RESCUE PLAN

Date: ……………… Location: ……………………………………….. Rescue Plan is valid till: …………………………………….

Job Description: ……………………………………………………………………………………………………………………………………………………
Corresponding Work Permit No: ………………………………………………………………………………………………………………………….
Worst Case Rescue Scenario: …………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………….

Contacts Rescue Equipment Critical Rescue Factors

Rescuer(s): Aerial Lif Anchor Point(s):
1)……………………………………………….. Alternative Lifing / Lowering …………………………………………………………
Mob No.:…………………...………….. Device …………………………………………………………
2)……………………………………………….. Crane with bucket arrangement …………………………………………………………
Mob No.:…………………...………….. Rescue Ladder/ Rescue Pole Landing Area/ Platform:
3)……………………………………………….. Rescue Rope/ Haul line descender …………………………………………………………
Mob No.:…………………...………….. Tripod/ K-Pod & Winch System …………………………………………………………
Emergency Contact: Rescue Harness Rescue Obstructions/ Hazards
Fire: 1100 / 99372 51244 Automatic Descend device …………………………………………………………
Ambulance: 1200/ 99372 92897 Rescue Davit & Winch …………………………………………………………
Hospital: 1234/ 99372 92897 First Aid Kit …………………………………………………………
DO Refinery: 1500/ 9937251401 Multigas Detector …………………………………………………………
DO CGPP: 1400/ 9937251407 SCBA/ SAR Method of access to platform/
Method of Contact Fire-fighting equipment structure to initiate rescue:
Walkie Talkie/Radio Other:…………………………………….. …………………………………………………………
Mobile Phone Rescue Equipment Location …………………………………………………………
Internet Phone Jobsite …………………………………………………………
Physically at Job site Area Control Room …………………………………………………………
Method of Contact with person(s) Fire Station Type of Rescue stretcher (if reqd)
to be rescued: CCR …………………………………………………………
………………………………………………….. Other:……………………………………………. …………………………………………………………
Check for Yes
Has the site been visited and inspected by the Permit Issuer, Receiver and Rescuers?
If Confined Space rescue; Likely Victim retrieval by Non-Entry Rescue CS Entry Rescue
Has the rescue equipment been inspected, in good shape and secured?
Is rescue equipment adequate for the rescue plan?
Have communication devices been identified and tested?
Are all rescuers competent and familiar with the rescue equipment?

Response Procedure (Check as per applicability):

Notify Rescuer and Emergency Contact
Control Rescue Obstructions & Hazards (including hazard due to abnormal atmosphere, if present)
Pre-Rigging of rescue kit/ devices will be carried out
Self Rescue
Assisted Self Rescue
Assisted Rescue
Medically Evaluate Worker

Rescue Plan Requested by: Rescue Plan Authorized by:

Area Incharge (Name/ Signature) Competent Person/Rescue Leader (Name/ Signature)

Learnings (if any):

* The rescue plan will be invalid if there is deviation from the Work Permit scope or conditions.