FALL PROTECTION TASK PLAN
Task plans are to be completed every month, for every task involving fall protection systems.
Project:
Company
*
Date
*
/
Year
/
Month
Day
Date
What type of system will be used?
*
Engineering Controls
Fall Restraint Systems
Personal Fall Protection
The Fall Protection Permit is for: (specific location)
*
Prepared By:
*
Implemented By:
*
Monitored By:
*
Approved By:
*
Specific Task Description:
*
Fall Protection System to be used: (Check all that applies)
Personal Fall Arrest System
Harness
Lanyard
Retractable
Positioning Hooks
Hole Covers
Barricade
Yellow Caution Tape
Red Danger Tape
Guard Railing
Horizontal System
Vertical System
Safety Net System
*Controlled Access Zone
*Safety Monitored System
* Controlled Access Zones and Safety Monitored Systems require a specific fall protection plan and approval from NPCL Managers. Contact Barbara Yee.
Any other fall protection means that were not listed above?
The Anchor Point is established:
*
YES
NO
The Anchor Point is rated for:
*
ONE MAN USE (5000#)
TWO MAN USE (10000#)
Explain how Fall Protection System will be used
*
Personnel have been trained in the use, inspection and maintenance of the fall protection system to be used:
*
YES
NO
Personnel were trained by:
*
List the personnel to conduct this task: (First and Last names)
*
What is your emergency response plan?:
*
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