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JOB SITE FALL PROTECTION & SAFETY HAZARD PLAN <br /> 811CHOMEPlan de seguridad y proteccion contra caidas en el lugar de trabajo <br /> On Site Lead: Phone# Job# <br /> Job Name: Job Address: <br /> Date: Job Description: <br /> Roof Height(max): Roof Width(max): Roof Length(max): <br /> Slope over 4/12: Slope under 4/12: <br /> The fall Hazards associated with this project are: Method of fallpro ec Ion to be use : <br /> Los Riesgos de caida asociados con este proyecto son: Metodo de proteccion contra caidas a utilizar: <br /> ❑Roof Edges(Bordes de Techo) ❑ 1 (take and send pictures to IM) <br /> Ladders(Escaleras)Please add any additional precautions in 7 below. ❑ 7 <br /> ❑Skylights(Tragaluces) If any (si to hubiera) ❑ 5 <br /> ❑Falling Objects(Caida de objetos) 116, 4-Controlled Access Zone CAZ <br /> ❑Roofing Hatch(Escotilla de Techo) If any (si Io hubiera) ❑ 5 <br /> ❑Other(Otro)Please identify below 118 <br /> I <br /> Note: Ladders will be properly secured with a minimum of X above the roof. CAZ signs will be posted to secure all <br /> hazardous areas (Las escaleras estaran debidamente aseguradas con un minimo de 3 pies por encima del techo. <br /> Se colocaran letreros de CAZ en las areas peligrosas). <br /> Method(s)of Fall Protection: <br /> 1. Fall Arrest System (Safety Harness/Lanyard/Lifeline) (Sistema anti caidas) 2.Safety Monitor(Monitor de seguridad) <br /> 3. Fall Restraint System (Guardrails, Safety Net) (Sistema de contencion) 4. Hardhats(Cascos) <br /> 5. Wood cover over opening (mark"Hole") (Cubierta de madera sobre la 6. Barricade Area Below(Area de la <br /> abertura) barricada debajo) <br /> 7.Tie off Ladders/Amarre de escaleras <br /> 8.Other: <br /> Emergency Information <br /> Injured Worker Removal: <br /> worker that is held in the air by fall arrest gear OR has fallen on an upper level will be rescued using the following method <br /> and equipment: <br /> Nearest Phone(Telefono mas cercano): []Cell ❑Truck ❑ Other: <br /> First Aid Kit(Botiquin de primeros ❑Truck <br /> Auxilios): ❑ Other: <br /> Accident procedures: Call 911 or render first aid at the job site. Go to the nearest Emergency Room if treatment is <br /> needed. Call the office at 206.841.0881. DO NOT MOVE AN INJURED WORKER who cannot move himself unless <br /> you first call 911 and talk to an emergency medicine technician. Fill out an accident report and take pictures. <br /> (Procedimientos de accidentes:Llame al 911 o preste primeros auxilios en el lugar de trabajo. Acuda a la sala de emergencias <br /> mas cercana si necesita tratamiento. Llame a la oficina al 206.841.0881. NO MUEVA A UN TRABAJADOR LESIONADO que no <br /> puede moverse por si mismo a menos que primero Ilame al 911 y hable con un tecnico de medicina de emergencia. Llene un <br /> informe de accidente y tome fotografias). <br />