(03) Worker Protection form (1).pdf

This is a Worker Protection form submitted for the Pennsylvania Department of Human Services, Polk Center, in connection with annual emission testing services for a 1.2 MW generator located at 100 Lakewood Circle, Polk, Pennsylvania 16342. The form documents worker protection requirements and compliance procedures that contractors must follow when performing emission testing activities to meet Department of Environmental Protection regulations under Pennsylvania Code Chapter 139. The document establishes the safety and protective standards that must be implemented during the testing process and outlines the obligations of the contractor to protect workers engaged in the emission testing operations.

The form serves as a mandatory compliance document that contractors must complete and submit as part of their bid submittal or contract execution. It specifies worker protection measures, safety protocols, and certifications required for personnel performing the emission testing work. This document is integral to the contract award process and ensures that all contractors meet state-mandated worker safety and protection standards before being eligible to perform services on Department of Human Services facilities.