Fall Protection Work Plan

Worksite:

Date:

Working Height:

System to be Used:

Describe Work Area:

Work Area Photos:
Rescue Options:

Describe Rescue Procedures:

WORKERS TRAINED
Name:
Conducted by:
Reviewed by:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.