<p> Fall Protection Consulting, Inc. Steel Erector Information Work Sheet Complete, Toll Free Fax 1-866-202-4843 or email back to Craig. [email protected] NOTE: In developing a site specific fall/safety protection plan for you’re project the below information will provide a guideline that will help ensure that you’re specific job will meet or exceed the applicable safety standards required by Division of Occupational Safety and Health– or DOSH, for short (formerly WISHA) /OSHA as well as the general contractors specific requirements. </p><p>1. Project Controlling (general) contractor name, address, contact person/numb</p><p>1. Project name: </p><p>1. Project address: 2. 3. Approximate start date of project: </p><p>4. Your Job # (if any) </p><p>2. You’re scope of work for this project, i.e.</p><p>1. Number of floors? </p><p>2. Bar joist, misc iron? </p><p>3. Stairways: </p><p>4. Metal decking? </p><p>5. Welding operations? </p><p>6. Are you required to provide a fire watch? </p><p>3. General contractors contract language Fax or email me the their specific safety language that they require you to comply with, that may include specific requirements above the minimum standards in the DOSH or OSHA standards, examples like 6 feet fall protection rather than 10 feet, NO safety monitor system, safety glasses, high visibility vests required at all times, OSHA 10 or 30 etc. </p><p>4. Multiple Lift Rigging, Will you be using (Christmas Treeing)? 1. If yes do you have a rated Multiple Lift Rigging Assembly? </p><p>5. Overhead hoisting All wire rope slings used in overhead hoisting must have tags with rated capacity, and the manufacture as a minimum. 1. Will this be provided? </p><p>6. Designated foreman (Onsite safety rep) superintendent for your project?</p><p>(NOTE) This person will become you’re competent person (on site safety person) as defined by OSHA, DOSH & EM385-1-1“as one who can identify existing or predictable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has authorization or authority by nature of their position to take prompt corrective measures to eliminate them. The person must be knowledgeable of the requirements of this part. (Meaning Steel Erection activities WAC 296-155 part P) </p><p>Fall Protection Consulting. Inc. Craig Carlson (253)-740-3354 1 Fall Protection Consulting, Inc. Steel Erector Information Work Sheet Complete, Toll Free Fax 1-866-202-4843 or email back to Craig. [email protected]</p><p>7. Critical lifts Do you plan on doing any? No Meaning: 1. 75% of crane capacity 2. two crane picks or 3. Mousing the hook back. 4. If the answer is yes you are required to have a site specific erection plan. </p><p>8. Leading edge work like decking are you (if allowed by you’re contract with the general) going to use the Safety Monitor System? NOTE: The monitor system can’t be used with a pitch of more than 4-12” </p><p>9. If you’re NOT going to use the Safety Monitor System, then what fall protection system are you going to use? 1. Retractable lifelines? </p><p>2. Approved Horizontal Lifeline System? </p><p>3. Retractable lifelines connected to Horizontal lifeline? </p><p>4. Manufactured stanchions? </p><p>5. Catch platform? </p><p>6. Vertical lifeline with rope grabs? </p><p>7. Other? </p><p>10. Connecting/bolt up activities: What fall protection are you planning on using form steel erection activities above 10 feet? Check all that apply</p><p>1. Self propelled elevating work platforms. (Scissor lift) </p><p>2 Boom supported elevating work platforms. (JLG Type) </p><p>3. Supported Scaffolds (brackets, pole type) </p><p>5. Full body harness connected to retractable lifeline </p><p>6. Full body harness and “Beamer” type anchorage </p><p>7. Approved horizontal Lifeline (ankle wire) </p><p>8. Vertical Lifeline with rope grab </p><p>11. Does you’re contract require to install pipe and wire rope guardrails? </p><p>If YES Then you must follow DOSH requirements for when to install: “on multistory structures, perimeter safety cables must be installed at the final interior and exterior perimeters of the floors “as soon as metal decking has been installed.” 1. posts and top and intermediate railings shall be at least 1 1/2 inches nominal OD diameter with posts spaced not more than 8 feet on centers.</p><p>Fall Protection Consulting. Inc. Craig Carlson (253)-740-3354 2 Fall Protection Consulting, Inc. Steel Erector Information Work Sheet Complete, Toll Free Fax 1-866-202-4843 or email back to Craig. [email protected] 2. For wire rope railings, the top and intermediate railings shall be at least ½ inch fibre core rope, or the equivalent.</p><p>12. Crane Supplier: Will you be supplying the crane or will the general contractor furnish? </p><p>1. If you are the supplier who is the crane rental firm? </p><p>2. Will they provide you or operator with crane certs? Yes 13. Onsite Project Safety Orientation: </p><p>1. Will your designated foreman be your site-specific employee orientation? </p><p>2. If not who will do the orientation? </p><p>14. Fall Protection Rescue: DOSH (296-155-24505(f) requires the employer to provide prompt rescue of a “suspended worker” therefore I must include your planned rescue procedure. 1. Will you use on site aerial lifts to rescue worker? </p><p>2. Will you use on site mobile or tower crane for retrieval? 3. If none of the above, will you provide a “self rescue” kit? </p><p>15. Components of you’re Site specific Fall/Safety Work Plan will include: </p><p>1. Commitment to Safety 9. Enforcement of plan 2. Responsibilities under This Plan 10. Disciplinary Measures 3. Onsite/Offsite Safety Representative 11. Exposure Vehicular Traffic 4. Safety Orientation/Training 12. Crane Safety 5. Fall Hazard Identification 13. Accident Investigations/Near Misses 6. Fall Protection Methods 14. Changes to the Plan 7. Emergency Preparedness 15. Hazard Communication 8. Fall Protection Rescue 16. Training and Instruction signature page</p><p>16. Delivery of Site Specific Fall/Safety Plan: NOTE: I will provide two copies in binder form, one for the general contractor which includes CD ROM of all contents including you’re company accident prevention Program and one for you’re jobsite. Delivery:</p><p>1. Deliver generals copy directly to their job or rep? </p><p>2. FedEx or mail general copy? </p><p>3. Deliver both copies to your office? </p><p>4. FedEx or mail both copies to your office? </p><p>17. Offsite safety representative: </p><p>1. Do you want me to be you’re offsite safety person? </p><p>2. If not, who will be that person? </p><p>Fall Protection Consulting. Inc. Craig Carlson (253)-740-3354 3 Fall Protection Consulting, Inc. Steel Erector Information Work Sheet Complete, Toll Free Fax 1-866-202-4843 or email back to Craig. [email protected]</p><p>Addition comments</p><p>Sketches/Diagram etc.</p><p>Fall Protection Consulting. Inc. Craig Carlson (253)-740-3354 4</p>