Title Page
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Site conducted
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Conducted on
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Prepared by
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Work Scope
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Height OverVeiw
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Location
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ISO Number
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RELEVANT SUPERVISOR
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RELEVANT PERSONAL
<br>PRIOR TO RESPONCE- SUPERVISOR TO CONFIRM<br>1. Entry into incident must be controlled via Wardens<br>2. Dynamic risk assessment must be under taken to asses situation <br>3. Only trained personnel are to undertake rescue<br>4. Safe emergency access and egress by means of of access shall be considered prior to any works being conducted<br>5. Heights rescue equipment to be available onsite.<br>6. Relevant personal to be contacted prior to first entry to assist with rescue plan development and area familiarization. <br><br>
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Access type
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Potential Rescue Hazards
- Medical
- Fall from Height
- Hazardous Chemicals
- Electrical
- Entrapment
- Fire
- Restricted movement
- Physiological "Acrophobia / fear of heights"
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Will entry and exit to the work area impact on any emergency rescue
Required Heights Equipment Requirements
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Rescue Equipment
- Trauma and Resus Kit
- Helmet
- Glasser's
- Gloves
- Working at height Harness
- Rescuer harness
- SRL
- Twin leg lanyards
- Fall restraint system "roofers kit"
- Self rescue equipment
- Rescue pole
- Ladder
- Slings
- Karabiners
- Pulleys
- Milan rescue kit
- Rope lowering system
- Basket stretcher
- EWP
- Crane
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Communication Requirements
- Radios
- verbal
- Wiesel
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Possible High Points {Add Photos}
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Possible Anchor points {Add Photos}
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Access for use of EWP/Crane
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Possible Personal Required
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Will rescue be complex and require external assistance
- Possible Assistance Required
- MFS Assistance Required
- SAAS Assistance Required
- SAPOL Assistance Required
- None Required
Rescue Break Down<br>• Assess situation to establish if external assistance is required.<br>• If Safe to do so entry space to apply medical treatment to the injured worker if required <br>• If able to assist worker out if space for further medical assessment and possible treatment<br>
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Rescue plan Review
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Review of rescue plan required
