Fall Protection Program Template — free, no sign-up Download PDF

Fall Protection Program Template

A fill-in-the-blanks written fall protection program for Canadian employers, structured around the height triggers and written-plan duties in the Ontario, Alberta and British Columbia OHS regulations. Built for construction, industrial maintenance and utility work.

How to use it. Complete Sections 1–9 once for your organization, then complete a Site Fall Protection Plan (Part 2) for each project or work area where the program applies.
To print: Click "Print Template" below → select Portrait orientation → enable Background graphics in print settings → Print.
To fill in: Print and complete by hand, or use your browser's "Save as PDF" and fill the fields in any PDF editor.
Want a second set of eyes on your fall protection program?
HSE Advisor Canada is CRSP Certified, COR & ISO 45001 Lead Auditors. We will review what you have written, confirm it lines up with the requirements in your province, and help you close the gaps. The first conversation is free.

Want our most-requested checklists by email?

This template is free to read, print and use right here — no sign-up. We can also email you our most-requested free checklists and templates. The full library is always at Free HSE Resources.

We send occasional Canadian OHS updates. Unsubscribe any time.

Part 1 of 2 — Written fall protection program

Fall Protection Program

Written program · Template for Canadian employers
HSE ADVISOR CANADA
hseadvisor.ca
Employer / company:
Program owner:
Prepared by:
Position:
Effective date:
Review date:
1. Purpose and scope

This program sets out how protects workers from falls, and applies to all work described below.

Work activities covered:

Sites / work areas covered:

2. When fall protection is required

Record the trigger that applies to your jurisdiction and work type. Confirm against the current regulation before you rely on it — requirements change.

JurisdictionPrincipal regulationGeneral height trigger and common additional triggers
Ontario
(construction)
O. Reg. 213/91, s. 26.1 Fall of 3 m or more; also where a fall is into operating machinery, into water or another liquid, into or onto a hazardous substance or object, or through an opening in a work surface.
Ontario
(industrial)
R.R.O. 1990, Reg. 851, s. 85 Where a worker is exposed to the hazard of falling and the fall would be more than 3 m, or into an operating machine, or into a hazardous substance.
Alberta OHS Code, Part 9 Fall of 3 m or more; also at less than 3 m where there is an unusual possibility of injury, and where a worker may fall into or onto a hazardous substance, object or moving equipment.
British Columbia OHSR, Part 11 Fall of 3 m (10 ft) or more; also from a lesser height where there is an unusual possibility of injury greater than injury from landing on a flat surface.
Our applicable
jurisdiction(s)
Verify before you rely on this. The rows above summarise the general triggers only and do not reproduce the full text, exceptions or sector-specific provisions. Federally regulated workplaces follow the Canada Occupational Health and Safety Regulations, not the provincial rules above. Always confirm the current wording of the regulation that applies to your work.
3. Control selection — highest to lowest

Work down this order. Record why any higher control was rejected before moving to the next.

#ControlWhere we use itIf not used, why not
1Eliminate the work at height (do it at ground level)
2Guardrails / permanent engineered barrier
3Travel restraint (worker cannot reach the edge)
4Fall restricting system
5Fall arrest (full body harness + connecting device)
6Safety net
4. Responsibilities
RoleName / positionResponsibility under this program
Employer / senior managementProvide equipment, training and supervision; fund the program; review it annually.
Program ownerMaintain this document, equipment register and training records; lead the annual review.
SupervisorConfirm the site plan is complete before work starts; verify training and pre-use inspection; stop unsafe work.
Competent person
(anchorage / plan)
Identify and approve anchorage; sign off the site fall protection plan.
WorkerUse the system as trained; inspect equipment before each use; report defects and remove equipment from service.
5. Equipment — selection, standards and register

Equipment used under this program conforms to the applicable CSA standards adopted by our jurisdiction. Standards we specify:

ID / serialItemIn service dateManufacturer life limitAssigned to
6. Inspection and removal from service
  • Pre-use, by the worker: webbing, stitching, hardware, labels, energy absorber indicator, connectors and gates.
  • Periodic, by a competent person: at the interval set by the manufacturer or our jurisdiction, whichever is shorter. Our interval:
  • Remove from service immediately after arresting a fall, on any deployed energy absorber, on any cut, burn, chemical damage, distorted hardware, or missing/illegible label.
  • Tag and quarantine removed equipment so it cannot be returned to use. Quarantine location:
Never return fall arrest equipment to service after it has arrested a fall unless the manufacturer explicitly permits it and a competent person has recertified it in writing.
7. Anchorage

Anchor points are identified and approved by the competent person named in Section 4 before use, and are rated for the system in use.

Location / structureType (permanent / temporary)Rated capacityApproved by / date
Record the clearance calculation for every fall arrest location: free fall + energy absorber extension + harness stretch + D-ring shift + safety margin, measured from the anchor to the nearest lower level or obstruction.
8. Training

Ontario construction workers who use fall protection must hold a valid Working at Heights certificate from a Chief Prevention Officer–approved training provider under O. Reg. 297/13, and it must be renewed on the prescribed cycle. Other jurisdictions and sectors set their own competency requirements — record what applies to you.

WorkerTraining / certificateProviderCompletedExpires
9. Program review

This program is reviewed at least annually, and after any fall, near miss, equipment failure, change in work method, or change in the applicable regulation.

Fall Protection Program Template · HSE Advisor Canada · Free to use and adapt.
hseadvisor.ca · (647) 620-5278

Part 2 of 2 — Site fall protection plan

Site Fall Protection Plan

Complete one per project or work area · Keep on site
HSE ADVISOR CANADA
hseadvisor.ca
Project / site:
Date:
Prepared by:
Competent person:
A. The work and the fall hazard

Task:

Fall distance / height:   Surface or hazard below:

B. Control in use
  • Elimination — work relocated to ground level
  • Guardrails / engineered barrier
  • Travel restraint
  • Fall restricting system
  • Fall arrest — anchor location:
  • Safety net

Required clearance below the anchor:   Available clearance:

C. Equipment assigned
WorkerHarness IDConnecting device IDPre-use check
D. Rescue procedure

A suspended worker must be reached quickly — calling 911 alone is not a rescue plan. Write down who does what, with what equipment, and how long it will take.

Rescue method:

Rescue equipment on site and its location:

Trained rescuers on site:   Target time to reach worker:

Emergency contact / muster point:

Suspension trauma. A worker hanging motionless in a harness can deteriorate quickly. Plan to reach and relieve suspension without delay, and get medical assessment even if the worker appears uninjured.
E. Sign-off — everyone doing this work
Name (print)SignatureDate
Site Fall Protection Plan · HSE Advisor Canada · Retain with your site records.
hseadvisor.ca · (647) 620-5278

This template is general guidance, not legal advice. Confirm every requirement against the current regulation in your jurisdiction before relying on it.