Title Page
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Fall Protection Program Assessment
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Are workers provided fall protection when exposed to falls of four (4) feet or more? Reference 13.2.2
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Are active and passive means of fall protection considered before using procedural controls? Reference 13.3.1.3
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Has a JSA been performed and coordinated with the installation safety office prior to the use of procedural controls for protecting workers from falls? Reference 13.3.1.3
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Are all PFAS components marked to indicate compliance with ANSI Z359.1.? Reference 13.4.6.2
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Are wire rope, rope covered wire lanyards, plastics (such as nylon) and wet lanyards prohibited where an electrical hazard may be present? Reference 13.4.6.5
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Can anchorage connectors withstand a 5000 pound load for each PFAS connected? Reference 13.4.6.7
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Do workers inspect their PFAS prior to each use for mildew, wear, damage and other deterioration? Reference 13.4.6.10.2
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Does the supervisor ensure all PFAS components receive a thorough inspection at least quarterly and keep the record of inspection for at least one year? Reference 13.4.6.10.3
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Are PFAS components subjected to impact loading immediately removed from service and not be used again until inspected and determined by a competent person to be undamaged and suitable for reuse? Reference 13.4.6.11.8
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Are workers/competent persons trained and evaluated on the fall protection/fall arrest system prior to use? Reference 13.6
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Is recurring fall protection training conducted annually, when work conditions change or when new fall protection/fall arrest systems are procured? Reference 13.6
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Is a rescue plan included in each fall protection plan to assure prompt rescue of fallen workers? Reference 13.7