Camp Pendleton Hospital Replacement Project - Perimeter Edge Fall Protection Removal Final Instal

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

This form is to be signed and completed jointly by the CMJV Superintendent, Carpenter and a Safety Manager

• Fall Protection Description and Location:

• Reason for Perimeter Fall Protection Removal: (Brief Description).

Inspection Results / Comments:

• Will the removal of perimeter fall protection system (guardrails, cables) create a fall hazard?

  Yes

  No

  N/A

• Have replacement or alternate methods of fall protection been installed?

  Yes

  No

  N/A

• Will replacement or alternative means of fall protection protect all exposed persons from falling?

  Yes

  No

  N/A

• Will the replacement Fall Protection system meet the requirements of EM 385 Section 21 and OSHA 1926 Subpart M requirements?

  Yes

  No

  N/A

• Will removal of the fall protection require a new procedure or communication to others in the area or the work crew? Will an AHA be required?

  Yes

  No

  N/A

• Will alternate or replacement fall protection systems be completed immediately after the existing approved fall protection system is removed?<br>If not, how long until it is installed?

  Yes

  No

  N/A

• Photos (Optional):

  Media

Comments / Restrictions / Limitations:

• Comments / Restrictions / Limitations:

Signatures:

• CMJV Superintendent:

  Sign

• CMJV Safety Manager:

  Sign

• CMJV / Sub. Carpenter / Laborer / Employee:

  Sign