10 L 5 SOW ATT 1 Section 01546_October_2007.pdf

1/2016

SECTION 01546 - SAFETY AND HEALTH

PART 1 - GENERAL

1.1 DESCRIPTION OF WORK:

A. General: This section is general in nature and identifies some of the precautions necessary to protect the safety and health of employees, visitors, and facility occupants, and to prevent the loss of or damage to property and the environment.

Note: The Construction Contractor submittal requirements at paragraph 1.6.

B. Related Work Specification Sections: The following sections, located elsewhere in this spec.

package, indicate the scope of work and specific measures to control hazardous materials/conditions:

Edit out specification sections that do not apply to the current project.

Section 018111- Sustainable Design Requirements Section 017419- Construction Nonhazardous Waste & Management Disposal

Section 017410- Construction Indoor Air Quality Management for Construction Section 00900 - PCB Removal and Disposal

Section 02085 - Asbestos Abatement Procedures Section 02085R - Asbestos Roofing Removal Procedures Section 02087 - Avian Excreta Removal Section 02089 - Small PCB Items and Lamps

Section 02090 - Lead Based Paint Control Procedures

1.2 REFERENCES:

The publications listed below form a part of this specification to the extent referenced. The publications are referred to in the text by basic designation only. Current edition of the publications will be used.

A. Code of Federal Regulations (CFRs):

29 CFR 1910 - OSHA General Industry Safety and Health Standards 29 CFR 1926 - OSHA Construction Industry Standards 40 CFR Chapter 1 Subchapter R– Toxic Substances Control Act (TSCA) 40 CFR Part 61 – EPA National Emission Standard for Hazardous Air Pollutants (NESHAPs) 40 CFR Part 761 – Polychlorinated Biphenyl Manufacturing, Processing, Distribution and Use 40 CFR Parts 260 through 271 – EPA Resource Conservation and Recovery Act (RCRA) 41 CFR Parts 102 - Federal Management Regulation

B. Other Recognized Standards:

American National Standards Institute (ANSI) American Society for Testing and Materials (ASTM) National Fire Code (NFC) National Fire Protection Association (NFPA) 70E National Electrical Code (NEC)

Underwriters laboratories (UL) Federal Standard 313E - Material Safety Data, Transportation Data and Disposal Data for Hazardous Materials Furnished to Government Activity

ASME B31.9, Code for Pressure Piping, Section on Building Services Piping

C. Applicable state and local regulations shall apply.

1.3 WORK COVERED BY THIS SECTION: This section is applicable to all work performed under this contract.

1.4 DEFINITION O F H A Z A R D O U S M A T E R I A L S : Refer t o h a z a r d o u s and t o x i c m a t e r i a l s / substances, Subparts H and Z of 29 CFR 1910; and to others as defined in Federal Standard 313.

A. Those hazardous materials most commonly encountered can include pesticides, cleaning agents, paints, adhesives, strippers, solvents, asbestos, polychlorinated biphenyls (PCB's), mercury vapor lamps, explosives, and radioactive materials, but may include others. Any unlabeled substance should be handled as hazardous material until properly identified.

B. All thermal systems insulation (i.e., boiler insulation, duct insulation, pipe insulation), surfacing materials (i.e., plaster and sprayed-on fireproofing) and miscellaneous materials (i.e., asphalt flooring, ceiling tiles, adhesives and mastics, drywall, roofing, gaskets and cement board), installed no later than 1980, must be considered asbestos containing unless proven otherwise in accordance with 29 CFR 1926.1101.

C. All finished/painted surfaces of buildings constructed prior to 1978 shall be considered finished with lead based paint unless proven otherwise.

D. Products likely to contain PCB's are electrical transformers, capacitors, voltage regulators, fluorescent light ballasts and oil switches. Transformer vaults with PCB contaminated floors are identified by signage at the entry door (see paragraph 3.1).

1.5 QUALITY ASSURANCE:

A. Pre-Construction Safety Meeting: Representatives of the Contractor must meet with the

Contracting Officer and his/her representative(s) prior to the start of work under this contract.

The purpose of the pre-construction meeting is to review the Contractor's safety and health programs and policies, and to discuss the implementation of all safety and health provisions pertinent to the work to be performed under the contract. The Contractor shall be prepared to discuss, in detail, the measures he/she intends to take in controlling any unsafe or unhealthy conditions associated with the work to be performed under the contract. If directed by the Contracting Officer, this meeting may be held in conjunction with other pre-construction meetings such as the General Pre-Construction meeting. The level of detail of the safety meeting is dependent upon the nature of the work and the potential inherent hazards. The Contractor's principal on-site representative(s), the general superintendent and his/her safety representative(s) shall be in attendance.

B. Compliance With Regulations: All work, including contact with and handling of hazardous materials, the disturbance or dismantling of structures containing hazardous materials, and/or the transport and disposal of hazardous materials shall comply with the applicable requirements of 29 CFR 1910/1926, and 40 CFR 761/260-271.

1. Work involving the disturbance, dismantling or demolition of asbestos containing materials or structures containing asbestos; and/or the removal and disposal of asbestos, shall also comply with the requirements of 40 CFR Part 61, Subparts A and M, and 29 CFR

1915.1001 (where applicable), as well as GSA Specification 02085 (Asbestos Abatement Procedures).

2. Work involving the disturbance, dismantling or demolition of lead based paint shall comply with 29 CFR 1926.62, as well as GSA Specification 02090 (Lead Based Paint Abatement Procedures). It shall be the responsibility of the Contractor to adequately test and characterize the waste by the toxicity characteristics leaching procedures (TCLP) – Lead.

C. Work involving the removal and disposal of PCBs shall comply with 40 CFR 761. Removal and disposal of gross PCBs (contamination) and large PCB items (greater than or equal to 3 pounds (1.36 kg) of dielectric fluid) shall also comply with GSA Specification 00900 (PCB Removal and Disposal). Work involving the removal of PCB light ballasts, switches and similar small PCB items (less than 3 pounds (1.36 kg) shall also comply with GSA Specification 02089 (PCB Light Ballasts, Switches and Mercury Lamps).

D. All work shall comply with applicable state and municipal safety and health requirements.

Where there is a conflict between applicable regulations, the most stringent shall apply.

E. Contractor Responsibility:

1. All Contractors shall assume full responsibility and liability for compliance with applicable regulations pertaining to the health and safety of personnel during the execution of work, and shall hold the Government harmless for any action on his/her part, or that of his/her employees or subcontractors, which results in illness, injury or death.

2. Construction Contractors shall comply with the following additional requirements in accordance with 29 CFR 1926.16 (Prime/Subs):

A. Compliance with the accepted accident prevention plan written by the prime Contractor for the specific work, submitted to the government, and reviewed by the Contracting Officer. The Contractor's plan will be job specific and will include work to be performed by the subcontractors, and measures to be taken by the Contractor to control hazards associated with materials, services, or equipment provided by suppliers.

B. Regularly scheduled safety meetings shall be held at least once a week for all supervisors on the project to review past activities, to plan ahead for new or changed operations, and to establish safe working procedures for the anticipated hazards. An outline of each meeting shall be submitted through the Contracting Officer’s Representative to the Contracting Officer.

C. At least one “toolbox” safety meeting shall be conducted weekly by field supervisors or foreman for all workers. An outline report of the meeting, including date, time, duration, attendance, subjects discussed and the name of the director shall be maintained and copies furnished to the designated authority on request.

3. Electrical work performance.

a. Job site safety and worker safety is the responsibility of the contractor.

b. Electrical work shall be accomplished with all affected circuits or equipment de-energized.

When an electrical outage cannot be accomplished in this manner for the required work, the following requirements are mandatory:

1) Electricians must use full protective equipment (i.e., certified and tested insulating material to cover exposed energized electrical components, certified and tested insulated tools, etc.) while working on energized systems in accordance with NFPA 70E.

2) Electricians must wear personal protective equipment with the appropriate arc flash rating while working on energized systems in accordance with NFPA 70E.

3) Before initiating any work, a job specific work plan must be developed by the contractor with a peer review conducted and submitted to the Contracting Officer's Representative (Construction Engineer), to the Contracting Officer.

a). The work plan must address at a minimum:

• Description of work and location

• justification setting forth the reason why the work must be performed in an energized condition

• Electrical shock and arc flash analysis and boundaries

• PPE that will be used to protect the employees

• Methods and means to restrict access of unqualified persons in the work area

4. Work on energized circuits or equipment cannot begin until prior written acceptance is obtained from the National Capital Regions, Safety Environment and Fire Protection Branch.

1.6 SUBMITTALS: A submittal punch list for projects involving “other” hazardous materials as identified in 1.6-E, and/or flammable/toxic products is provided as Appendix A.

A. Accident Reporting: Contractor shall post emergency first aid and ambulance information at project site. Serious accidents such as those resulting in: treatment of an injury at a medical facility; response by emergency medical personnel; or damage to property will be reported to the contracting officer's representative by telephone within (2) two hours of the occurrence. A copy of each accident report, which the Contractor or subcontractors submit to their insurance carriers, shall be forwarded through the Contracting Officer's Representative (Construction Engineer), to the Contracting Officer as soon as possible (in no event later than seven (7) calendar days after the occurrence). All non-GSA Associate accidents/losses shall be reported using GSA form 3620 (page 01546-9).

B. Permits: When hazardous materials (as defined in Paragraph 1.4, and 40 CFR 261) are disposed of, the Contractor must submit copies of permits and manifests from applicable, Federal, state, or municipal authorities, and necessary certifications that the material has been disposed of as per regulations within 30 days of removal from the site.

C. Hot Work Permits: Submit GSA Form 1755 - Permit for Welding, Cutting or Brazing as required. (See Paragraph 3.5-B)

D. Scaffolding: All scaffolding that is erected on this job will be erected in accordance with the requirements of 29 CFR 1926.451. For scaffolding over two sections high, a scaffold erection plan will be developed by the Contractor, certified by an engineer and provided to the Contracting Officer (CO) prior to set up. Once in place, the Contractor's assigned safety officer or competent person shall inspect and document the conditions of the scaffold and scaffold anchor points prior to use, and once per shift thereafter. Weekly reports shall be provided to the designated Contracting Officer's Representative (COR) for inclusion in the contract records.

E. Construction Contractor’s Plan of Action: Submit a plan of action for handling hazardous materials (except for asbestos, lead based paint, PCBs and mercury lamps as they are covered by specific sections) and/or flammable or toxic products as follows. The Construction Contractor’s plan of action shall contain:

1. Activity Hazard Analysis - identification of anticipated hazards, problems, and proposed control measures/mechanisms for each definable feature of work.

2. Description of how applicable safety and health regulations and standards are to be met

3. Protection of the public or others not related to the operation

4. Means of protection for adjacent non-construction areas and occupants and for controlling dust/fumes/debris generated by the work

5. Specialized training and experience of employees to be used for the work

6. Type of protective equipment and work procedures to be used

7. Safety Data Sheets (SDSs) for, and proposed procedures for using, disposing of, or storing toxic/hazardous materials (also see 29 CFR 1910.1200)

8. Phasing requirements to minimize impact to non-construction work activities

9. Emergency procedures for handling accidental spills, releases or potential exposures

10. Interfacing of trades and control of subcontractors, if applicable

11. Identification of any required analyses, test demonstrations, and validation requirements

12. Methods of certification for compliance

F. Waste Management Plan: Submit plan within Fourteen days of date established for the Notice to Proceed, prepare and submit a Waste Management Plan including, but not limited to, the following:

1. List of the recycling facilities, reuse facilities, municipal waste landfills and other disposal area(s) to be used. Include: Name, location, and phone number.

2. Copy of permit or license for each facility.

3. Include a bulk estimate in weight (tons) or volume (cubic yards) of waste diverted and anticipated weight/volume for materials going to landfill.

4. List of proposed materials to be diverted identified on a site pre-assessment.

5. Identify materials that cannot be recycled or reused. Provide explanation or justification.

6. Schedule meetings to address waste management with all subcontractors affected by the Waste Management Plan.

7. Delineate storage and collection methods of disposed materials and diverted materials, Handling procedures, and means of keeping diverted materials free of contamination.

8. Describe the methodology that will be used for the proper transportation of diverted materials. If possible, estimate the quantities and timeframes when containers for diverted materials will be emptied.

9. Description of the quality control program to ensure the disposed materials and diverted materials generated from the facility alterations and additions are not leaving the project building through uncontrolled or unmonitored channels.

10. Revise and resubmit Plan as required by Owner.

11. Approval of Contractor’s Plan will not relieve the Contractor of responsibility for compliance with applicable environmental regulations.

PART 2 – PRODUCTS

2.1 MATERIALS AND EQUIPMENT: Special facilities, devices, equipment, clothing, and similar items used by the Contractor in the execution of work shall comply with the applicable regulations.

Such materials and equipment shall be identified in the Plan of Action called for herein.

2.2 SAFETY DATA SHEETS (SDSs): SDSs shall be available on-site for all products used under this contract. The prime contractor is responsible for meeting the hazard communication requirements, in accordance with 29 CFR 1910.1200. To the extent feasible, substitute non-flammable and non-toxic products.

PART 3 - EXECUTION

3.1 CAUTIONARY PROCEDURES AT EXISTING VAULTS: Transformer vaults may have floors which are PCB contaminated. These vaults are generally marked by blue signs, which identify the vault as PCB contaminated. Consult the Building Manager to ascertain whether precautionary procedures must be taken.

On rare occasions, vault doors in existing buildings may be equipped with protective alarms and devices. Consult the Building Manager to ascertain whether vault doors in areas under this contract are so equipped.

3.2 HAZARDOUS MATERIALS: The Contractor shall bring to the Contracting Officer’s attention, any material suspected of being hazardous which he/she encounters during execution of the work. The Contracting Officer shall then determine whether the Contractor shall perform tests to determine the nature or toxicity of the material. If the Contracting Officer directs the Contractor to perform tests, and/or if the material is found to be hazardous and additional protective measures are needed, a change of contract may be required (subject to applicable provisions of the contract).

3.3 CONFINED SPACES: The controlling contractor has the overall responsibility for all confined space operations and is the primary point of contact for information about the permit spaces at the work site.

Before entry of the confined space, the controlling contractor will submit a copy of their confined space entry plan and their confined space permit. After the confined space operation is completed, the controlling contractor will submit copies of the confined space permit and information on any new hazards they encountered in the space to the Contracting Officer or the Contracting Office Representative (COTR) for review and copies retained for one year.

A. All confined space entry shall comply with 29 CFR 1910.146 / 29 CFR 1926.1201 except for specifically referenced operations in 29 CFR 1926 such as excavations/trenches 1926.651(g).

B. A site-specific Confined Space Entry Plan (including permitting process) shall be developed and submitted to the COTR / Contracting Officer for review before entry into the confined space is permitted.

The Contractor is responsible for prior notification of the Contracting Officer on the type of work to be conducted in all confined spaces, and to issue the required entry permit according to their Confined Space Entry Program requirements.

3.4 CONTROL OF HAZARDOUS ENERGY (Lock-out Tag-out): The contractor will establish a program for the control of hazardous energy and establish procedures for affixing appropriate lockout devises or tagout devices to any system that produces, uses, or stores hazardous energy including areas where energy is introduced (e.g., commissioning equipment and/or testing activities, etc.), these activities will be coordinated with and communicated to all affected personnel.

A. The contractor performing the work shall create and implement an activity hazard analysis (AHA) for the work requiring a lock-out tag-out to ensure that the inherent risk is identified.

B. When a piece of equipment or machine must be tested or conditioned for service/maintenance, and re- energization is required, the temporary removal of lockout/tagout devices procedures must be provided to the Contracting Officer’s Representatives prior to performing the activities.

3.5 CONSTRUCTION STOP WORK ORDERS: Should the Contractor or his/her subcontractors be notified by the Contracting Officer's representatives of any non-compliance with the provisions of the contract, and/or that corrective action(s) are required, the Contractor shall immediately (if so directed) or within 48-hours after receipt of a notice of violation, correct the unsafe or unhealthy condition. If the Contractor fails to comply promptly, the Contracting Officer or his/her representatives may issue a "Stop Work Order" for all or any part of the work being performed. In instances of imminent danger conditions, the Contractor must stop all work immediately. When, in the opinion of the Contracting Officer or his/her representatives, satisfactory corrective action has been taken to correct the unsafe or unhealthy condition, a written order reinstating the work will be issued. The Contractor shall not be allowed any extension of time or compensation for damages by reason of, or in connection with, such work stoppage.

PART 4 - PROTECTION:

4.1. THE FOLLOWING ARE PUBLIC PROTECTION REQUIREMENTS FOR ALL CONTRACTS:

A. Contractor Responsibility: The Contractor shall take all necessary precautions to prevent injury to the public, building occupants and visitors, and damage to or contamination of property or the environment. For the purposes of this contract, the public or building occupants shall include all persons not employed by the Contractor or subcontractor thereof.

B. Welding, Cutting, and Brazing: GSA specifically requires a permit for welding, cutting, and brazing.

This permit, GSA Form 1755 - Welding, Cutting and Brazing (page 01546-11) shall be approved each day by the GSA Buildings Manager (facility manager for delegated buildings) whenever welding, cutting or any open flame work is performed.

C. The welding area shall be screened, shielded or other safeguards provided to protect the public and standby personnel from rays, flashes, sparks, molten metal and slag..

D. Work areas shall be kept clear of combustibles within a 25-foot (7.62-meter) radius of any open flame work. Combustibles which cannot be removed shall be covered with flame- resistant blankets.

E. Compressed gas cylinders shall be secured in a vertical position at all times. Valve protection caps shall be in place whenever cylinders are not in use, moved or stored.

F. Appropriate fire extinguishers shall be maintained at welding and cutting operations.

G. A designated fire watch shall sign and return the permit. The fire watch shall be on duty during operations and for a sufficient time afterwards to ensure no possibility of fire exists.

H. Storage: It is prohibited to store, position, or use equipment, tools, materials, scraps, and trash in a manner likely to present a hazard to the public or building occupants by its accidental shifting, ignition, or other hazardous qualities. Storing of combustible or flammable liquids shall be in accordance with the current edition of the National Fire Code for Flammable and Combustible Materials (NFPA 30).

I. Obstructions: No corridor, aisle, stairway, door, or exit shall be obstructed or used in such a manner as to encroach upon routes of ingress or egress utilized by the public or building occupants, or to present an unsafe or unhealthy condition to the public or building occupants.

j. Housekeeping: Housekeeping practices shall be in conformance with OSHA 29 CFR 1910.141 and 29 CFR 1926.25, for non-construction and construction contracts respectively.

4.2. THE FOLLOWING ARE PUBLIC PROTECTION REQUIREMENTS FOR CONSTRUCTION

CONTRACTS:

A. Protection of the Public and Federal Employees: Work shall not be performed in any area occupied by the public or Federal employees unless specifically permitted by the contract and the Contracting Officer and unless adequate steps are taken for the protection of the public and Federal employees.

B. Fences & Barricades: The work area shall be fenced, barricaded, or otherwise segregated from the public or building occupants to prevent unauthorized entry into the work area.

C. Alternate Precautions: When the nature of the work prevents isolation of the work area and the public or building occupants may be in or pass through, under or over the work area, alternate precautions such as the posting of signs, the use of signal persons, the erection of barricades, canopy structures or similar protection around particularly hazardous operations shall be approved and used as appropriate.

D. Public Thoroughfare: When work is to be performed over a public thoroughfare such as a sidewalk, lobby, or corridor, the thoroughfare shall be closed, if possible, or other precautions taken such as the installation of screens, barricades or canopy structures. When exposure to sizeable falling objects exists, as during the erection of building walls or during demolition, special protection of the type detailed in 29 CFR 1910/1926 shall be provided.

E. Temporary Construction Barriers: Paragraphs 3.5-F through 3.5-I above specifies the erection of construction barriers in specific situations. Temporary construction barriers, partitions which cover a hole in a rated fire wall, or separate the construction from public access and exit corridors shall be erected floor-to-ceiling, wall-to-wall, and shall remain in place for the duration of the contract. The minimum construction standards for these temporary barriers shall be metal studs, anchored top and bottom at a maximum spacing of 16 inches (406 mm) on-center, and covered with a minimum of one layer of 1/2 inch gypsum wallboard.

F. Dust and Fume Control Measures: Work performed adjacent to occupied areas shall be done within dust control barriers (generally constructed of polyethylene sheeting). To the extent feasible, maintain the work environment at a negative pressure differential with the adjoining occupied areas. The use of fume and odor producing products and materials shall be done in such a manner, or at such a time as to minimize impact on building occupants. Provide measures to minimize tracking of dust through non-construction areas.

G. Roof Work: During the performance of roofing work on low-pitched roofs, employees will be protected as required by the OSHA standards contained in 29 CFR 1926.500, except that a safety monitoring system, as defined in 29 CFR 1926.501 (b)(10) and 1926 502 (h)is not an allowable option when working within six feet (1.83 m) of the roofs edge or any opening. When working within six feet (1.83 m) of the roof edge or an opening, motion-stopping safety systems, as defined in 29 CFR 1926.502(p)(5), will be used.

H. Removal of Fences and Barricades: Fences and barricades shall be removed upon completion of the project, in accordance with local ordinance and to the satisfaction of the Contracting Officer or his/her representative(s).

APPENDIX A

01546 – SAFETY SUBMITTAL PUNCH LIST

PROJECT DATE REVIEWED

PROJECT NUMBER REVIEWER

IN

REVIEWED APPROVED FILE

CONSTRUCTION SUBMITTALS: Post-award but prior to the start of construction:

1. GSA FORM 1755 – Permit for Welding, Cutting or Brazing

2. SCAFFOLDING: All scaffolding that is erected on this job will be erected in accordance with the requirements of 29 CFR 1926.451. For scaffolding over two sections high, a scaffold erection plan must be developed by the Contractor:

A. Scaffold erection plan:

B. Certified by an engineer:

3. PLAN OF ACTION: A plan of action for handling hazardous materials (except asbestos, lead based paint, PCBs and mercury vapor lamps) must be submitted. The hazardous materials plan of action shall contain the following:

A. Activity Hazard Analysis – identification of anticipated hazards, problems, and proposed control mechanisms

B. Description of how applicable safety and health regulations and standards are to be met

C. Protection of the public or others not related to the operation

D. Means of controlling dusts/fumes/debris generated

E. Specialized training and experience of employees

F. Protective equipment and work procedures to be used

G. Safety Data Sheets (SDSs)

H. Proposed procedures for using, disposing of, or storing toxic/hazardous material (also see 29 CFR 1910.1200)

I. Phasing requirements to minimize disruption of operations

J. Emergency procedures for handling accidental spills, releases or exposures

K. Interfacing of trades and control of subcontractors

L. Identification of any required analyses, test demonstrations, and validation requirements

M. Methods of certification for compliance

IN

REVIEWED APPROVED FILE

CONSTRUCTION SUBMITTALS: During construction but prior to project closeout

4. SCAFFOLDING: DAILY DOCUMENTATION (ONCE PER SHIFT):

5. PERMITS: When hazardous materials (as defined in paragraph 1.4, and 40 CFR 261) are disposed of, the Contractor must submit copies of permits and manifests from applicable Federal, state, or municipal authorities

And

CERTIFICATES that the material has been disposed of as per regulations.

6. “Toolbox” safety meeting documentation

7. Accident Reporting: must be reported to the contracting officer’s representative by telephone within twenty-four hours of the occurrence

A. Serious accidents such as those resulting in:

treatment of an injury at a medical facility;

response by emergency medical personnel;

or damage to property other than that of the Contractor

B. A copy of each accident report, which the

Contractor or subcontractors submit to their insurance carriers shall be forwarded as soon as possible, but not later than seven (7) calendar days after the occurrence.

A. Inspect and document the conditions of the scaffold (weekly)

B. Scaffold anchor points (weekly)

C. Weekly reports have been provided to the designated Contracting Officer’s Representative (COR) – contract record

REPORT OF GSA PROPERTY DAMAGE OR

NON-GSA EMPLOYEE PERSONAL INJURY

REPORT CONTROL NUMBER

1. REGION 2. DATE OF ACCIDENT

This form is not to be used for reporting GSA motor vehicle accidents or GSA employee occupational injuries/illnesses. Use Standard Form 91 or 91A or CA-1 or CA-2 respectively. See reverse for complete instructions.

3. ACCIDENT REPORT NUMBER

4. PERSON’S NAME AND HOME ADDRESS 5. REASON FOR REPORT

6. PERSON’S PHONE NO. C. TIME OF ACCIDENT

AM PM

8. EXACT LOCATION OF ACCIDENT 9. NAME AND ADDRESS OF GSA FACILITY

10. MEDICAL EXPECTATION

11. DESCRIBE EQUIPMENT INVOLVED AND EXTENT OF DAMAGE

12. OWNER OF EQUIPMENT INVOLVED

A. NAME B. ADDRESS

C. PHONE NO.

13. DETAILED DESCRIPTION OF ACCIDENT

14. CORRECTIVE ACTION IS THERE A NEED FOR EMPLOYEE TRAINING ? Y OR N

A. DESCRIPTION B. RESPONSIBLE PERSON

C. ACTION DATE

15. NAME AND TITLE OF SUPERVISOR 16. SIGNATURE OF SUPERVISOR 17. PHONE NO.

18. DATE

19. REVIEWERS COMMENTS ATTACHED Y OR N (NO INDICATES NO COMMENTS ADDED)

20. NAME AND TITLE OF REVIEWER 21. SIGNATUR OF REVIEWER 22. DATE

23. NAME AND TITLE OF BRANCH OFFICIAL 24. SIGNATURE OF BRANCH OFFICIAL 25. DATE

GENERAL SERVICES ADMINISTRATION GSA FORM 3620 (2-91)

INSTRUCTIONS FOR COMPLETING GSA FORM 3620

(Print or type all entries except where signatures are required)

The supervisor in charge of the area of occurrence or equipment involved shall prepare this report.

Item No. Instructions

1 List GSA region reporting the accident

2 Show date of accident occurrence

3 Leave blank. The regional Safety Office enters the report number.

4 Identify the person(s) involved in the accident. If more than one person, use separate pages.

5 State precisely why this report is being completed (e.g., Non-Federal personal injury, Federal property damage, or Non-Federal property damage).

6 Provide the telephone number of the person most responsible or involved in the accident.

If more than one person, make sure a telephone number is included on additional pages as directed in item 4.

7 Self-explanatory.

8 Self-explanatory.

9 Identify the name, address and building number (if known) of the GSA facility where the incident occurred.

10 If a personal injury resulted, what is the exact nature of the injury and what is the actual or expected result (e.g., death, amputation of left leg, fractured right arm, strained back).

Note if hospitalized and where.

11 Self-explanatory. Use additional pages as necessary.

12 Self-explanatory.

13 Self-explanatory. Use additional pages as necessary. If known, provide the names of witnesses. Also identify personal protective equipment and/or engineering controls being utilized at the time of occurrence.

14 A. Specifically, what needs done (or has been done) to correct the cause of the accident.

Does the incident indicate that training is necessary?

B. Identify the individual responsible for making the corrective action.

C. State when the corrective action will be completed/implemented.

15 Items 15 through 18 identify the supervisor in charge of the area of occurrence or equipment involved. Again, the supervisor is responsible for preparing this report.

19 Attach comments and additional corrective actions suggested by the reviewer and or the reviewer official as identified in items 20 through 25.

GENERAL SERVICES ADMINISTRATION GSA FORM 3620 BACK(2-91)

PERMIT FOR WELDING,

CUTTING, OR BRAZING

1A. NAME OF EMERGENCY CONTACT 1B. TELEPHONE NUMBER

2. OFFICE ISSUING PERMIT

3. LOCATION

FOR PERMIT

A. BUILDING NAME B. SPECIFIC LOCATIONS OF WORK COVERED

4A. DATE OF WORK 5. NATURE OF WORK

4B. START TIME

4C. STOP TIME

6. ANTICIPATED HAZARDS DUE TO WORK (SAFETY, HEALTH, FIRE)

7. LIST PROTECTIVE CLOTHING, EQUIPMENT AND CONTROLS REQUIRED FOR THE WORK (INCLUDES PPE AND PUBLIC PROTECTION)

8. NAME OF PERSONS AUTHORIZED TO PERFORM WORK 9. NAME OF PERSONS SERVING AS FIRE WATCH

10. EMERGENCY PRECAUTIONS (INCLUDE TYPE, NUMBER AND LOCATIONS OF FIRE EXTINGUISHERS)

11. PERMIT ISSUED BY

A. NAME AND TITLE B. SIGNATURE C. DATE

12. PREWORK SITE INSPECTOR

A. NAME AND TITLE B. SIGNATURE C. DATE

13. POSTWORK SITE INSPECTOR

A. NAME AND TITLE B. SIGNATURE C. DATE

GENERAL SERVICES ADMINISTRATION GSA FORM 1755 (REV 6-91)

INSTRUCTIONS FOR COMPLETING GSA FORM 1755

(Print or type all entries except where signatures are required)

General: A permit must be issued prior to starting of welding, cutting, or brazing, regardless of GSA Service involved. All welding, cutting, or brazing shall adhere to the relevant OSHA Standards (29 CFR 1910, OR 29 CFR 1926). Every item on the form must be completed. The lack of signatures or any item not completed voids the permit. If the work is performed for a confined space entry task, a copy of this form is posted next to GSA Form 3625, Permit for Confined Space Entry. Both forms must be clearly posted outside the confined space. Prior approval from the Regional Safety, Environment and Fire Protection Branch is mandatory if the permit is issued for a confined space entry task. Upon completion of the work, or when the expected stop time is reached (whichever occurs first), the completed permit must be returned to the issuing authority for filing. The issuance of the permit in no way relieves the Contractor of responsibility for an accident resulting from negligence.

Item No. Instructions

1 Provide the emergency name and telephone number (Preferably in RED)

2 Self-explanatory.

3 Indicate all locations where work will take place and areas adjacent areas that may be impacted by the work (particularly floors below).

4 Permits are good for 24-hour periods only.

5 Provide validation for issuing the permit (i.e., repair leaking pipe).

6 Self-explanatory.

7 Protective devices also include screens, blankets and barricades for public protection.

8 Initial beside the persons actually performing the work to indicate that they understand the form, its intended purpose, requirements therein, and the safety precautions per OSHA Standard 29 CFR 1910, Subpart Q.

9 Initial beside the persons actually serving as a fire watch to indicate knowledge and understanding of the form and the duties and responsibilities of a fire watch per OSHA Standard 29 CFR 1910, Subpart Q. The fire watch will not be the same person performing the work.

10 Identify the number, type and locations of fire extinguishers to be maintained during the performance of work.

11 The pre-work inspection must be performed the date of the work, prior to commencement. The supervisor in charge of the GSA employee performing the work, or the Contracting Officer’s representative conducts the inspections. The inspector ensures all combustibles are removed, covered, or protected.

12 Approved by the facility manager or authorized representative.

13 Conduct a post-work checkup 30 minutes after the completion of work. Inspection shall ensure the area is free of hazardous conditions. The fire watch is not permitted to leave the area until the post-work inspection is conducted.

GENERAL SERVICES ADMINISTRATION GSA FORM 1755 BACK (REV 6-91)

END OF SECTION 01546