection System to be used:
Contractors and staff will be trained by a competent trainer in the proper assembly, maintenance, and
storage of fall protection devices. Manufacturer’s recommendations must be followed. If a diagram of
the system installation is required, include it in the fall protection plan. Adequate (dry, secure, safe
from damage) storage areas will be provided for equipment not in use.
Before each use, equipment must be inspected and all defective/damaged equipment will be
immediately tagged and removed from site for repair or disposal.
Scaffolding will be inspected and erected under the supervision of a competent person.
Inspection Checklist:
Identification Tags
Horizontal Lifeline Tension is Correct
Integrity of stitching in Shock Absorber
Integrity of stitching in Harness/ Lanyard
Manufacturer’s assembly/ disassembly instructions
Locking capability of retractable lanyards assured
Locking capability of carabiners assured
Locking capability of snap hooks assured
Knots & other connection methods do not weaken lifeline
Lifelines installed & used under supervision of Competent Person & protected from cuts or abrasions
Rope (wear, fraying, damage, mildew)
Lanyards (wear, fraying, damage, mildew)
Dee-rings have adequate strength, are not cracked or deformed
Guardrails are sound and of adequate strength
Devices that are used to connect to horizontal lifelines lock in both directions
Anchorage points provide adequate strength and are capable of meeting regulated strength req.
Safety Monitor is Competent, can see workers, is close enough to communicate, has no other duties
Hole covers are secured, marked & capable of withstanding anticipated weight loads
Other (Identify)
Other (Identify)
Standard Quality Food OHS ENV
Safety
Marine Industrial Electro Solutions reference
4.2 4.2
SHE Management System Clause:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 6 of 12
Approved By: Chris Bosch Signature:
Occupational Health and Safety Act, 1993 (Act No. 85 of 1993) - Construction Regulations
(2014)
3. The contractor must ensure that a construction manager appointed under regulation 8(1) is in
possession of the most recently updated version of the fall protection plan.
5. Where roof work is being performed on a construction site, the contractor must ensure that, in
addition to the requirements set out in sub regulations (2) and (4), it is indicated in the fall protection
plan that:
• the roof work has been properly planned;
Standard Quality Food OHS ENV
Safety
Marine Industrial Electro Solutions reference
4.2 4.2
SHE Management System Clause:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 7 of 12
Approved By: Chris Bosch Signature:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 8 of 12
Approved By: Chris Bosch Signature:
Below 3 meters Above 3 meters & below 8 meters Above 8 meter All Elevations
Once completed a copy of this plan must be available for review by the Safety Officer.
Standard Quality Food OHS ENV
Safety
Marine Industrial Electro Solutions reference
4.2 4.2
SHE Management System Clause:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 9 of 12
Approved By: Chris Bosch Signature:
3.2. Procedure
The following must be adhered to at all times by all employees who are exposed to a potential fall;
1. Protect all floor, roof and wall openings with adequate covers or guardrails as required;
2. Implement, maintain and enforce the use of fall arrest safety harnesses where employees
are exposed to fall hazards of 7.5m or above.
3. Solid hole covers shall be secured and labelled with a circle and an “X”.
4. All guardrails must meet the requirement;
5. Enforce proper housekeeping practices, including the immediate clean-up of all spills,
removals of debris, power cords, hoses and tools to eliminate slipping or tripping hazards;
6. A safety officer and/or contractor is to ensure the work activity is performed in accordance
with the Fall Protection Plan and in a manner that minimizes the potential for an
employee to fall. A safety officer and/or contractor must be trained and have visual
contact at all times with the work activities;
7. When using lanyards limit the fall distance of the worker to 1.2m. If shock absorbing
lanyards are being used fall distance should be increased to 2m.
Determine what fall hazards exist in the work area. Check all that apply and then refer to the next
section for the appropriate fall protection system to implement.
It is important to make sure that only these hazards exist in the work area. If other work areas have
different fall hazards, then an area specific fall protection plan will be required.
Standard Quality Food OHS ENV
Safety
Marine Industrial Electro Solutions reference
4.2 4.2
SHE Management System Clause:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 10 of 12
Approved By: Chris Bosch Signature:
• Is there sufficient clearance below workers to arrest a fall (min 12 feet measured vertically
from the work platform; may differ for horizontal life line systems)? Yes No
• If No, can the hazard be removed (i.e. thrust out platform)? Yes No
• If No, can vertical clearance be reduced? Yes No
• If No, can the work be done from below? Yes No
• If No, can a platform or net be installed below the work area? Yes No
For the hazards noted in the above section, follow the guidelines below for each hazard identified:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 11 of 12
Approved By: Chris Bosch Signature:
9. Roof Edge: Guardrails if practical, otherwise horizontal lifeline or anchor point with vertical
lifeline, full body harness retractable safety line and/or lanyard.
10. Slab/Roof Openings: Guardrails if the opening is large (4x4 feet or greater) and floor
covers for smaller openings. Both must be secured to the deck using nails.
3.3.3.Assembly/Maintenance/Inspection/Storage:
Contractors and staff will be trained by a competent trainer in the proper assembly, maintenance, and
storage of fall protection devices. Manufacturer’s recommendations must be followed. If a diagram of
the system installation is required, include it in the fall protection plan. Adequate (dry, secure, safe
from damage) storage areas will be provided for equipment not in use.
Before each use, equipment must be inspected and all defective/damaged equipment will be
immediately tagged and removed from site for repair or disposal.
Scaffolding will be inspected and erected under the supervision of a competent person.
Hoisting of materials or working overhead of other employees should be avoided. When working
overhead is necessary, tools should be secured from falling. Covered walkways will be used if
crossing under scaffolds. Materials shall be securely banded prior to hoisting. Netting should be used
on perimeter handrails where materials are stored near the edge.
3.3.5.Overhead Protection:
Hard hats are required. Warning signs will be posted to caution of existing hazards whenever they are
present. Barricading will be used where appropriate. All openings will have toe boards installed.
4. Employer Responsibilities:
5. Employee Responsibilities:
Revision No: 1
Fall Protection Work Plan and Site Specific Plan Rev Date: 09/08/2022
Page: Page 12 of 12
Approved By: Chris Bosch Signature:
• Hard hats, safety boots, hearing protection (as required), eye protection (as required)
• Adequate Signage
• Fall protection as required by hazard assessment
7. Training:
The fall protection plan will be part of the initial work site safety orientation of all employees new to the
project. Attendance for this will be documented and records will be kept on site. Employees will be
given instructions on personal fall restraint devices before initial use. This training will be documented
and records will be kept on site. Records must be signed and are kept together for review. Return a
copy of the safe work procedure and sign in form to the general contractor for their records.