Mobil Cepu Ltd.

Work Aid
Cepu Production Operation Working At Height Rescue Plan

Working At Height Rescue Plan

Operation : Work Area :

Date : Specific Location :

WAH Task Description

Drawings of Work Area & the Way of Rescue

Attached ☐Yes ☐No ☐Not required
If required, but not available, hand sketch the work area & the way of rescue on the last page of
this tool

Potential Emergencies
☐Personal injured ☐Personnel Fall ☐Electric Shock ☐Personnel unconscious

☐Fire or explosion ☐Spill ☐Toxic gas release ☐Other (please list)

Rescue Equipment

☐Body harness ☐Rescue kit ☐Ropes ☐Stretcher

☐SCBA/SABA ☐Tripod ☐First aid kit ☐Fire extinguisher

☐Gas detector ☐Lifeline ☐Crane ☐Portable ladder

☐Personal basket ☐Flashlight (intrinsically safe) ☐Other (please list)

Communication Plans and Equipment

Communication between safety watch and workers

☐Radio ☐Horn ☐Phone ☐Other
Communication between safety watch and rescue team
☐Radio ☐Horn ☐Phone ☐Other
Mobil Cepu Ltd. Work Aid
Cepu Production Operation Working At Height Rescue Plan

Working at Height Rescue Plan (cont’d)

Resource
Phone Number Approximate Response Time
☐ Medical

☐ Fire Dept.

☐ Security

☐ Aviation

☐ ERP designate

☐ Additional personnel

Have all these numbers been verified? ☐ Yes ☐ No

Rescue Team & Procedure

Personnel to be involved in the rescue
Name Method of Contact
Leader
Member 1
Member 2
Member 3
Member 4
Are these people qualified to do this rescue? ☐ Yes ☐ No
Designated Safe Area

If a rescue is necessary, how are you going to do it?

Mobil Cepu Ltd. Work Aid
Cepu Production Operation Working At Height Rescue Plan

Working at Height Rescue Plan (cont’d)

Sketch of Work Area & the Way of Rescue

Developed by Permit Holder (PH) Date

Reviewed by Area Authority (AA) Date

Approved by Area PIC Date