create a lift plan template

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Washington State Department of Labor & Industries Division of Occupational Safety and Health # Fall Protection Work Plan WAC 296-880-[redacted postal code]: You must develop and implement a written fall protection work plan including each area of the work place where the employees are assigned and where fall hazards of 10 feet or more exist and be available on the job site for inspection by the department. Company Name Date Company Name:<empty> Date:<empty> Site Address:<empty> (If additional space is needed, use the back of the sheet.) Identify all fall hazards 10 feet or more above the ground or lower level. Check all that apply. [ ] Open-sided floors [ ] Openings [ ] Leading edge work [ ] Decks/Balconies [ ] Roof [ ] Mobile lift work [ ] Hole [ ] Skylights Methods of fall protection to be used: (LSO = Low Slopes Only. Low Slope = 4 x 12 or less) [ ] Personal fall arrest system [ ] Safety watch system (LSO) [ ] Warning line system (LSO) [ ] Catch platform [ ] Positioning device system [ ] Safety net [ ] Covers [ ] Horizontal life lines [ ] Vertical life lines & rope grab [ ] Personal fall restraint system [ ] Warning line with safety monitor (LSO) Name of safety watch or monitor (if used):<empty> Overhead Hazard Protection Methods [ ] Hard Hats [ ] Toe boards on guardrails [ ] Other:<empty> [ ] Overhead Hazard Signs [ ] Screens on guardrails [ ] Other:<empty> [ ] Debris Nets [ ] Barricade to control access to area Describe procedures for assembly, maintenance, inspection, disassembly of fall protection system to be used.:<empty> Describe procedures for handling, storage, and securing tools, equipment, and materials.:<empty> Describe methods of overhead protection for workers who may be in, or pass through work area.:<empty> Describe method for prompt rescue of employees in the event of a fall.:<empty> Employees who received fall protection training on the above site specific fall protection work plan. Name(s):<empty> Date:<empty> <empty> <empty> <e…

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WORK SAFE KENTUCKY Free safety resources provided by KEMI HOME SAFETY RESOURCES SAFETY TRAINING SAFETY BLOG ABOUT KEMI CONTACT US O # Fall Rescue Plan ## Print a Sign-In Sheet | Spanish Version Coming Soon What do you do if someone falls and becomes suspended toward the top of a tower? Would you know how to get that person down? A good fall rescue plan helps everyone understand what to do before a fall. Following are some important components of a fall rescue plan: • Gain an understanding of the physical environment where you will be working. - Determine the proximity of a professional rescue team. • Determine if 911 works from the area where you would be calling. • Determine approximate response time for 911 responders. • Understand the type of rescue that may be necessary (lowering a victim from a ladder, platform, or manbasket). • Determine who is trained to do the rescue. Decide if the rescuers will be on-site or standby. If standby, determine the response time. • - Perform a job safety analysis of the rescue: • Is the victim clear of obstructions when lowered? • Does the lifeline deploy correctly? • Is the lifeline long enough? • Can you see the victim throughout the entire rescue operation? In addition to having a plan, it is also important to have the correct rescue equipment and supplies on-site and ready to use: • Rescue devices that can raise or lower a victim, such as a controlled rate descent device. • Ropes and lifelines rated for rescue and evacuation. - Rolling edge protectors or Velcro edge protectors to protect the rope from sharp edges and abrasion. • Designated anchor points for rescue equipment (rated at least 3100 pounds). • Anchor straps and carabiners for making an anchor point when one is not available or convenient. • First-aid kit and defibrillator. KEMI does not assume liability for the content of information contained herein. Safety and health remain your responsibility. This information is to be used for infor…

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# How to Plan for Workplace Emergencies and Evacuations (cont.) ## What is an emergency action plan? An emergency action plan covers designated actions employers and employees must take to ensure employee safety from fire and other emergencies. Not all employers are required to establish an emergency action plan. See the flowchart on page 17 to determine if you are. Even if you are not specifically required to do so, compiling an emergency action plan is a good way to protect yourself, your employees, and your business during an emergency. Putting together a comprehensive emergency action plan that deals with all types of issues specific to your worksite is not difficult. You may find it beneficial to include your management team and employees in the process. Explain your goal of protecting lives and property in the event of an emergency, and ask for their help in establishing and implementing your emergency action plan. Their commitment and support are critical to the plan's success. ## What should your emergency action plan include? When developing your emergency action plan, it's a good idea to look at a wide variety of potential emergencies that could occur in your workplace. It should be tailored to your worksite and include information about all potential sources of emergencies. Developing an emergency action plan means you should do a hazard assessment to determine what, if any, physical or chemical hazards in your workplaces could cause an emergency. If you have more than one worksite, each site should have an emergency action plan. At a minimum, your emergency action plan must include the following: - A preferred method for reporting fires and other emergencies; • An evacuation policy and procedure; - Emergency escape procedures and route assignments, such as floor plans, workplace maps, and safe or refuge areas; 5

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# <Name of Project> - Traffic Management Plan (cont.) ## 2. Traffic Control Plan (cont.) Template Category 2 or 3 Traffic Management Plan # <Name of Project> - Traffic Management Plan ## 1. Site Factors (Risk Assessment) <table><tr><th>Road Alignment</th><th>Windy, straight, hilly, banked, etc.</th></tr><tr><td>Road Type</td><td>Primary, secondary, urban, rural, divided, undivided, arterial, expressway, freeway, number of lanes.</td></tr><tr><td>Driver Sight Distances</td><td>Consider signs, trees, buildings, and other obstructions that limit visibility.</td></tr><tr><td>Approaches</td><td>Hill, curves, intersection, accesses, etc.</td></tr><tr><td>Work Zone Length</td><td></td></tr><tr><td>Affected Lanes</td><td></td></tr><tr><td>Regulated Speed</td><td></td></tr><tr><td>Reduced Speed Limit</td><td></td></tr><tr><td>Traffic Volumes</td><td>Approximate traffic volume and type (commercial, residential, agricultural, etc.).</td></tr><tr><td>Shoulders</td><td>Width, material, etc.</td></tr><tr><td>Surrounding Land Use</td><td>Commercial, industrial, residential, agricultural, etc.</td></tr><tr><td>Residential Areas</td><td>Driveways, school buses, etc.</td></tr><tr><td>Pedestrians/Cyclists</td><td>Is project in an area with potential pedestrians and cyclists?</td></tr><tr><td>Weather Conditions</td><td>Clear, icy, wet, foggy, snowy, etc.</td></tr><tr><td>Site Hazards</td><td>List of hazards within project limits.</td></tr><tr><td>Concrete Roadside Barriers</td><td>Will concrete barriers be removed? If so, what traffic control measures will be in place?</td></tr></table> Traffic Management Manual for Work on Roadways 2020 C-14

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# Category 1 Traffic Management Plan (cont.) Template Daily Sign Check Form # DAILY SIGN CHECK FORM Project Name and Number Project Location Type of Work Highway Location <table><tr><th>Date yyyy/mm/dd</th><th>Time of Inspection</th><th>Location and Deficiency Type</th><th>Comments</th><th>Initials</th></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td></tr></table> Traffic Management Manual for Work on Roadways 2020 C-7

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# Emergency Action Plan (cont.) ## COMPANY NAME: (cont.) (name of person or title) is responsible for making sure this emergency action plan is kept up to date, practices, and reviewed periodically. The Emergency Plan Coordinator can be reached at (location and phone number). ## III. REPORTING PROCEDURES (List the types of emergencies that could occur at your workplace and how employees should report them. Options include internal telephone numbers, intercom, public address systems, etc. Employees must also notify external emergency responders if the company uses them for help in emergencies.) <table><tr><th>Type of Emergency</th><th>How to Report</th></tr><tr><td>Fire</td><td></td></tr><tr><td>Explosion</td><td></td></tr><tr><td>Weather</td><td></td></tr><tr><td>Bomb threat</td><td></td></tr><tr><td>Chemical Spill/Leak</td><td></td></tr><tr><td>Violence</td><td></td></tr><tr><td>Medical</td><td></td></tr><tr><td>Other (list)</td><td></td></tr></table> Reporting procedures are posted (locations). ## IV. EVACUATION PROCEDURES ## A. Emergency Escape Procedures and Routes Emergency escape procedures and route assignments have been posted in each work area, and all employees have been trained by supervision in the correct procedures to follow. New employees are trained when assigned to a work area. A sample escape procedure and escape route sheet of the type posted in work areas is included with this plan. ## B. Procedure for Employees Who Remain to Operate Critical Operations Before They Evacuate During some emergency situations, it will be necessary for some specifically assigned and properly trained employees to remain in work areas that are being evacuated long enough to perform critical operations. These assignments are necessary to ensure proper emergency control. The following lists these employees and their duties: <table><tr><th>Name</th><th>Title</th><th>Work Area</th><th>Special</th></tr><tr><td></td><td></td><td></td><td>Assignment</td></tr></…

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# Emergency Action Plan (cont.) ## B. Procedure for Employees Who Remain to Operate Critical Operations Before They Evacuate (cont.) The preceding individuals have received special instructions and training by their immediate supervisors to ensure their safety in carrying out the designated assignments. A training record describing the instructions provided and the detailed procedures to be followed is maintained in the Emergency Plan Coordinator's Office. ## C. Employee Accountability Procedures after Evacuations Each supervisor is responsible for accounting for all assigned employees, personally or through a designee, by having all such employees report to a predetermined designated rally point and conducting a head count. Each assigned employee must be accounted for by name. All supervisors are required to report their head count (by name) to the Emergency Evacuation Coordinator. A summary of the evacuation rally points, together with the identities of supervisors and assigned employees who must report to each, is included with this plan. ## D. Alarm System Describe the alarm system to be used to notify employees (including disabled employees) to evacuate and/or take other actions. The alarms used for different actions should be distinctive and might include horn blasts, sirens, or even public address systems. Alarm systems for notifying all employees in case of an emergency are: <table><tr><th>Action to be taken</th><th>Alarm system</th></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr></table> (OSHA Standard 29 CFR 1910.165, Employee Alarm Systems, provides guidance on emergency alarms.) ## E. Sheltering in Place (Certain emergencies require employees not to evacuate, but to move to an interior, windowless room. Describe procedures for sheltering-in-place emergencies at your workplace.) ## F. Training The following personnel have been trained to assist in the safe and orderly emergency evacuation of other employe…

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# <Name of Project> - Traffic Management Plan (cont.) ## 5. Implementation Plan (cont.) Template Category 2 or 3 Traffic Management Plan <Name of Project> - Traffic Management Plan ## 6. Contact List ## 1. Emergency Response Agencies/Assistance <table><tr><th>Agency/Assistance</th><th>Contact 1</th><th>Contact 2</th></tr><tr><td></td><td></td><td></td></tr><tr><td>RCMP</td><td></td><td></td></tr><tr><td>BC Ambulance</td><td></td><td></td></tr><tr><td>Fire and Rescue</td><td></td><td></td></tr><tr><td>HazMat 24 hr</td><td>1-[redacted phone]</td><td></td></tr><tr><td>PEP 24 hr</td><td>1-[redacted phone]</td><td></td></tr><tr><td>Towing Company</td><td></td><td></td></tr><tr><td>Road Authority Contacts</td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td>Other</td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr></table> ## 2. Non-Emergency Contacts <table><tr><th>Agency</th><th>Name</th><th>Phone/Fax</th><th>Address</th></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>WorkSafeBC</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>BC Hydro</td><td></td><td></td><td></td></tr><tr><td>Telus</td><td></td><td></td><td></td></tr><tr><td>Maintenance Contractor</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>CP Railway</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>Local City Office</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>First Aid</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>Traffic Control Supervisor</td><td></td><td></td><td></td></tr><tr><td>Traffic Control Company</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr><tr><td>Other</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td></tr></table> Traffic Management Manual for Work on Roadways 2020 C-22