Fall Protection Plan Template Page 2

FALL PROTECTION PLAN TEMPLATE

Name of the Company/Site:

Person Completing Form:

Date:

Period for Which Plan Is

Valid:

Fall Hazard(s) at the Site: Outline the specific situation(s) where fall protection is required, considering what

objects are below the worker and how far they are below, such as “work on steel, heights between 4 and 8 m

above, steel below.”

Fall Protection System to Be Used at the Site: Details about the type of equipment (such as travel restraint, fall

arrest, fixed anchor, lifeline and grab, shock-absorber, etc.), brands and models of components, length of

lanyard, etc.

Anchors to Be Used: Be specific. Describe the precise anchor point, including anchor strength and location

relative to worker.

O H S T

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H I S T O O L A N D H U N D R E D S M O R E A V A I L A B L E I N T H E

O O L B O X A T

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