FALL PROTECTION TASK PLAN
Task plans are to be completed every month, for every task involving fall protection systems.
Project:
*
Company:
*
Please Select
PLS Power
NIC
NPCL
NUCOR
Quality General
Evergreen Steel Erectors
Oahu Metal and Glass
Distinctive
Norelco
Meson
Tru Line Construction Systems (TLCS)
Beachside Roofing
Alakai Mechanical
RL Ohana
HAAS
IPD
OMG
CPS
A-American
Zelinsky
Contract Specialties
Pacific AquaScapes
Otis
Honolulu Fire
Tradewinds Mechanical
Date:
*
/
Year
/
Month
Day
Date
What type of system(s) will be used?
Engineering Controls
Fall Restraint Systems
Personal Fall Protection
The Fall Protection Permit is for (SPECIFIC LOCATION):
*
Please Select
Elevator Core
Building Exterior
All Levels
Prepared By:
*
Implemented By:
Monitored By:
*
Approved By:
Specific Task Description:
*
Fall Protection System to be used: (Check all that apply)
*
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
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 for your task (describe what you are using, where you are using it, how are you making sure leading edges are not exposed to other workers in area, are you barricading areas below, how are you tethering tools/equipment, etc.)
*
Personnel have been trained in the use, inspection, and maintenance of the fall protection system to be used:
*
YES
NO
Personnel were trained by: (Instructor name or company)
*
List the personnel to conduct this task: (First and Last names)
*
Emergency Response Plan:
*
Fall rescue kit located at manhoist on 1st floor...
Signature:
*
Continue
Continue
Should be Empty: