Grunley Fall Protection Plan Checklist

Write yes, no or n/a with the reason in the spaces below as it relates to the Fall Protection
Plan is developed by the contractor or reviewed by Grunley

Yes No not Not Applicable

Information Needed
included included with reason
1. Overview to include a detailed summary of the work
to include Grunley project name, Grunley project
number, Grunley project address, Subcontractor
name, Subcontractor address and Subcontractor
phone number.
2. Competent Person (CP) Designation – In writing and
signed by the Contractor’s Executive Manager or
Owner designating their Competent Person by name,
title, phone number and email address.
3. Fall protection Competent Person training must be
provided. This training shall be 24 hours minimum
with combination of formal classroom training and
practical application as Per USACE 21. C.04.
4. State that the Competent Person is responsible for
the work, shall be onsite during the work, enforces
compliance with the plan, inspects the equipment
and the setup prior to it being used, and has the
Company’s authority to take action and expend funds
when needed to resolve safety issues.
5. Include current CPR and First Aid training documents
for the Competent Person.
6. Provide employee/worker fall protection training
within a 5-year compliance date to verify that they
have been trained in the use, care, and inspection of
the specific fall protection equipment.
7. Provide inspection criteria and procedures for fall
protection equipment.
8. Provide a detailed diagram or pictures showing
specific anchor points for personal fall arrest systems
that are capable of withstanding 5000 pounds.
9. Provide Fall Protection Manufacturer Engineered
system cut sheets with details of installation. Please
circle or highlight the sections that show the actual
equipment to be used.
10. Develop and provide the Fall Protection Activity
Hazard Analysis (AHA). Use the Corps of Engineers
(COE) current AHA format.

GRUNLEY CONSTRUCTION CO., INC.

 Yes No Not Not Applicable
Information Needed
Included Included With Reason
11. Sign-in sheet to verify the AHA meeting with all
personnel involved with the work prior to the work
taking place to include presenter (preferably the
company safety representative) company name,
legible printed name and signature of each attendee,
and date of meeting.
12. Provide a detailed rescue plan with an emergency
point of contact and alternate name and phone
number.
13. Name, title, phone number and email address of the
contractors Safety Director or Safety Manager that
will frequently and periodically visit the project and
monitor the work for compliance.
14. Provide contractor Safety Director or Safety manager
credentials and training certifications that would
deem this person to be the Qualified Person.
15. Printed name, signature and title of the Contractors
Safety Director, Safety Manager, Risk Manager, Vice
President, Operations Manager, President, Principal
of the Company or otherwise authorized Executive
Manager of the company that has reviewed, accepted
and takes responsibility for the developed and
submitted Fall Protection Plan

GRUNLEY CONSTRUCTION CO., INC.