Form Number
LLCF-084
Issue Date 07/22/16
Revision Date 01/01/24
Rope Access Rescue Plan
Form Number
LLCF-084
JOB INFORMATION
Client
Job No.
Work Location
Facility Location
Level III Name
Date
Task Description
ACCESS (Check the relevant boxes and enter further detail where appropriate)
Climbing with cow’s tails
Suspended aid climbing
Lead climbing (separate assessment)
Fall arrest climbing
Over water
Appropriate equipment available
Abseil in / abseil out
Abseil in climb out
Rope transfers
Deviation / rebelay / knots to pass
Other (Describe):
Additional
Details
RIGGING (Check the relevant boxes and enter further detail where appropriate)
Anchors assessed as 100% reliable
Anchors will sustain 15kN minimum
Basic anchor system deployed
Small Y hang
Large Y hang
Path of ropes checked for hazards
Deviation / rebelay / knots in system
Rope protection required
Knots in end of ropes
Other
Additional
Details
RESCUE (Check the relevant boxes and enter further detail where appropriate)
Appropriate rescue kit at site
All personnel briefed in plan
Pre-rigged lower
Pre-rigged haul
Pick-off and descent separate ropes
Pick-off and descent same ropes
Over side rescue
RISK ASSESSMENT (Tools Used)
Generic TBRA
Desktop
Descent past deviation / rebelay / knots
Rope transfer with casualty
Cross-haul casualty
Use of tensioned lines (tramways)
Emergency contacts known (Specify below)
Sky hook
Other
Workplace
Manual Handling
Personal Last Minute
Tool Box Talk
Form Number
LLCF-084
Issue Date 07/22/16
Revision Date 01/01/24
Rope Access Rescue Plan
Form Number
LLCF-084
WORK PLAN (Detailed Description and Rigging Diagram)
RESCUE PLAN (Detailed Description and Rigging Diagram)
TEAM MEMBERS HAVE RECEIVED A FULL BRIEFING BEFORE WORK COMMENCES
PRINT NAME
SIGNATURE
PRINT NAME
SIGNATURE