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Working at Heights Rescue Plan Template

This document outlines a rescue plan for working at heights. It provides information on the job site location, available emergency contacts and rescue equipment, rescue factors like landing areas and hazards, and a preparation checklist. The response procedure instructs notifying emergency contacts, assessing any medical needs and the situation, having the employee self-rescue if possible or contacting emergency services, and leaves space to describe specific rescue actions.

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JESUS BASILIO ANTONIO
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57 views2 pages

Working at Heights Rescue Plan Template

This document outlines a rescue plan for working at heights. It provides information on the job site location, available emergency contacts and rescue equipment, rescue factors like landing areas and hazards, and a preparation checklist. The response procedure instructs notifying emergency contacts, assessing any medical needs and the situation, having the employee self-rescue if possible or contacting emergency services, and leaves space to describe specific rescue actions.

Uploaded by

JESUS BASILIO ANTONIO
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

WORKING

AT HEIGHTS RESCUE PLAN



Site Name: ________________________________ Supervisor: __________________________

Job Description: ________________________________________________________________

Date: _____________________________ Location: _________________________________

Emergency Information

LOCAL CONTACTS – CALL 911 or ___________________________________________________

Police: _________________ Ambulance: _________________ Fire: _________________

OTHER CONTACTS

Rescuer(s): ____________________________________________________________________


Emergency Contact: _________________________

Method of Contact: ☐ PA ☐ Verbal/In Person ☐ Phone: _______________________

☐ Radio (Channel): ____________ ☐ Other: ________________________________

AVAILABLE RESCUE EQUIPMENT

☐ Ladder ☐ Alternative Lifting & Lowering Device


☐ Rescue Pole ☐ RSQ
☐ Rescue Rope ☐ First Aid Kit
☐ Scaffold ☐ Life Ring
☐ Crane ☐ RPD
☐ Aerial Lift ☐ R550

EQUIPMENT LOCATION
☐ Jobsite ☐ Gang Box ☐ Tool Box ☐ Other: ___________________________
WORKING AT HEIGHTS RESCUE PLAN

RESCUE FACTORS

Landing Area: __________________________________________________________________




Anchor Point: __________________________________________________________________


Obstructions or Hazards: _________________________________________________________


Other: ________________________________________________________________________

PREPARATION CHECKLIST

☐ Has rescue equipment been inspected and in good, working condition?


☐ Is the equipment adequate for the rescue plan?
☐ Have devices necessary for communication been identified and tested?
☐ Are all listed rescuers familiar with the use of the rescue equipment?
☐ If working over or near water, is there a boat available?
☐ Have alternatives to fall resist equipment been considered?

RESPONSE PROCEDURE

1) Notify Emergency Contact



2) Make medical assessment of at risk person

3) Make assessment of situation
a. If possible, have employee perform self-rescue
b. If necessary, contact 911 or other emergency services
4) ________________________________________________________________________

5) ________________________________________________________________________

6) ________________________________________________________________________

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