Fall Protection Plan Template Page 4
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5Inspection of Fall Protection Systems
System
Schedule
Person Responsible
Guardrails
Temp Flooring
Personnel Net
Travel restraint
Fall Arrest
Work Positioning
Worker Acknowledgement
By signing this Fall Protection Plan the workers acknowledge they have received training concerning the
proper use of the fall protection equipment, are familiar with the hazards and understand the Fall Protection
Procedure and the contents of this Fall Protection Plan.
Date (mm/dd/yy)
Print Name
Signature
SAF010714
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