Sample appointment of Fall Protection Planner form

OCCUPATIONAL HEALTH AND SAFETY ACT, 85 of 1993

Construction Regulation 8

APPOINTMENT OF FALL PROTECTION PLANNER

I, ___________________________(Employer), for
_____________________________(Company) do hereby appoint :
________________________(Employee) as the Fall Protection Planner for:
___________________________ at
_____________________________________(Site/Address).

Duties:
1. Ensure compliance with Construction Regulation 8.
2. Compile a Fall Protection Plan for the project.
3. Implement the Fall Protection Plan and amend where required.
4. Take steps to ensure all employees adhere to the plan.
5. Ensure risk assessments are conducted prior to commencing work in elevated positions.
6. Ensure persons required to work in elevated positions are physically and psychologically
fit.
7. Ensure all employees required to work in elevated positions are trained.
8. Ensure all fall arrest equipment is inspected and maintained.
9. Ensure the construction supervisor is issued the latest version of the Fall Protection Plan.
10. Ensure all checklists are kept up to date, with copies in the Health and Safety File.
11. Ensure roof work is included in the planning.

Signature:_______________________________________________
(for Employer)
Designation:_____________________________________________

Date:___________________________________________________

ACCEPTANCE OF APPOINTMENT

I______________________________ hereby accept and understand this appointment.

Signature:______________________ Date: _______________________________

Designation:_____________________________________