<p> Chapter 6 Section D Working from Heights and/or Part A Open Hole Checklist Version: 4</p><p>This checklist must be completed by the Person in Charge (PIC) prior to personnel working from heights and/or opening of holes requiring guarding and/or fall protection. Platform: Date Issued: Time Issued: </p><p>Work Location (be specific): </p><p>PIC Working from Heights: Work on unguarded elevations 6 feet or more above floor or grade level. Initials 1. All practical options to eliminate the need to perform elevated work from heights have been explored. </p><p>2. Personnel working from heights have been properly trained in fall hazards and the use of fall protection.</p><p>3. A Job Safety Analysis (JSA) has been completed, signed and approved by the PIC.</p><p>4. A rescue plan has been developed and all equipment needed to execute the plan is on-site.</p><p>5. Another individual in the area has been assigned to initiate the rescue plan should a fall occur.</p><p>6. All fall arrest equipment/systems being utilized are in good condition and have been inspected prior to use.</p><p>7. Anchor point(s) are capable of supporting 5000 lbs and located directly overhead of the user as possible.</p><p>8. Fall protection system(s) being utilized allow workers to be tied off 100% of the time.</p><p>9. Lanyards shall be of the "Y" type design and equipped with a shock absorbing device.</p><p>10. Personnel working over water will also be required to wear a USCG approved personal flotation device. PIC Open Hole: Openings 2 inches or more located in any walking or working surface. Initials 1. Open holes have been properly barricaded and/or covered according to Safe Work Practices Fall Protection Section D Chapter 6.</p><p>2. Barricades have a top rail and middle rail installed. Top rails of each barricade are at least 42 inches in height and capable of withstanding a load of at least 200 lbs. applied in any direction.</p><p>3. A 4" kick plate, or 3rd rail no more than 4” above the decking is installed if personnel are working below. 4. Personnel performing work inside the barricade have been notified that fall protection will be required. 5. Open holes that cannot be immediately barricaded after exposure will be monitored by an Open Hole Attendant (Hole Watch) with no other duties and equipped with adequate fall protection at all times.</p><p>Hole Watch Name: ______Approval Signatures: Immediate Supervisor of Job/Task: Name (Print): Company: Signature: Date: Facility Person in Charge (PIC) or Consultant (Print): Company: Signature: Date: File the completed form in your platform file system. REV: July 2012 Gulf of Mexico Shelf Region Safe Work Practices Page D-6-A-1</p>