Fall Pro and Rescue Plan

Online Safety Forms: Fall Pro and Rescue Plan

This is where a copy of the completed form will be sent once submitted.

Anchor System

i.e. roof anchor system, concrete anchor points, i-beam with dog leash, etc)

Fall Hazards

Calculating Free Fall Distance (in ft)

Clearance Required Calculations (in feet)

Clerance Available Calculations (in feet)

System used to Control Hazards

When the use of a guardrail is not reasonable practicable or would not be effective, an employer must ensure that the worker is protected by at least one of the above fall protection systems.
An employer must ensure that a fall protection system is designed, installed, tested, used and maintained in accordance with the applicable requirements of the above CAN/CSA Standards.

Procedure for Essembly, Maintenance, Use and Disassembly of fall protection system

Rescue Procedure/Plan

Note: Relief steps help take the pressure applied to the fallen worker and only help extend the rescue time.
Name of Person who will be contacted

Signature of Workers

Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
Workers signing this form acknowledge that they have reviewed and understand this Fall Protection and Rescue Plan
If Supervisor is not available to sign off on this rescue plan, please ensure that the most senior qualified worker signs this as acting supervisor.