FALL PROTECTION PROGRAM

FALL
PROTECTION
PLAN

IMPORTANT: This document is intended to provide guidance only for developing

site-specific fall protection plans for working at heights.
 FALL PROTECTION PROGRAM

FALL PROTECTION PLAN

IMPORTANT: This document is intended to provide guidance only for developing site-specific working at
heights fall protection plans. It must be specific for each work site.

THIS WORK PLAN WILL BE AVAILABLE ON THE JOB SITE FOR INSPECTION.
All employees that will be working on this job site will be aware of the fall hazards
and will understand the means of mitigation that will be utilized as contained in
this fall protection plan.

1. Fill Out the Specific Job Information

Company Name: ___________________________________________________________________

Job Name: _________________________________________ Date: ______________________________

Job Address: ______________________________________ City: ______________________________

Job Foreman: _____________________________________ Jobsite Phone: _____________________

2. Fall Hazards in the Work Area - Include locations and dimensions for hazards.

Elevator shaft: _______________________________ _ Stairwell: _________________________________

Leading edge: _______________________________ _ Window opening: __________________________

Outside static line: _____________________________ Roof eave height: __________________________

Perimeter edge: _______________________________ Roof perimeter dimensions: _________________

Other fall hazards in the work area: _______________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

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3. Method of Fall Arrest or Fall Restraint - For fall protection equipment, include details such as,
manufacturer etc.

Full body harness: ______________________________ Body belt (Restraint only): _____________________

Positioning Lanyard: _____________________________ Self-Retracting Lifeline: _______________________

Lifeline: _______________________________________ Restraint line: _______________________________

Horizontal lifeline: _____________________________ Rope grab: _________________________________

Deceleration device: _____________________________ Shock absorbing lanyard: _____________________

Locking snap hooks: _____________________________ Safety nets: _________________________________

Guard rails: ____________________________________ Anchorage points: ___________________________

Warning Lines: __________________________________ Scaffolding platform: _________________________

Safety monitor & Name: ________________________________________________________________________

Other: _______________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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4. Assembly, Maintenance, Inspection, Disassembly Procedures

Assembly and disassembly of all equipment will be done according to manufacturers’ recommended
procedures. (Include copies of manufacturer’s data for each specific type of equipment used.) Designate
who will be responsible for each task and what level of training they have.

Specific types of equipment on the job are: ________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

A visual inspection of all safety equipment will be done daily or before each use, as stated in the Employee
Training Packet. Any defective equipment will be tagged and removed from use immediately. The
manufacturer’s recommendations for maintenance and inspection will be followed. ______________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

5. Handling, Storage & Securing of Tools and Material

Toe boards will be installed on all scaffolding to prevent tools and equipment from falling from scaffolding.

Other specific handling, storage and securing is as follows: __________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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6. Overhead Protection

Hard hats are required on all job sites with the exception of those that have no exposure to overhead hazards.
Warning signs will be posted to caution of existing hazards whenever they are present. In some cases, debris
nets may be used if a condition warrants additional protection.

Additional overhead protection will include: _______________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Toe boards (at least 4 inches in height) will be installed along the edge of scaffolding and walking surfaces for
a distance sufficient to protect employees below. Where tools, equipment or materials are piled higher than
the top of the toe board, paneling or screening will be erected to protect employees below.

7. Injured Worker Removal

Normal first aid procedures should be performed as the situation arises. If the area is safe for entry, the first
aid should be done by a foreman or other certified individual.

Initiate Emergency Services – Dial 911 (where available)

Phone location: _______________________________ First aid location: ___________________________

Elevator location: ______________________________ Crane location: ______________________________

Other: ________________________________________ Location: ___________________________________

Rescue considerations. When personal fall arrest systems are used, the employer must assure that
employees can be promptly rescued or can rescue themselves should a fall occur. The availability of rescue
personnel, ladders, or other rescue equipment should be evaluated. In some situations, equipment that
allows employees to rescue themselves after the fall has been arrested may be desirable, such as devices
that have descent capability.

Describe methods to be used for the removal of the injured worker(s): _________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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8. Training and Instruction Program

All new employees will be given instructions on the proper use of fall protection devices before they begin
work. They will sign a form stating they have been given this information. This form becomes part of the
employee’s personnel file.

The written fall protection plan will be reviewed before work begins on the job site. Those employees
attending will sign below. The fall protection equipment use will be reviewed regularly at the weekly safety
meetings.

Date: _________________________

_____________________________ _____________________________ _____________________________

_____________________________ _____________________________ _____________________________

_____________________________ _____________________________ _____________________________

_____________________________ _____________________________ _____________________________

Foreman or Job Superintendent: ________________________________________________________________

Prior to permitting employees into areas where fall hazards exist, all employees must be trained regarding
fall protection plan requirements. Inspection of fall protection devices/systems must be made to ensure
compliance with OSHA and (Company Name) internal regulations.

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RESCUE PLAN
FALL PROTECTION PROGRAM

IMPORTANT: This document is intended

to provide guidance only for developing
site-specific rescue plans for working
at heights.
 FALL PROTECTION PROGRAM

RESCUE PLAN
This document is intended to provide guidance only for
developing site-specific rescue plans for working at heights.

1.0 PURPOSE
The purpose of this rescue template is to establish corporate-wide guidelines for responding
to falls from height. This rescue plan is intended to reduce risks to an employee’s health after
a fall arrest event. The rescue plan should also minimize the amount of at-risk behavior of the
rescuer during the rescue attempt, and help to ensure that the rescue is conducted promptly
in a safe and professional manner.

2.0 APPLICATION
2.1 
This rescue plan applies to all locations where personnel are employed to work at height.
2.2 
The requirements of this rescue plan must be observed by all personnel involved in
working at heights.
2.3 
This rescue plan must be reviewed or included in any job safety analysis or pre-task
planning for activities that require working at heights.

3.0 DEFINITIONS
3.1 RESCUE PLAN: A strategy or procedure, planned in advance, to safely retrieve a person
who has fallen from an elevated work surface and is suspended in a full body harness. This
includes self-rescue or mechanically aided rescue.

3.2 SELF RESCUE: An act or instance of an employee using his fall protection equipment to
rescue him or herself.

3.3 MECHANICALLY AIDED RESCUE: A strategy or procedure, planned in advance, to safely

retrieve a person who has fallen from an elevated work surface using mechanical means.

3.4 SUSPENSION TRAUMA: A serious medical condition that can lead to unconsciousness,
injury or death, which can occur when a worker is suspended in a harness for too long
after a fall.

3.5 PROMPT RESCUE: The recommended goal for rescue subject contact is less than six
minutes, per ANSI Z359.2-6.1.

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4.0 RESPONSIBILITIES
4.1 EMPLOYEES:
• Must be trained in and familiar with the Fall Protection Program.
• Must understand and be able to evaluate the risks associated with working at heights.
• Must be trained and competent in the use of fall protection equipment prior to
conducting work at heights.
• Must report unsafe conditions or behaviors to the Person-In-Charge.
• Must be familiar with and understand the company’s rescue plan to provide prompt
rescue in the event of an arrested fall event.

4.2 AUTHORIZED RESCUER:

• Must be trained by a competent rescuer trainer before being exposed to a fall hazard or
potential rescue application.
• Must be re-trained when the nature of the work, workplace, or methods of control or
rescue change to an extent that prior training is no longer adequate.
• Must be trained on how to inspect, anchor, assemble and use the fall protection and
rescue equipment used in locations where employees work. Training must include
physical demonstrations by trainees.
• Training must include at least the following:
o Fall hazard recognition;
o Fall hazard elimination and control methods;
o Applicable fall protection and rescue
regulations;
o How to use written fall protection and
rescue procedures;
o Inspection of equipment components and
systems before use.
• Refresher training must occur at least every two
years for the authorized rescuer to stay current with
fall protection and rescue educational requirements
per ANSI.
• Must be evaluated by a competent rescuer or
competent rescuer trainer at least annually to ensure
competency of the duties assigned. This evaluation
must include both a written examination and a
physical demonstration of usage of all equipment the
person is authorized to operate.

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4.0 RESPONSIBILITIES
4.3 COMPETENT RESCUER:
• Must be trained by a competent rescuer trainer.
• Must be trained on how to inspect, anchor, assemble and use the fall protection and
rescue equipment used in locations where employees work. Training must include
physical demonstrations by trainees.
• Training must include use of all types of equipment and systems used in locations
where rescues may be required, including inspection of systems prior to use, installation,
component compatibility, descent control, secondary systems, packaging methods,
dismantling, storage and the common hazards associated with each system and
component.
• Training must include at least the following information:
o Fall hazard elimination and control methods;
o Applicable fall protection and rescue regulations;
o Assessment of fall hazards to determine
rescue methods;
o Responsibilities of designated persons
under this standard;
o Detailed inspection and recording of
rescue equipment components and
systems;
o Rescue systems assessment and
determination of when a system is unsafe;
o Development of written fall protection
rescue procedures;
o Selection and use of non-certified
anchorages.
• Refresher training for Competent Person
Rescuers must be conducted at least every year
per ANSI.

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5.0 PROCEDURE
5.1 A
 rescue plan must be a part of the Job Safety Analysis for any job that requires work
at height. The rescue plan must include consideration of the following rescue types and
circumstances:
5.1.1 SELF RESCUE:

If the person working at heights has properly selected and used his or her fall
protection equipment, 90% of workers will be able to perform a Self Rescue, which
should include these steps:
1. Climbing back up to the level from which he fell (from a few inches to 2-3
feet).
2. Returning to the floor or ground to be evaluated for possible medical
attention per OSHA.
3. Removing all components of fall arrest system impacted by the fall event
from service and documenting (bag and tag) the components with name,
date and activity at time of fall and giving the equipment
to management.

5.1.2 ASSISTED SELF RESCUE WITH MECHANICALLY AIDED HAULING/ROPE SYSTEM:


If self-rescue is not possible, than an Assisted Self Rescue will be needed. The
following guidelines should be used during a mechanically aided rescue:
1. The Capital Safety Rollgliss™ R550 or other compliant rescue and descent
device will be secured to an anchor that is rated for at least 3,000 lbs.
2. The haul line may be swung over or
lowered to the fallen worker, who will
grab the rescue lifeline snap hook and
secure it to the appropriate D-ring on his
body support. A positive connection to
the D-ring must be verified by one of the
rescue team members.
3. The rescue team will raise or lower the
fallen employee to the appropriate work
platform or ground and provide medical
aid as required by OSHA.
4. Remove all components of fall arrest
system impacted by the fall event from
service and document (bag and tag) the
components with name, date and activity
at time of fall and give the equipment
to management.

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5.0 PROCEDURE
5.1.3 MECHANICALLY AIDED *(UNCONSCIOUS) WITH HAULING/ROPE SYSTEM:

If the worker’s injuries prevent the worker from attaching to the rescue system, both
self-rescue and assisted self-rescue are not options, and a fully Assisted Rescue is
necessary:
1. The Capital Safety Rollgliss™ R550 or other compliant rescue and descent
device will be secured to an anchor that is rated for at least 3,000 lbs.

2. A rescue team member must attach the haul line to the worker’s fall arrest
system. This can be performed by accessing the fallen worker and then
attaching the rescue system directly to a D-ring on the worker’s harness,
or by using a rescue pole for the attachment. The rescue team could also
attach a rescue grab to the lanyard or vertical lifeline.

3. The rescue team must raise or lower the fallen worker to the appropriate
work platform or ground and provide medical aid as required by OSHA.

4. Remove all components of fall arrest system impacted by the fall event
from service and document (bag and tag) the components with name, date
and activity at time of fall and give the equipment to management.

5.1.4 ASSISTED RESCUE WITH MECHANICALLY AIDED AERIAL LIFT:


If Another means of performing a fully Assisted Rescue is to use an aerial lift under
the following guidelines:
1. A rescuer will get into the aerial lift and make sure there is a second fall
protection device, such as a shock absorbing lanyard or self-retracting
lifeline available for the fallen worker.

2. The aerial lift must be maneuvered into position (raised up underneath the
fallen worker) so that the rescuer can perform the rescue.

3. Attach the second lanyard or self-retracting lifeline in the aerial lift to the
fallen worker.

4. Disconnect the rescued worker from the impacted fall arrest equipment.

5. Lower the worker to the ground and provide medical aid as required by
OSHA.

6. Remove all components of fall arrest system impacted by the fall event
from service and document (bag and tag) the components with name, date
and activity at time of fall and give the equipment to management.

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RESCUE PLAN
This document is intended to provide guidance only for developing site-specific rescue plans for working at heights.

DATE:__________________________ JOB DESCRIPTION:_____________________________________________________________

___________________________________________________________________________________________________________

LOCATION:__________________________________________________________________________________________________

___________________________________________________________________________________________________________

CONTACTS RESCUE EQUIPMENT CRITICAL RESCUE FACTORS

Ladder
Rescuer(s): Anchor Point:
Rescue Pole
____________________________________ ____________________________________
Rescue Rope
____________________________________ Scaffold ____________________________________
Crane
____________________________________ ____________________________________
Aerial Lift
Competent Person: Alternative Lifting &Lowering Landing Area:

____________________________________ Device ____________________________________

RSQ
Emergency Contact: ____________________________________
First Aid Kit
____________________________________ Life Ring ____________________________________

Method of Contact: RPD Rescue Obstructions or Hazards:

PA Verbal/Face to Face R550
____________________________________
Radio Channel:_______________________ Location of Equipment:
____________________________________
Jobsite
Phone Number:______________________ ____________________________________
Gang Box
Other:______________________________ Tool Box Other:
____________________________________ Other:_____________________ ____________________________________

CHECK FOR YES COMMENTS

Have alternatives to using fall arrest equipment been considered? ___________________________________________________________

Has rescue equipment been inspected and in good shape? ___________________________________________________________

Is equipment adequate for the rescue plan? ___________________________________________________________

Have communication devices been identified, located and tested? ___________________________________________________________

Are all rescuers familiar with the use of the rescue equipment? ___________________________________________________________

If working over water, is there a boat available? ___________________________________________________________

Describe the tasks that will be done prior to work to prevent a fall and the step-by-step process to be followed in the event of a fall.
PRE-WORK TASKS: RESPONSE PROCEDURE:
1)___________________________________________________ 1) Notify Emergency Contact.

2)___________________________________________________ 2) Make medical assessment of person.

3)___________________________________________________ 3) If possible, have employee perform self-rescue.

4)___________________________________________________ 4)___________________________________________________

5)___________________________________________________ 5)___________________________________________________

6)___________________________________________________ 6)___________________________________________________
3M Fall Protection
Personal Safety Division
3833 SALA Way
Red Wing, MN 55066 USA
Phone 800-328-6146
Email 3mfallprotection@mmm.com
© 2017 3M Fall Protection April 2017, Rev: A
Web 3M.com/FallProtection