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Working at height rescue plan template
For people planning and reviewing rescue from work at height. Record work and scenarios, response arrangements and readiness. Try the form below, see every question or download a blank PDF or Word copy.
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Must rescue be planned before work at height?
HSE states that work-at-height planning must include emergencies and rescue and should not rely entirely on emergency services. Plans need competent people, suitable equipment and arrangements for the actual work location.
Last updated . Facts checked by the SiteSurvey team on 6 October 2026 against HSE work at height and rescue planning and HSE working at height brief guide.
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Every question in the work at height rescue plan record template
A work-at-height rescue planning record linking credible scenarios, competent responders, approved methods, equipment readiness and briefing evidence. 6 sections and 33 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.
Make it your own: every question is editable
This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.
Details you only enter once
Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.
- Project: the project name
- Site or premises address: the site address, from the space or the project
- Client or organisation: the project's customer
Record details and scope
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Site or premises addressShort answerFills in from the site address, from the space or the project
- Client or organisationShort answerFills in from the project's customer
- Record date*Date
- Person completing the record*Short answer
- CheckThis records a site-specific plan for competent review. It is not a rescue technique manual, training qualification or permission to improvise rope or lifting systems.
- CheckHSE states that work-at-height planning must include emergencies and rescue and should not rely entirely on emergency services. Plans need competent people, suitable equipment and arrangements for the actual work location.
Work and scenarios
- Work location, height and access system*Short answer
- Work risk assessment and approved method reference*Short answer
- Credible rescue scenarios and access constraints*Notes
- Competent plan author and rescue lead*Short answer
Response arrangements
- Scenario responseRepeat for each scenario response. Each one asks:
- Scenario ID*Short answer
- Approved rescue method reference*Short answer
- Trained responders and availability*Short answer
- Equipment, inspection and anchor verification references*Short answer
- Access, exclusion and casualty transfer arrangements*Notes
Readiness
- Alarm, communications and emergency-service coordination*Short answer
- First-aid and receiving arrangements*Short answer
- Rehearsal or validation evidence and limitations*Short answer
Record the scenario exercised, people involved and limitations revealed. Keep the practice outcome separate from authorisation for the job.
- Readiness decision*Choose one
- Ready under approved plan
- Not ready
- Unresolved readiness gaps and work restriction*NotesShown when “Readiness decision” is “Not ready”
Briefing
- Briefed team and dateShort answer
- Weather, personnel or equipment changes requiring review*Notes
- Authorised review and approval referenceShort answer
Actions and review
- Are further actions required?*Choose one
- Yes
- No
- Further actionRepeat for each further action. Each one asks:Shown when “Are further actions required?” is “Yes”
- Action and evidence reference*Notes
- Person responsible*Short answer
- Target dateDate
- Action status*Choose one
- Open
- In progress
- Completed
- Completion evidence*NotesShown when “Action status” is “Completed”
- Outstanding limitations and information to pass onNotes
- Record status*Choose one
- Ready for review
- Further work needed
- Work or use stopped
- Reviewed byShort answer
- Review dateDate
- Author signature*Signature
- CheckSigning records the information entered. It does not itself certify legal compliance, remove a limitation or authorise unsafe work.
Scope and responsibility
This records a site-specific plan for competent review. It is not a rescue technique manual, training qualification or permission to improvise rope or lifting systems.
What a useful entry looks like
Rehearsal or validation evidence and limitations
Record the scenario exercised, people involved and limitations revealed. Keep the practice outcome separate from authorisation for the job.
Rehearsal tested the recorded access and communication arrangements. A coordination gap was identified and assigned before the readiness decision.
Fictional example of record wording. Use the actual evidence and approved arrangements for your job; this is not a completed report or an instruction to carry out the work.
See it filled in
A completed work at height rescue plan record report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.
Work at Height Rescue Plan Record FAQs
How should I record “Rehearsal or validation evidence and limitations”?
Record the scenario exercised, people involved and limitations revealed. Keep the practice outcome separate from authorisation for the job.
Is calling emergency services a complete plan?
No. HSE says not to rely entirely on emergency services; the site needs suitable rescue arrangements.
Does this tell an untrained person how to rescue someone?
No. It references approved methods and trained responders.
What if the nominated rescue team is unavailable?
Record Not ready and the work restriction until arrangements are resolved and reviewed.
What are the limits of this template?
This records a site-specific plan for competent review. It is not a rescue technique manual, training qualification or permission to improvise rope or lifting systems.
Can I complete this form on site and share the record?
In the SiteSurvey app the form works offline, with signatures recorded against the questions. Share the completed record as a PDF or a link. Dates and action owners are recorded fields; this form does not send reminders or update other systems.
Related
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Templates that go with the work at height rescue plan record form
A confined space assessment recording the task, alternatives to entry, specified hazards, controls, safe-system references and rescue planning requirements.
A site-specific rescue planning record covering the space, credible emergencies, isolation, rescuers, communications, equipment readiness and practice.
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