1. Elevated Surface Work Plan Job / project name: Begin date: End date: Location (bldg, floor, grid): Description: List authorized workers Authorized worker name Important: two authorized workers must be present whenever fall protection is used. Indicate protection method to be used and describe Guard rail system Fall restraint Fall arrest (if fall arrest is used a fall hazard analysis must be developed [Section 3]) Control line (designated area) List equipment to be used, such as full body harness, minimum length lanyard, shock absorber, connecting hardware, lifeline) Include specific manufacturer and model of equipment to be used. Attach manufacturer cut sheets. (Required for all construction activities, for general industry only for fall arrest.)
1. Elevated Surface Work Plan Job / project name: Begin date: End date: Location (bldg, floor, grid): Description: List authorized workers Important: two authorized workers must be present whenever fall protection is used. Authorized worker name Indicate protection method to be used and describe Guard rail system Fall restraint Fall arrest (if fall arrest is used a fall hazard analysis must be developed [Section 3]) Control line (designated area) List equipment to be used, such as full body harness, minimum length lanyard, shock absorber, connecting hardware, lifeline) Include specific manufacturer and model of equipment to be used. Attach manufacturer cut sheets. (Required for all construction activities, for general industry only for fall arrest.)
fallFormESWP.docx