Fall Protection Work Plan (Fpwp) - University Of Washington

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FALL PROTECTION WORK PLAN (FPWP)
Fall protection is required at 4’; however, a written plan is required at 10’
Department Name ______________________________________________ Date __________________
Site Location
_______________________________________________________
(If additional space is needed, use the back of this sheet)
Identify all fall hazards 10’ or more above the ground or lower level (check all that apply):
Open-sided walking/working surfaces (i.e. roofs, open-sided floors)**
Floor openings
Open-sided ramps, runways, platforms
Wall openings
Trenches
Skylight openings
Surfaces that do not meet the definition of a walking/working surface (i.e. top plate)
** Walking/working surface = any area whose dimensions are 45 inches or greater in all directions, through which workers pass or
conduct work.
Methods of fall protection to be used:
Appropriate anchors for system used
Personal fall arrest system
Warning line (LSO)*
Covers (floor holes & openings)
Personal fall restraint system
Warning line w/safety monitor (LSO)*
Guardrail system
Positioning device system
LSO = Low Slopes Only
Horizontal lifelines
Vertical lifeline and rope grab
(low slopes = 4 in 12 or less)
Other methods of fall protection selected:
Scaffold w/guardrail
Boom lift *
Other:
Scissor lift or other aerial lift *
___________________________________________
*must wear personal fall arrest equipment
Describe procedures for assembly, maintenance, inspection, and disassembly of the fall protection system to be used:
Describe procedures for handling, storage, and securing tools, equipment, and materials:
Describe methods of overhead protection for workers who may be in, or pass through the area below the worksite:
Describe the method for prompt, safe removal of injured worker(s):
Emergencies: DIAL 911
Employees who received fall protection training on the above site-specific fall protection work plan:
Name (print)
Signature
Date
____________________________________
_____________________________________
__________________
____________________________________
_____________________________________
__________________
____________________________________
_____________________________________
__________________
____________________________________
_____________________________________
__________________
____________________________________
_____________________________________
__________________
Name & title of person who provided training: _____________________________________________________________
Name of lead worker or supervisor (print)
Signature
Date
____________________________________
_____________________________________
__________________
This Fall Protection Work Plan must be kept at the job site.
Revised February 2015
Questions? Contact
ehsdept@uw.edu

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