Rescue Plan For Lifting
Rescue Plan For Lifting
THIS FORM MUST BE FILLED OUT AND ATTACHED TO THE CONFINED SPACE PERMIT.
THE ATTENDANT OUTSIDE THE CONFINED SPACE MUST BE BRIEFED AND BE FAMILIAR WITH THE RESCUE PLAN.
Description of work:
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Associated Hazards:
( ) Oxygen deficiency ( ) Oxygen enrichment
( ) Toxic atmosphere ( ) Flammable substances
( ) High noise level ( ) Extreme temperature
( ) Fall hazard
( ) Other hazards (specify) ______________________
( ) Retrieval system (tripod, harness, rescue/safety line, carabineers, pulley, shock absorbers)
(√ ) Main Rope (√ ) Safety Rope
(√ ) Harness
Breathing Apparatus ( ) Emergency communication method___________
( ) SCBA ( ) Portable explosion-proof lighting
( ) Air-line ( ) Gas monitoring equipment
( ) Air-line suit ( ) Medical equipment (stretcher, First Aid kit)
( ) MSDS (√) Resuscitation apparatus
( ) Ambulance standby