WRITTEN RESCUE PLAN
Communication:
What communication systems will be used between the suspended worker and supervisor / rescue team?
Direct voice communication
Mobile Phone
Whistle
Two-way Radios / Headsets
Other; _______________________________________________________________________________
Emergency Contact:
In the event of a fall from height, the supervisor will immediately alert the rescue team and first aid.
If the rescue team cannot affect a rescue within 5 minutes Emergency Services are to be called at once.
Name of this site: ___________________________________
Supervisor:
_________________
First Aid Attendant(s): ___________________________________________________________________
Fall From Height RESCUE TEAM MEMBERS:
_____________________________________________________________________________________
_____________________________________________________________________________________
EMERGENCY PHONE NUMBERS - CALL 9-1-1 or ___________________________________________
Fire: ___________________
Police: __________________
Ambulance:
_________________
Safety of Rescuers:
Are Operators trained and competent to use of rescue equipment?
Yes No
Are Rescue training records current?
Yes No
Are there a sufficient number of rescuers available?
Yes No
Is rescue equipment appropriate for nature of work?
Yes No
What obstructions are in the way of reaching the suspended Operator? (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have assessments been made of anchor points, and are they acceptable?
Yes No
Has consideration been given to the method of attaching the casualty? (Detail):
Yes No
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Available for free download at: [Link]
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WRITTEN RESCUE PLAN
How will rescuers get to casualty?
Rescue ladder
Pull casualty up through floor / roof
Remote Rescue Kit
Climb / repel down building / structure
Keys to building and roof
Suspended access equipment
Elevator
Aerial equipment from ground
Crane man basket
Pull casualty in through window / balcony
What equipment is needed to ensure rescue within 5 minutes, to minimize suspension trauma?
Rescue ladder
Low Height Rescue Kit
Aerial truck
Crane man basket
Rescue Kit Winch
Descent Rescue Kit
Suspended access equipment
Stretcher
Rescue Kit Haul-up
Elevated Work Platform
Climbing / rope rescue system
First Aid Kit
If Worker is injured
Can the casualty still be rescued within 5 minutes?
Yes No
Is a qualified first aider who understands suspension trauma present?
Yes No
Who will alert emergency services and the hospital? (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
How will others be protected?
Assign someone to direct traffic
Set up barriers
Other;
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Available for free download at: [Link]
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WRITTEN RESCUE PLAN
How will Accident scene be protected?
Prevent further injury or damage
Set up barriers
Preserve wreckage
Take photographs
Notify Employer
Notify Ministry of Labour
Other Considerations:
Precautions for working alone (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Unusual features of building / structure (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Weather Conditions (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Proximity to emergency services / hospital (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Language barriers (agency / contract staff) (Detail):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
APPROVAL OF WORK AT HEIGHT RESCUE PLAN:
Supervisor:
Name (print): ____________________________________
Cell Phone # ________________________
Signature: ______________________________________
Date: ______________________________
Available for free download at: [Link]
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