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Fall Protection Plan

OSHA 1926/1910 Compliant Documentation

⚠️ OSHA COMPLIANT

📋 General Information

Work Task(s) to be Performed *

⚠️ STEP I: Hazard AssessmentIdentify the Hazard

OSHA Requirements: Work at heights of 6 feet or more in construction (1926) or 4 feet in general industry (1910) requires fall protection.

Height Above Lower Level (ft) *

Landing Hazard Present? *

Yes

Fall Hazard Type *

Unprotected Edge

Leading Edge

Floor Opening

Wall Opening

Excavation

Scaffolding

Ladder Work

Aerial Lift

Derrick/Mast Work

Rig Floor

Other

Additional Hazard Details

🛡️ STEP II: Protection System SelectionSelect the Solution

Primary Protection Method *

Eliminate Hazard

Traditional Fall Protection

Fall Protection Plan

📐 STEP III: System Details & ClearanceCalculate Requirements

Anchorage Strength *

Anchorage Location Description

Positioning D-Rings Used? *

Yes

📏 Fall Clearance Calculator

Calculate minimum clearance required to prevent contact with lower level during fall arrest.

Free Fall (ft)Max 6 ft per OSHA

Deceleration (ft)Typically 3.5 ft

Worker Height (ft)D-ring to feet

Safety Buffer (ft)Recommended 2-3 ft

Estimated Required Clearance (ft)

Available Clearance (ft)

Controlled Access Zone Used? *

Yes

N/A

Warning Line System Used? *

Yes

🚨 Emergency Response

Rescue Plan Required: OSHA requires employers to provide for prompt rescue of workers in the event of a fall, or ensure workers can rescue themselves.

Emergency Response Plan in Place? *

Yes

No - Plan Required

Emergency Phone Number *

Emergency/Rescue Equipment Available

🔧 Equipment Requirements

Full Body Harnesses

Lanyards

SRLs

Anchorage Connectors

Connecting Devices

👷 Workers Protected

Names of Workers (Primary) *

Additional Workers (if applicable)

✍️ Signatures & Approval

Competent Person (Required)

Name *

Signature (Type Full Name) *

Is a Qualified Person Required for this Plan?

Yes

All fall protection equipment has been inspected prior to useAll personnel have been trained on fall protection requirements and equipment useThis plan has been reviewed and approved by a Competent PersonAny engineered systems have been designed/approved by a Qualified Person

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