Fall Protection Program Annual Review

• Unit Program Administrator/Competent Person will complete this assessment annually & maintain a minimum of three (3) years of completed assessments IAW DAFMAN 92-203, para. 13.3.3.

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Document Number

Fall Protection Program

• Any discrepancies are required to have an Action assigned against them. Actions can be assigned to specific supervisors and/or workers. Updates to actions are required every 30 days until closure.

• General Industry: Is fall protection provided whenever workers can fall four (4) feet or more? Reference 13.1.1.

  Yes

  No

  N/A

• Construction Industry: Is fall protection provided whenever workers can fall six (6) feet or more during construction operations? Reference 13.1.2.

  Yes

  No

  N/A

• Has the unit commander developed a Unit Fall Protection Policy? Reference 13.3.1.

  Yes

  No

  N/A

• Has the supervisor ensured each authorized, qualified and competent person using a fall protection/fall arrest system is trained and evaluated on proper use, application and inspection of fall protection/fall arrest systems? Reference 13.3.2.9.1.

  Yes

  No

  N/A

• Are program managers, competent persons, & trainers designated in writing by unit commanders? Reference 13.3.2.2., 13.3.2.4., 13.3.2.10

  Yes

  No

  N/A

• Are competent persons trained and meet the responsibilities outlined in ANSI/ASSP Z359.2 and as defined in 29 CFR § 1910.140(b)? Reference 13.3.2.4.1.

  Yes

  No

  N/A

• Has a fall hazard survey been conducted in all work area where employees are exposed to fall hazards? Reference 13.4.1.

  Yes

  No

  N/A

• Are fall protection and rescue procedures documented specifically for each workplace and task they are applied to when the use of fall protection is required? Reference 13.5.1.

  Yes

  No

  N/A

• Has the supervisor ensured each worker/qualified person/competent person using a fall protection/fall arrest system trained and evaluated on proper use, application and inspection of fall protection/fall arrest systems? Reference 13.6.5

  Yes

  No

  N/A

• Do authorized person(s) shall inspect PFAS prior to use.? Reference 13.8.2.

  Yes

  No

  N/A

• Do supervisors ensure personal fall arrest systems components receive a thorough inspection at least quarterly? Reference 13.8.3.

  Yes

  No

  N/A

• Are falls from heights, regardless of whether an injury or damage has occurred, reported to the servicing occupational safety office and investigated by a competent person and occupational safety personnel? Reference 13.8.3.

  Yes

  No

  N/A

Unit Coordination

• Program Administrator/Competent Person shall out brief the commander of the findings of this annual review within 10 days of completion.

• Program Administrator/Competent Person:

  Sign

• Unit Commander:

  Sign

• If your unit is scheduled an Occupational Safety Program Assessment during this fiscal year, this inspection can be completed and does not need routed to Occupational Safety. An assessment of the unit's fall protection program will be conducted by Occupational Safety during that time.

• When complete, select View Report on the right side of the screen. Then select PDF from the dropdown menu in the upper right of the screen to download the file.

Wing Safety Coordination

• Occupational Safety: Conduct thorough annual review of fall protection program elements and documents annually in safety inspection/assessment reports. Reference 13.3.2.6.3

• Program Rating:

  Select Met & Effective Met but Needs Minor Improvement Met but Needs Significant Improvement Not Effective

  • Met & Effective
  • Met but Needs Minor Improvement
  • Met but Needs Significant Improvement
  • Not Effective

• Occupational Safety Inspector:

  Sign