Fall Protection Task Plan
Project:
Company:
Date:
/
Year
/
Month
Day
Date
Implemented/ Monitored By:
Approved By:
TASK PLAN
Specific Task Description:
System(s) to be used:
Engineering Controls
Fall Restraint Systems
Personal Fall Protection
Fall Protection System(s) to be used:
P.F.A. System
Harness
Lanyard
Retractable
Position Hook
Hole Covers
Baricade
Yellow Caution tape
Red Danger tape
Guard Railing
Horizontal Lifeline
Vertical System
Safety Net System
Controlled Access Zone- Requires HSE approval
Safety Monitored System- Requires HSE approval
Identify means for protection here if not listed:
Anchor Point Established?
Yes
No
Anchor Point Rated For?
One Man Use (5000lbs)
Two Man Use (10,000lbs)
Explain how Fall Protection System will be used:
Personnel Been Trained?
Yes
No
Instructed By:
List personnel involved in task:
Emergency Response (Rescue) Plan:
Prepared By:
Signature:
Continue
Continue
Should be Empty: