Fall Protection Application Sheet

Please fill out all items and click on the submit button on the bottom of the page and we will contact you very shortly with a recommendation
NAME: COMPANY NAME:
ADDRESS:
CITY: STATE:
ZIP: E-MAIL:
PHONE: FAX:

Do you know if you want a Fall Arrest or a Fall Restraint System
Please describe what specific work or activities are being performed that you have a concern with?

Is the area of concern on: an access ladder a roof hatch on a roof

on a overhead crane over trucks over buses over railcars

What is the estimated height exposure (walking surface to ground level )?
Is the application inside or outside
If inside, is there a ceiling height restriction? yes no
If yes, how high is the ceiling?
Are there obstructions ( pipes, conduit, rails, valves ) between the walking surface and the ground? yes no
If you are concerned with a "leading edge" what is the estimated length of the exposure?
If the exposure is on a roof or a ledge - Is there a structure you think might be strong enough to attach and anchor a lifeline system to?Yes No
If on a roof - is there a pitch? Yes No
Based upon the chart below - please make a check in the box that best describes your roofs pitch
A is equal to 10-12 or steeper
B is equal to 9-12
C is equal to 9-10
D is equal to 7-12
E is equal to 6-12
F is equal to 5-12
G is equal to 4-12
H is equal to 3-12
I is equal to 2-12
J is equal to 1-12
K is equal to a flat roof
What is the maximum number of users anticipated?
How would the users gain access to the roof, ledge, or other working surface?

Is there a structure above the walking surface a life line could be attached to? Yes No
Are there any other issues we should be aware of?

If you'd like to send us pictures and/or drawings of the application click here