Location: Inspection Date:
Fall Protection Competent Person:
Subject: Fall Protection
“Fall Protection” it is required when any person who could fall more than 1.8 m (6 ft); therefore, he/she shall be protected from falling by a fall protection
system (❶ fixed fall protection systems & ❷ personal fall arrest systems).
# Item Description Yes No Reference Remarks
CSM II-5 “Fall Protection”
General Requirements
Is the personal fall arrest system including the following?
1. Full-body harness.
2. Shock-absorbing lanyard (Y/double-leg lanyard) or self-retracting lifeline.
3. Substantial anchor points and/or horizontal/vertical lifeline.
CSM II-5-Fall
Protection-
1
sections
5.3.5/5.3.6
2 Did SA proponent organizations (SAPOs) and contractor companies develop a fall protection CSM II-5-Fall
plan for the specific work at heights to be performed by their personnel? It shall include, but Protection-
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not be limited to, the following:
1. Specific tasks personnel may perform that require use of a personal fall arrest system.
2. Method(s) of access to elevated work areas (e.g., ladder, scaffold).
3. Fall protection systems and equipment to be used
4. Identification and fitting of correct fall protection equipment to the task. section 5.3.7
5. Selection of appropriate anchor points (i.e., anchorage).
6. Methods for securing lanyards and lifelines.
7. Protection from falling objects.
8. Storage, inspection and maintenance of fall protection equipment.
9. High elevation rescue procedures.
Supervisors of personnel exposed to fall hazards shall having a sufficient/ adequate
knowledge on the fall protection, you can test them by asking the below questions:
Did the supervisor ensure that fall protection equipment is in good working condition
before commencing work?
CSM II-5-Fall
Did the supervisor periodically monitor work activities to ensure personnel are properly
3 Protection-
using fall protection equipment?
section 5.3.8
Did the supervisor ensure fall protection equipment is properly stored in a clean, dry
environment away from direct sunlight?
Did the supervisor ensure fall protection equipment is inspected by a competent person
at least monthly and is properly cleaned and maintained?
CSM II-5-Fall
8 Is the fall protection equipment used for any purpose other than its intended use? Protection-
section 5.3.9
Was equipment designed solely for use as a fall restraint or positioning system used? CSM II-5-Fall
9 Note: Equipment labeled “ANSI Z359.3” or “EN 358” shall not be used. Only fall arrest Protection-
equipment are allowed when fall restraint or positioning is needed. section 5.3.13
CSM II-5-Fall
Were personal fall arrest systems in compliance with ANSI Z359.1 (or equivalent as specified
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in writing by the SA Loss Prevention Department), and were they labeled?
section 5.5.1
Do personnel in motorized aerial lifts (e.g., scissor lifts, aerial work platforms, JLG lifts) are CSM II-5-Fall
11 continuously wearing a full-body harness with the lanyard securely attached to an appropriate Protection-
anchorage point (not the handrail of the aerial lift)? section 5.3.14
12 CSM II-5-Fall
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Do the personnel inspected their fall protection equipment, including full-body
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harnesses, lanyards and D-rings prior to each use?
section 5.3.15
Are the rescue capabilities immediately available for personnel involved in a fall?
CSM II-5-Fall
Suspension trauma safety straps (foot stirrups) shall be provided with each full-body harness
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to ensure that personnel involved in a fall can stand up in their harness to prevent loss of
section 5.3.17
circulation until they can be rescued.
Training
CSM II-5-Fall
Do the personnel performing work at heights and their supervisors are trained in the nature
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of fall hazards in the work area?
section 5.7
CSM II-5-Fall
Do the personnel performing work at heights and their supervisors trained in use, inspection
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and maintenance of fall protection equipment?
section 5.7
CSM II-5-Fall
Did the personnel performing work at heights and their supervisors successfully pass the
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written and practical tests?
section 5.7
CSM II-5-Fall
Did the personnel performing work at heights and their supervisors undergo refresher training
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at least every 3 years?
section 5.7
Anchor Points and Lifelines
Did anchor points for lanyards and self-retracting lifelines meet the following criteria:
1. Be capable of supporting at least 2,268 kg (5,000 lb.) per person attached. CSM II-5-Fall
18 2. Not be guardrails, standpipes, vents, small diameter piping systems, cable trays, or Protection-
electrical conduit. section 5.6.1
3. Be high enough (preferably above shoulder height) to prevent personnel from free
falling more than 1.8 m (6 ft) or striking any lower level during a fall.
19 Did horizontal lifelines meet the following criteria: CSM II-5-Fall
Protection-
1. Be a minimum 12 mm (1/2 inch) diameter wire rope having a breaking strength section 5.6.2
specified by the manufacturer of at least 9,000 kg (20,000 lb.). Other materials, such
as manila, nylon or polypropylene rope, shall not be used.
2. Have a safety factor of at least two against failure and be capable of supporting 2,268
kg (5,000 lb.) per person attached.
3. Designed by a degreed structural engineer, and the material specifications,
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calculations and drawings reviewed by SAPO prior to installation.
4. Not have an unloaded sag/drooping at the center of the lifeline greater than 30 cm (12
inches) for every 10 m (33 ft.) of lifeline length between anchor points and have a
means of tensioning, e.g., turnbuckles.
5. Have no more than three persons attached at one time between anchor points, unless
designed by a degreed structural engineer.
6. free of splices.
Did vertical lifelines meet the following criteria:
1. Have only one person attached at a time.
2. Be attached to an anchor point that is capable of supporting at least 2,268 kg (5,000
lb.) dead weight.
3. Be made from wire rope with a minimum diameter of 10 mm (3/8 inch).
4. Be used with rope grab devices or with connectors designed for shock-absorbing
lanyard attachments.
CSM II-5-Fall
20 Protection-
section 5.6.3
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