WORK AT HEIGHT RESCUE PLAN (template)

Facility Address: ……………………………………………………………………

……………………………………………………………………..
……………………………………………………………………..
Location/area of work: …….……………………………………………….……….
Job Task: Describe the work task to be done at height…………….……………………………………………….
…………………………………………………………………………………………………………………………………….….

……………………………………………………………………………………………………………………………….……….

……………………………………………………………………………………………………………………………………….
Personnel: List the names of personnel who are involved in the work at height:

1) ……………………………………………..………...... 2) …………..…………………….…………..………..…….

3) …………………………………………………….…… 4) ……………………………………………………………

5) …………………………………………………….…… 6) ……………………………………………………………

Safety Standby: …………………………………………… Employer: ……………….……………………………………

NOTE: Workers must never work at height alone so that the plan can be immediately activated. A lone
worker cannot initiate a plan for self rescue if they are hurt or unable to reach a means of communication

Rescue:
For this Work at Height we have decided to use: ( as appropriate)
 On-site Rescue Services: List names: 1) ...……………………………………………………….….

2) ………………………………………………………... 3) ...……………………………………………………….….

4) …………………………………………………..….… 5) ..…………………………………………………………..
 Off-site Rescue Services: ( as appropriate)
The Person in Charge will contact (rescue service) ………… ………… at  ………….………….… to do a
familiarization visit of the work area/location.

NOTE: It is not acceptable to rely on the local emergency service provider to be the emergency response as
rescue is time critical.

Methods of Communication:
( as appropriate)
Safety Standby and suspended worker:  Direct voice  Visual Hand Signal  Phone  Audible
Signal
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¨ Radio channel to monitor  Other …………………………………. …..
Safety Standby and Rescue Team:  Direct voice  Visual Hand Signal  Phone  Audible
Signal
 Radio channel to monitor  Other ……………………………………….

Safety Standby to Person in Charge of area:  Phone  Audible Signal  Radio channel to monitor
 Other ……………………………………….

Emergency Contacts:
In the event of an emergency / fall from height the WAH Safety Standby should immediately alert:

Rescue Team Name………………………………. Name……………………...………. …..

 - ………….………….……………  - …………………………………....
First Aid Attendant(s) Name………………………………. Name………………………………….
 - ……………..………….…………  - …………………………………....
If the site rescue team is unable to affect a rescue within 5 minutes the Fire & Rescue Service and the
Ambulance Service are to be called on  - ………. (Insert local emergency number e.g., 911)

Local Accident & Emergency Hospital  - ………………………………….……

Control Room / Person in Charge of area  - ……………...…….……….…………

Note: If required, a nominated person must go to the site entrance to meet, and direct the emergency
services, and provide the following information:

Location / how high up is worker…………………………………………………………………………….

Worker’s condition after fall……………………………………………………...…………………………………

Safety of Personnel:
(Check as appropriate)
Are the workers competent & their training current in the use of rescue equipment? Yes  No 

Are there enough trained rescuers available? Yes  No 

Is the rescue equipment selected appropriate for nature of work? Yes  No 

What obstructions are in the way of reaching the suspended worker? (Detail)……………………………….

………………………………….…………………………………………………………………………………….

………………………………………………………………………………………………….…………………….

Have assessments been made of anchor points, & are they in test date? Yes  No 

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Has the method of lowering casualty been decided? Yes  No 

(Detail) ……………………………………………………………………………………………………………...

.………………………………………………………………………………………………………………………...

Methods of Rescue:
(Check  as appropriate)
 Rescue ladder  Remote Rescue Kit
 Keys to building & roof  Elevator
 Pull worker in through window / balcony  Pull worker up through floor / slab / roof
 Climb / abseil down building / structure  Suspended access equipment
 Aerial equipment from ground  Crane man basket
 ………………………………………... (list other)

 Patient lowering system required/lowering area …………………………………………………….…….

 Anchor overhead ………………………………………………………………………………….…….….…
Anchorage:  Beam  Stairwell  Support Strut  Support Column  Other: ….………………….
Pre-Rigging required?  Yes  No
 Hauling system required ……………………………………………………...………………………………
 Patient lowering system required/lowering area ………………………………………………………...…
 Anchor overhead ……………………………………………………………………………………….….…

Rescue Equipment Requirements:

(Check  as appropriate and indicate quantity needed)
 Rescue ladder: ____  Aerial ladder truck: ____
 Remote Rescue Kit: ____  Suspended access equipment: ____
 Suspension trauma safety strap: ____  Self rescue ladder: ____
 Climbing / rope rescue system: ____  Crane man basket: ____
 MEWP: ____  Hauling Systems: ____
 Carabineers: ____  Pulleys: _____
 Shock absorbers/lanyards: _____  Body Harnesses: _____
 Anchor Straps: _____  Webbing: _____
 Ascenders: _____  Rigging Plates: _____
 Safety Lines: _____  Main Lines: _____
 Wrist/Ankle Harnesses: ____  Stretcher: _____
 Fire Extinguishers: _____
 ………………………………………... (list other)

Rescue Equipment Inspections:

Identified rescue equipment inspected by competent person: (name)…………………………………………...
Record of inspection(s) attached  Yes

Medical Equipment Requirements: (check where applicable below and indicate quantity needed)
 Trauma Kit: _____  First Aid Kit: _____
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¨ Resuscitator & Automated External Defibrillator

Additional PPE Requirements: (Indicate what is needed)

 High Visibility Vests  Hearing Protection  Safety Boots  Hard Hats  Safety Glasses/Goggles
 Gloves  Face Shields  

Action if worker is injured:

( as appropriate)
Can casualty still be rescued within 5 minutes? Yes  No 
Is a qualified first aider who understands suspension trauma present? Yes  No 
Who and how will the emergency services and hospital be alerted? (Detail)………………………………......

………………………………………………………………………………………………………………………...

Actions to protect others:

( as appropriate) ( as appropriate)
 Assign someone to direct traffic  Set up barriers

Diagram of Work Area: Include direction of approach for rescue team/emergency response and any
staging areas.

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Description of Response Steps: (List the response steps. It is recommended they be listed separately
for a fall with no injury and a fall with injuries or unconscious).

Fall and Uninjured

Step 1: Call for help.
Step 2:
Step 3:
Step 4:
Step 5:
Step 6:
Step 7:
Step 8:
Step 9:
Step 10:
Step 11:
Step 12:
Step 13:
Step 14:
Step 15: Report the incident.

Fall and Injured

Step 1: Call for help.
Step 2:
Step 3:
Step 4:
Step 5:
Step 6:
Step 7:
Step 8:
Step 9:
Step 10:
Step 11:
Step 12:
Step 13:
Step 14:
Step 15: Report the incident.

Approved by: ______________________ Title: _____________________ Date: ____________

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ON SITE RESCUE PROCEDURES

These procedures form part of the written Work at Height Rescue Plan and are based on the
assessment of hazards in the named area of work. These procedures must be amended to
include any specific procedures for summoning rescue and emergency services for the
worksite.

Prior to work at height:

1. The Person in Charge shall ensure that the attached work at height rescue plan template
has been completed and that all the rescue equipment identified in the plan is available to
affect a rescue at the named location/area of work.
2. The Person in Charge shall ensure that an adequate number of appropriately trained
persons (as documented in the attached rescue plan) are available for immediate
implementation of these on-site rescue procedures that apply to the named work area.
3. The Person in Charge shall review all emergency procedures, including procedures relating
to emergencies outside the named work area with all appropriate personnel.
4. The Person in Charge shall confirm that the rescue equipment is located at the agreed
staging area.
5. The Safety Standby shall establish communication with all workers, using the means
described in the attached rescue plan.

On commencement of work at height:

1. The Safety Standby who is stationed near the area of work as described in the attached
rescue plan remains in constant communication with all workers working at height.
2. The Safety Standby must be notified immediately if a work at height worker recognizes:
• an unexpected hazard
• an unsafe act
• a condition prohibited by the permit
3. Work at Height Workers must descend and evacuate the area as quickly as possible, when:
• an order to evacuate is given by the Safety Standby or Person in Charge
• an unacceptable condition arises
• an evacuation alarm is activated

In the event of a work at height rescue:

1. The Safety Standby shall not affect a rescue until they have summoned a rescue response
from the designated rescue team, using the means of communication described in the
attached rescue plan.
2. Unit operator and any available personnel in the area will respond to the location of the
alarm if safe to do so.
3. Using applicable rescue techniques to move the person, the person requiring rescuing will
be retrieved and moved out of the area to a safe location by the recue team.
4. An ambulance can safely transport the individual to the hospital if necessary.
5. List other additional site-specific steps as necessary.

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