20B3010 Pkg1vol1.PDF

Fort Bragg, North Carolina

Solicitation Number

W912HN-20-B-3010

Runway Pavement and Airfield Lighting Rehab Procurement and Contracting Requirements and Package 1: Runway 05-23 Runway Rehabilitation Volume 1 of 2: Specification Divisions 01 - 23

PN FA-80003-18-1

August 2020

U.S. ARMY ENGINEER DISTRICT, SAVANNAH

CORPS OF ENGINEERS

100 WEST OGLETHORPE AVENUE

SAVANNAH, GEORGIA 31401-3640

US Army Corps of Engineers Savannah District

Runway Pavement and Airfield Lighting Rehab: Runway 05-23 20B3010 Fort Bragg, NC Pkg 1

PROJECT TABLE OF CONTENTS

DI VI SI ON 01 - GENERAL REQUI REMENTS

01 00 00 GENERAL REQUIREMENTS

01 11 00 SUMMARY OF WORK

01 14 00 WORK RESTRICTIONS

01 30 00 ADMINISTRATIVE REQUIREMENTS

01 32 01.00 10 PROJECT SCHEDULE

01 33 00 SUBMITTAL PROCEDURES

01 33 29 SUSTAINABILITY REPORTING

01 35 13 SPECIAL PROJECT PROCEDURES

01 35 26 GOVERNMENTAL SAFETY REQUIREMENTS

01 42 00 SOURCES FOR REFERENCE PUBLICATIONS

01 45 00.00 10 QUALITY CONTROL

01 45 00.15 10 RESIDENT MANAGEMENT SYSTEM CONTRACTOR MODE (RMS CM)

01 50 00 TEMPORARY CONSTRUCTION FACILITIES AND CONTROLS

01 57 19 TEMPORARY ENVIRONMENTAL CONTROLS

01 58 00 PROJECT IDENTIFICATION

01 74 19 CONSTRUCTION WASTE MANAGEMENT AND DISPOSAL

01 78 00 CLOSEOUT SUBMITTALS

01 78 23 OPERATION AND MAINTENANCE DATA

01 91 00.15 10 TOTAL BUILDING COMMISSIONING

DI VI SI ON 02 - EXI STI NG CONDI TI ONS

02 41 00 [DEMOLITION][ AND ][DECONSTRUCTION]

DI VI SI ON 03 - CONCRETE

03 30 00 CAST-IN-PLACE CONCRETE

03 42 13.00 10 PLANT-PRECAST CONCRETE PRODUCTS FOR BELOW GRADE

CONSTRUCTION

DI VI SI ON 04 - MASONRY

04 23 00 GLASS UNIT MASONRY

DI VI SI ON 07 - THERMAL AND MOI STURE PROTECTI ON

07 92 00 JOINT SEALANTS

DI VI SI ON 09 - FI NI SHES

09 06 00 SCHEDULES FOR FINISHES

09 51 00 ACOUSTICAL CEILINGS

09 90 00 PAINTS AND COATINGS

DI VI SI ON 23 - HEATI NG, VENTI LATI NG, AND AI R CONDI TI ONI NG ( HVAC)

23 00 00 AIR SUPPLY, DISTRIBUTION, VENTILATION, AND EXHAUST SYSTEMS

23 05 93 TESTING, ADJUSTING, AND BALANCING FOR HVAC

23 07 00 THERMAL INSULATION FOR MECHANICAL SYSTEMS

DI VI SI ON 25 - I NTEGRATED AUTOMATI ON

25 05 11.00 CYBERSECURITY FOR FACILITY-RELATED CONTROL SYSTEMS

25 05 11.01 CYBERSECURITY FOR FACILITY-RELATED CONTROL SYSTEMS

25 10 10.00 UTILITY MONITORING AND CONTROL SYSTEM (UMCS) FRONT END

PROJECT TABLE OF CONTENTS Page 1

AND INTEGRATION

DI VI SI ON 26 - ELECTRI CAL

26 00 00.00 20 BASIC ELECTRICAL MATERIALS AND METHODS

26 05 00.00 40 COMMON WORK RESULTS FOR ELECTRICAL

26 05 19.10 10 INSULATED WIRE AND CABLE

26 20 00 INTERIOR DISTRIBUTION SYSTEM

26 24 16.00 40 PANELBOARDS

26 28 01.00 10 COORDINATED POWER SYSTEM PROTECTION

26 41 00 LIGHTNING PROTECTION SYSTEM

26 51 00 INTERIOR LIGHTING

26 52 00.00 40 EMERGENCY LIGHTING

26 53 00.00 40 EXIT SIGNS

26 56 20 AIRFIELD LIGHTING AND VISUAL NAVIGATION AIDS

DI VI SI ON 27 - COMMUNI CATI ONS

27 13 23.00 40 COMMUNICATIONS OPTICAL BACKBONE CABLING

27 21 10.00 40 FIBER OPTIC DATA TRANSMISSION SYSTEM

DI VI SI ON 28 - ELECTRONI C SAFETY AND SECURI TY

28 31 64.00 10 FIRE DETECTION AND ALARM SYSTEM, ADDRESSABLE

DI VI SI ON 31 - EARTHWORK

31 00 00 EARTHWORK

31 05 19 GEOTEXTILE

DI VI SI ON 32 - EXTERI OR I MPROVEMENTS

32 01 11.51 PAINT REMOVAL FROM AIRFIELD PAVEMENTS

32 01 16.71 COLD MILLING ASPHALT PAVING

32 01 17.61 SEALING CRACKS IN ASPHALT PAVING

32 01 18.71 GROOVING OF AIRFIELD PAVING

32 01 19 FIELD MOLDED SEALANTS FOR SEALING JOINTS

32 11 13.13 CEMENT MODIFIED SUBGRADE

32 11 23.00 GRADED-CRUSHED AGGREGATE BASE COURSES

32 11 23.23 BASE COURSE DRAINAGE LAYERS

32 11 40.00 CONTROLLED LOW-STRENGTH MATERIAL (CLSM)

32 12 13 BITUMINOUS TACK AND PRIME COATS

32 12 15.13 ASPHALT PAVING FOR AIRFIELDS

32 13 14.13 CONCRETE PAVING FOR AIRFIELDS AND OTHER HEAVY DUTY

PAVEMENTS

32 13 73.19 COMPRESSION CONCRETE PAVING JOINT SEALANT

32 17 23 PAVEMENT MARKINGS

32 18 20.00 RUNNING TRACK PROTECTIVE SURFACING

32 92 19 SEEDING

32 92 23 SODDING

DI VI SI ON 33 - UTI LI TI ES

33 05 23.13 UTILITY HORIZONTAL DIRECTIONAL DRILLING

33 40 00 STORM DRAINAGE UTILITIES

33 46 16 SUBDRAINAGE PIPING

33 71 02 UNDERGROUND ELECTRICAL DISTRIBUTION

-- End of Project Table of Contents --

PROJECT TABLE OF CONTENTS Page 2

PROJECT TABLE OF CONTENTS Page 3

ATTACHMENT 1 TO SECTION 00 73 00

LIST OF ATTACHMENTS

Attachment 1 - 1

Fort Bragg Project Sign

Project Sign Legend Defined

Project Sign Erection Detail

Safety Performance Sign

Corps of Engineers Logo

Accident Prevention Plan Checklist

Construction Quality Control Report

Weekly Temporary Electrical Inspection

Minimum Standard for Temporary Electrical Service (Ref. FAR 52.236-14)

SAS Form 9 - Activity Hazard Analysis

SAD FL198 - Report of Safety Meeting

DA Form 5418-R - Cost Estimate Analysis

DD Form 1354 - Transfer and Acceptance of Military Real Property

DD Form 1354 Checklist

DD Form 1532 - Pest Management Report

DD Form 1532 - Pest Management Maintenance Record

DHS Form I-9 - Employment Eligibility Verification

ENG Form 16-2 - Standard Pre-Lift Plan (LHE)/Checklist

ENG Form 16-3 - Critical Lift Plan

ENG Form 2454 - Construction Progress Chart

ENG Form 3394 – Accident Investigation Report

ENG Form 4025 - Transmittal of Shop Drawings, Equipment Data, Material

Samples, or Manufacturer's Certificates of Compliance

Real Property Inventory and BIS Worksheet

Fort Bragg Form 1605 - Directorate of Engineering and Housing Excavation

Permits

Fort Bragg Asbestos Removal, Transportation, and Disposal

Fort Bragg Access Request Form

Standard Form LLL-A - Disclosure of Lobbying Activities

ATTACHMENT 1 TO SECTION 00 73 00

LIST OF ATTACHMENTS

Attachment 1 - 2

Contractor Hazardous Material Inventory Log (EPRCA)

Contractor-Furnished Spoil, Disposal Areas

PROJECT SIGN LEGEND DEFINED

Legend Group 1: The words:

"Construction or "Design and Construction Supervised by:" Supervised by:"

shall be placed on two lines using black, 1.25" Helvetica regular typeface.

Maximum line length is 19".

10.5" Reverse Signature: The Corps symbol shall be a 10.5" white reverse signature using a 6" castle on a red background. The castle and surrounding border lines shall be white. The castle windows, door, and logo background are to be red. The words "U.S. Army Corps of Engineers" shall be black.

Legend Group 2: The words:

"Savannah District South Atlantic Division" shall be placed on two lines below the 10.5" reverse signature, using black, 1.25" Helvetica regular typeface.

Legend Group 3: The "Name of Project" shall be placed on one to three lines using white 3" Helvetica bold typeface. Maximum line length is 42".

Legend Group 4: The "Army Installation" shall be a one or two line identification of the facility or name of the sponsoring department.

Lettering is to be white, 1.5" Helvetica regular typeface. Maximum line length is 42".

NOTE: Cross-align the first line of legend group 4 with the first line of the Corps signature (U.S. Army Corps) as shown.

Legend Group 5a: The words:

"Architects:" or "Engineers:" or "Architect-Engineers:"

shall be a one to five line identification of the prime architect or engineering corporate or firm name, city, and State. Lettering shall be white, 1.25" Helvetica regular typeface. Maximum line length is 21".

Legend Group 5b: The "Contractor:" shall be a one to five line identification of the prime Contractor corporate or firm name, city, and State. Include type of Contractor, i.e. General Contractor, etc. Lettering shall be white, 1.25" Helvetica regular typeface. Maximum line length is 21".

NOTE: All typography shall be flush left and rag right, upper and lower case with initial capitals only as shown.

Safety Performance Sign EP 310-1-6a 01 Jun 06

16-3

Each contractor’s safety record is to be posted on Corps managed or supervised construction projects and mounted with the Construction Project Identification sign specified on page 16-2.

The graphic format, color, size and type-faces used on the sign are to be repro-duced exactly as specified below. The title with First Aid logo in the top section of the sign, and the performance record captions are standard for all signs of this type. Legend groups 2 and 3 below identify the project and the contractor and are to be placed on the sign as shown.

Safety record numbers are mounted on individual metal plates and are screw-mounted to the background to allow for daily revisions to posted safety perfor-mance record.

Special applications or situations not covered in these guidelines should be referred to the district Sign Program Manager.

Legend Group 1: Standard two-line title “Safety is a Job Requirement” with 8” (outside diameter) Safety Green first aid logo.

Color: To match Pantone system 347 Typeface: 3" Helvetica Bold Color: Black

Legend Group 2: One- to two-line project title legend describes the work being done under this contract and name of host project.

Color: Black Typeface: 1.5" Helvetica Regular Maximum line length: 42"

Legend Group 3: One- to two-line identifica-tion: name of prime contractor and city, state address. Color: Black Typeface: 1.5" Helvetica Regular Maximum line length: 42"

Legend Group 4: Standard safety record captions as shown.

Color: Black Typeface: 1.25” Helvetica Regular

Replaceable numbers are to be mounted on white .060 aluminum plates and screw-mounted to background.

Color: Black Typeface: 3" Helvetica Regular Plate size: 2.5" x 4.5"

All typography is flush left and rag right, upper and lower case with initial capitals only as shown. Letter- and word-spacing to follow Corps standards as specified in Appendix D.

3” 33.030” eq. 8” eq.

6”

4.5”

10.5”

2.25” 3”

2.25” 3”

4.875”

4.875”

6.75”

4.875” .75” 4.875”

4.5”

3”

3” 42” 3”

2.25” 2.25” 2.25” 2.25”

.75”

3”

.75”

Sign Legend Panel Post Specification Mounting Color Type Size (A) Size Size Code Height Bkg/Lgd

CID-02 various 4’x4’ 4”x4” HDO-3 48” WH/BK-SG

CORPS OF ENGINEERS LOGO

HALF SIZE

CESO Form A-02 MAR 15

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist

Date of Inspection

Location (Plant or Facility) Contract Number

Contractor Name Project Name

Inspector Name (Print) Inspector Signature

This checklist serves as a guide only, it does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated 30 Nov 2014. The references included in this checklist correspond to the applicable sections of EM 385-1-1.

Item Description Yes No N/A Remarks (Any NO or N/A item)

a. Signature sheet

1. Includes the name, title, signature, telephone number, and qualifications of the Plan Preparer (Qualified person, i.e. corporate safety staff person, QC)

2. Includes the name, title, signature, telephone number, and qualifications of the Plan Approver (e.g. owner, company president, regional vice president) (HTRW activities require approval of a Certified Industrial Hygienist, a Certified Safety Professional may approve the plan for operations involving UST removal where contaminants are known to be petroleum, oils, or lubricants).

3. Includes the name(s), title(s), signature(s), telephone number(s), and qualifications for Plan Concurrence (provide concurrence of other applicable corporate and project personnel (contractor)) (e.g. Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC.)

b. Background information

1. Includes the Contractor Name.

2. Includes the Contract Number.

3. Includes the Project Name.

4a. Includes the Brief Project Description.

4b. Includes a Discription of the Work to be Performed.

4c. Includes the Location of the Project (map).

4d. Includes the Equipment to be Used.

4e. Includes the Anticipated High Risk Activities.

5. Includes the Major Phases of Work Anticipated.

(Within these major phases of work identified, activities [includes Definable features of Work (DFOWs) and tasks] to be performed that will require an AHA shall be specifically highlighted. This information can then be used by QC, QA and Safety personnel to track AHA submittals. The AHAs for these activities, tasks of DFOWs are NOT submitted at this time (AHAs created/submitted at this time would not be activity-specific as they are intended to be). > See Sections 01.A.14 and 01.A.15.)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Item Description Yes No N/A Remarks (Any NO or N/A item)

c. Statement of Safety and Health Policy.

1. Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. (In addition to the corporate policy statement, a copy of the corporate safety program may provide a portion of the information required by the accident prevention plan.)

2. Includes Contractor’s written safety program goals.

3. Includes Contractor’s written safety program objectives.

4. Includes the Contractor Accident Experience (Copy of OSHA 300 Forms, or equivalent documentation).

d. Responsibilities and Lines of Authority.

1. Includes statement of the employer’s ultimate responsibility for the implementation of his SOH program for his own employees, all sub-contractors and all others on the worksite (includes the strict enforcement of the program).

2. Includes the identification and accountability of personnel responsible for safety and health at both the corporate and project level – including their resumes. Qualifications shall be in accordance with Section 01.A.17. (Only official OSHA 30-Hour cards will be accepted or, if equivalent training is provided, appropriate instructor qualifications.)

3. Includes equivalent training to the OSHA 30-Hour classes is being presented as qualification, the training shall cover, as a minimum, the areas discussed in Appendix A, Section 3.d.3.(a-d).

4. Includes the names of Competent (CP) and/or Qualified Person(s) (QP) and proof of competency/qualification to meet specific OSHA CP/QP requirements. (Must include copies of proof of CP/QP).

5. Includes requirements and details of the employer’s Risk Management Process. (USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process. Contractors and other individual employer’s may use the AHAs or their own version [Job Safety Analyses (JSAs), Job Hazard Analyses (JHAs), or similar Risk Management assessment tools]. These documents are considered equivalent to, and acceptable substitutes for, the USACE’s AHA provided the data collected is the same as that required by the AHA.)

6. Includes requirements for initial activity-specific AHAs to be submitted and accepted at preparatory meetings, prior to work being performed;

7. Includes requirements that no work by the Contractor shall be performed unless a designated Competent Person/SSHO is present on the job site.

8. Includes policies and procedures regarding non-compliance with safety requirements (to include disciplinary actions for violation of safety requirements).

9. Lines of authority.

10. Includes written company procedures for holding managers and supervisors accountable for safety.

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Item Description Yes No N/A Remarks (Any NO or N/A item)

e. Subcontractors and Suppliers.

1. Includes the list of subcontractors and suppliers.

(If not known at the time of initial APP submittal, the contractor shall include the following statement in their initial APP: “The subcontractors for the following DFOWs/activities are not known at this time, but additional information will be submitted to the APP for acceptance prior to the start of any activities listed”)

2. Includes safety responsibilities of subcontractors and suppliers.

f. Training

1. Includes requirements for new hire SOH orientation training at the time of initial hire of each new employee.

2. Includes requirements for mandatory training and certifications that are applicable to this project (e.g., explosive actuated tools, confined space entry, crane operator, diver, vehicle operator, HAZWOPER training and certification, PPE) and any requirements for periodic retraining / recertification.

3. Includes procedures for periodic safety and health training for supervisors and employees.

4. Includes the requirements for emergency response training.

g. Safety and Health Inspections

1. Includes specific assignment of responsibilities for a minimum daily jobsite SOH inspection during periods of work activity.

1a. Includes the name(s) of individual(s) responsible for conducting safety inspections. (e.g., PM, safety professional, QC, supervisors, employees) 1b. Includes proof of inspector's training / qualifications.

1c. Indicates when inspections will be conducted.

1d. Indicates procedures for documentation. (Furnished sample forms upon which inspections will be recorded.)

1e. Indicates deficiency tracking system and follow-up procedures.

2. Includes any external inspections / certifications which may be required. (e.g., US Coast Guard)

h. Mishap Reporting and Investigation

1. The plan identifies how, when, and who shall complete the Exposure data (man-hours worked).

2a. The plan identifies how, when, and who shall complete mishap investigations, reports, and logs. (The contractor shall report, thoroughly investigate, and analyze all mishaps occurring incidentally to an operation, project or facility for which this manual is applicable.)

2b. The plan identifies how, when, and who shall make immediate notification of major mishaps. (Mishaps shall be reported as soon as possible but not more than 24 hours afterwards to the KO/COR.)

2c. Includes how, when, and who will provide notice to the KO/COR when corrective actions are completed. (Implement corrective actions as soon as reasonably possible.)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable safety and occupational health risks and associated compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

(1)Include a project-specific compliance plan, as applicable to the work being performed, and as identified below. The plans shall incorporate project-wide procedures to control hazards to which the employees of all project employers may be exposed.

(2) These procedures shall be coordinated with all project employers and shall include project-specific, project-wide emergency response and evacuation procedures, PPE requirements, recordkeeping and reporting requirements, and training requirements.

(3) The plans shall be prepared prior to the start of any work activities on the job site (as much as the information can be known at that point in time). The plans shall be updated throughout the life of the project to include changes in personnel, equipment, conditions, etc. Additional revisions shall be incorporated as necessary to reflect changing site conditions, construction methods, personnel roles and responsibilities and construction schedules.

(4) No activity (DFOW) shall be started on site until the APP is revised and submitted to the GDA for acceptance, with the site-specific plans, programs and procedures required to complete the project.

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures, Assessments, and Evaluations) required by the Safety Manual

1. Fatigue Management Plan (01.A.20)

2. Emergency Plans (01.E):

(a) Procedures & Test (01.E.01)

(b) Spill Plans (01.E.01, 06.A.02)

(c) Fire Fighting Plan (01.E.01; 19.A)

(d) Posting of Emergency Telephone Numbers (01.E.05)

(e) Man overboard/abandon ship (19.A.04)

(f) Plan for prevention of alcohol and drug abuse (01.C.02 & Specs)

3. Site Sanitation/Housekeeping Plan (02.B)

4. Medical Support Agreement. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (03.A.01, 03.A.03)

5. Blood-borne Pathogen Program (03.A.05)

6. Exposure Control Plan (03.A.05)

7. Automatic External Defibrillator (AED) Program (03.B.04)

8. Site Layout Plan (04.A)

9. Access/Haul Road Plan (04.B)

10. Hearing Conservation Program (05.C)

11. Respiratory Protection Plan (05.G)

12. Health Hazard Control Program (06.A)

13. Hazard Communication Program (06.B.01)

14. Process Safety Management Plan (06.B.04)

15. Lead Compliance Plan (06.C.02 & Specifications)

16. Asbestos Abatement Plan (06.C.03 & Specifications)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures) continued.

17. Radiation Safety Program (06.F)

18. Abrasive Blasting Plan (06.I)

19. Heat Stress Monitoring Plan (HSMP) (06.J.02)

20. Cold Stress Monitoring Plan (CSMP) (06.J.04)

21. Indoor Air Quality Management Plan (06.L)

22. Mold Remediation Plan (06.L.04)

23. Chromium (VI) Exposure Evaluation (06.M)

24. Crystalline Silica Assessment (06.N.02)

25. Lighting Plan for Night Operations (07.A.06)

26. Traffic Control Plan (08.C.05)

27. Fire Prevention Plan (09.A.01)

28. Wild Land Fire Management Plan (09.L)

29. Arc Flash Hazard Analysis (11.B)

30. Assured Equipment Grounding Control Program (AEGCP), (11.D.05, Appendix E)

31. Hazardous Energy Control Program and Procedures (12.A.01)

32. Standard Pre-Lift Plan – LHE (16.A.03)

33. Critical Lift Plan – LHE (16.H)

34. Naval Architectural Analysis – LHE (Floating) (16.L)

35. Floating Plant Inspection and Certification (19.A.01)

36. Severe Weather Plan for Marine Activities (19.A.03)

37. Emergency Plan for Marine Activities (19.A.04)

38. Man Overboard/Abandon Ship Procedures (19.A.04)

39. Float Plan for Launches, Motorboats, Skiffs (19.F.04)

40. Fall Protection and Prevention Plan (21.D)

41. Demolition/Renovation Plan (to include engineering survey) (23.A)

42. Rope Access Work Plan (24.H)

43. Excavation/Trenching Plan (25.A.01)

44. Fire Prevention and Protection Plan for Underground Construction (26.D.01)

45. Compressed Air Work Plan for Underground Construction (26.I.01)

46. Erection and Removal Plan for Formwork and Shoring (27.C)

47. Precast Concrete Plan (27.D)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures) continued.

48. Lift-slab Plans (27.E)

49. Masonry Bracing Plan (27.F.01)

50. Steel Erection Plan (28.B)

51. Explosives Safety Site Plan (ESSP) (29.A)

52. Blasting Plan (29.A; 26.J)

53. Dive Operations Plan (30.A.14, 30.A.16)

54. Safe Practices Manual for Diving Activities (30.A.15)

55. Emergency Management Plan for Diving (30.A.18)

56. Tree Felling/Maintenance Program (31.A.01)

57. Aircraft/Airfield Construction Safety & Phasing Plan (CSPP) (32.A.02)

58. Aircraft/Airfield Safety Plan Compliance Document (SPCD) (32.A.02)

59. Site Safety and Health Plan (HTRW) (33.B)

60. Confined Space Entry Procedures (34.A.05)

61. Confined Space Program (34.A.06)

j. Risk Management Processes (AHAs). Detailed project-specific hazards and controls shall be provided by Activity Hazard Analysis for each activity (DFOW). No work will begin on an activity (DFOW) until the initial AHA has been accepted by the GDA addressing the project-specific hazards. (01.A.14 & 01.A.15) Note: USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process. Contractors and other individual employer’s may use the AHAs or their own version [Job Safety Analyses (JSAs), Job Hazard Analyses (JHAs), or similar Risk Management assessment tools].

These documents are considered equivalent to, and acceptable substitutes for, the USACE’s AHA provided the data collected is the same as that required by the AHA.

Remarks:

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Other Remarks:

CONTRACTOR'S NAME

(Address)

DAILY CONTRACTOR QUALITY CONTROL REPORT

Date: ______________ Report No. _____

Contract No. _____________________________

Description and Location of Work: ___________________________________________

Weather: (Clear) (P. Cloudy) (Cloudy); Temperature: ___ Min. ___ Max; ___

Rainfall ______ inches

Contractor/Subcontractors and Area of Responsibility

1. Work Performed Today: (Indicate location and description of work performed. Refer to work performed by prime and/or subcontractors by letter in table above.)

2. Results of Surveillance: (Include satisfactory work completed, or deficiencies with action to be taken.)

3. Tests required by Plans and/or Specifications Performed and Results of tests:

4. Verbal Instructions Received: (List any instructions given by Government personnel on construction deficiencies, retesting required, etc., with action to be taken.)

5. Remarks: (Cover delays and any conflicts in plans, specifications, or instructions.)

6. Safety Inspection: (Report violations noted; corrective instructions given; and corrective actions taken.)

7. Equipment Data: (Indicate items of construction equipment, other than hand tools, at jobsite, and whether or not used.)

CONTRACTOR'S VERIFICATION: The above report is complete and correct and all material and equipment used and work performed during this reporting period are in compliance with the contract plans and specifications except as noted above.

Contractor's Approved Authorized Representative

WEEKLY TEMPORARY ELECTRICAL INSPECTION

Week ending ________________

Contract No. __________________________

Contract Description _______________________________________________________

The following items were inspected in accordance with requirements in National Electrical Code and Corps of Engineers Safety and Health Requirements Manual, EM 385-1-1.

1. Wire (size, type, condition).

2. Systems and devices (polarity, continuity of ground, resistance to ground).

3. Resistance of ground rods (25 OHMS) measured and recorded.

4. Check GFI for 15/20 amp 120 volt circuits.

5. Plugs and receptacles (type, NEMA rating).

6. Circuit breakers and disconnect (size, type, weatherproof).

7. Extension cords (type, UL listed, insulation condition, splices, location).

8. Open wiring on insulators, nonmetallic sheathed cable, outside clearance (600 volts or less), Festoon lighting (as applicable).

Signature Electrician/Electrical Engineer

MINIMUM STANDARD FOR TEMPORARY ELECTRICAL SERVICE

(DIMENSIONS ARE APPROXIMATE)

A. The backboard for temporary service shall consist of not less than 1/2 inch plywood of exterior grade.

B. Numbers above correspond to the item below:

Item 1 - NEMA 3R circuit breaker type panelboard. This panelboard shall consist of 1 two-pole 60 amp main circuit breaker, 4* one pole 20 AMP branch circuit breakers, and 1* two pole 20 AMP branch circuit breaker. Breakers shall meet Federal Specifications Standards for Class 1A breakers and shall be plug-in type. (*Number of breakers to be adjusted to suit the job requirements.)

Item 2 - Duplex grounding type convenience outlets in standard utility type outlet boxes with covers, meeting the NEC and NEMA requirements for wet locations.

Connections to the branch circuit breakers shall be grounded by two conductors #12 NMC cable.

Item 3 – (Optional) A single three-conductor grounding type outlet rated for 250 volt service meeting the NEC and NEMA requirements for wet locations. Connections from this outlet to the two pole breaker shall be by two conductor grounded type NMC cable.

Item 4 - 3/4 inch PVC. This shall be used to support extension cords.

Item 5 – NEMA 3R service disconnect safety switch – 60 amp minimum.

C. The panelboard shall be grounded by #6 copper wire connected to a 3/4 inch by 10-foot long ground rod.

D. Service to the panel shall consist of three copper conductor #6 minimum service entrance cable. This cable may enter the top or side of the panelboard.

E. Periodic inspections of systems and devices will be made by the Contractor at intervals not to exceed 1 week, and a report will be submitted indicating the results.

F. All receptacle outlets that provide temporary electrical power during construction, remodeling, maintenance, repair, or demolition shall have ground-fault circuit-interrupter (CFCI) protection for personnel. GFCI protection shall be provided on all circuits serving portable electric hand tools or semi-portable electric power tools (such as block/brick saws, table saws, air compressors, welding machines, and drill presses). See EM 385-1-1 for exceptions.

G. Per EM 385-1-1 all temporary power distribution systems shall be submitted to the field office before installation.

ACTIVITY HAZARD ANALYSIS

1. Phase of Construction

2. Location 3. Contract No. 4. Project

5. Prime Contractor 6. Date of Preparatory 7. Estimated Start Date

Potential Safety Hazard Procedure to Control Hazard

8. Contractor=s Representative (signature)

9.

SAS Form 9 1 Jan 82

REPORTING OF SAFETY MEETING _________________________________________

(INSTALLATION, FIELD OFFICE, JOB, ETC.)

THRU EN

CD

OP

RE

TO SO

FROM:

DATE: _____________________________ TIME: _________________ (A.M./P.M.)

NO. EMPLOYEES PRESENT _____________ DURATION: _________________________

Old Business: (Review report of last meeting. Follow up on action taken or anticipated to correct any safety deficiencies brought up at last meeting. Discuss any unfinished business.)

New Business: (Discuss any unsafe acts or conditions observed since last safety meeting and any mishaps or injuries which occurred during the week.)

Safety Presentation: (Safety talk, movie, or slide presentation on subject that is relevant to operation at hand.)

DATE AND TIME OF NEXT MEETING

(Signature and Title)

SAD FL 198, 1 APR 80

# OF

UNITS

UNIT

AREAS

MIN

UNIT

TOTAL

HRS

UNIT

PRICE

COST

UNIT

PRICE

COST

UNIT

PRICE

COST

UNIT

WT

TOTAL

WT

TOTAL THIS SHEET

DA Form 5418-R

MATERIAL

TASK DESCRIPTION TOTAL

SHIPPING

COST ESTIMATE ANALYSIS

PROJECT

LOCATION

INVITATION/CONTRACTOR

CODE (Check one) ____A ____B ____C ____Other _________________

EFFFECTIVE PRICING DATE

QUANTITY LABOR EQUIPMENT

DRAWING NO.

ESTIMATOR

DATE PREPARED

SHEET OF SHEETS

CHECKED BY

1354 CHECKLIST for Project Closeout

PROJECT NUMBER: ______________________

BUILDING NUMBER: _____________________

DESCRIPTION OF PROJECT: ____________________________________________________________________ Describe description of work; i.e., New Construction, Addition, Modification, Renovation, etc…

DRAWING NUMBER : ______________________________

TOTAL COST OF BUILDING: _______________________ (Cost of building only, sometimes does not include the cost of systems or plants. Costs of installed equipment such as water coolers, urinals, etc. is included in the cost of the building) DEMOLITION COSTS: _____________________________ (if any)

ACTUAL PROJECT COMPLETION DATE: ____________________

CECMC PROJECT CLOSEOUT DATE: _______________________

CATEGORY CODES NOMENCLATURE TOTAL COST TOTAL SF

NOTE: Main Line Item Category Codes (A or B) may need clarification or approval sometimes by Real Property if there is a question as to the best definition of a facilities actual use. The CECB Programmer should be inputting the Main Category code prior to initiating an AFF 1391.

NUMBER OF FLOORS: _____________________________

OUTSIDE DIMENSIONS: (from outside wall to outside wall) _____________________________

Main building SF __________________________________________________

Wings SF __________________________________________________

Offsets SF __________________________________________________

CONSTRUCTION MATERIAL:

Foundations (such as concrete) TYPE _________________________________________

Floors (such as wood, concrete) TYPE _________________________________________

Walls (such as wood siding) TYPE _________________________________________

Roof (such as built-up, shingle) TYPE _________________________________________

UTILITIES ENTERING BUILDING from STREET:

Water Line (size of pipe ex: 1½”, 2”, 3 ½ ) SIZE___________________ LF __________________

Gas Line (size of pipe) SIZE___________________ LF __________________

Sewer Line (size of pipe) SIZE___________________ LF __________________ Electrical Service (phase, # wires, voltage, amperage capacity) SIZE___________________ LF __________________

PLANT SYTEMS - AIR CONDITIONING

Category Code Nomenclature Unit of

Measure Amount Cost Description

890-126 A/C Window Units

TN _______ _______ __________________________

SF _______ _______ __________________________

890-125 A/C System less than 5 Ton

TN _______ _______ __________________________

SF _______ _______ __________________________

890-121 A/C System 5 to 25 ton TN _______ _______ __________________________

826-122 A/C System (Plant) 25 to 100 ton TN _______ _______ __________________________

826-123 A/C System (Plant) Over 100 ton TN _______ _______ __________________________

826-234 A/C System from Central Plant TN _______ _______ __________________________ NOTE: Choose, which ever best applies. Include actual tonnage for each unit separately.

PLANT SYTEMS - HEATING

Category Code Nomenclature Unit of

Measure Amount Cost Description

821-113 Heating from a Central Plant MB _______ _______ __________________________ 821-115 Heating Plant 750-500 M Btu MB _______ _______ __________________________ 821-116 Heating Plant Over 3500 M Btu MB _______ _______ __________________________

NOTE: Heating Plants under 750 MB don’t need to be broken out as a plant on the DD Form 1354, but do need to be annotated on the Real Property Installed Equipment (RPIE) list. Related equipment such as boilers, hot water pumps, fans, etc., should be reflected in the cost for the plant on the DD Form 1354. See the last page for definition of RPIE and a short listing of RPIE items (not all-inclusive).

ELECTRICAL SYSTEMS:

135-583 Telephone Duct Facility LF _______ _______ __________________________ 135-586 Telephone Pole LF _______ _______ __________________________

811-147 Emergency Electric Power Generation Plant kW _______ _______ __________________________

GA _______ _______ __________________________

Type

FUEL

812-223 Primary Overhead Electrical Distribution Line LF _______ _______ __________________________

Transformers KVA _______ _______ __________________________ Power Poles LF _______ _______ __________________________

812-224 Secondary Overhead Electrical Distribution Line

LF _______ _______ __________________________

812-225 Primary Underground Electrical Distribution Line

LF _______ _______ __________________________

812-226 Secondary Underground Electrical Distribution Line

LF _______ _______ __________________________

812-926 Exterior Area Lighting (Street, Parking Area, Safety and Security Lighting) list type, mercury vapor, metal halide, high pressure, low pressure

EA _______ _______ __________________________

812-928 Traffic Lights EA _______ _______ __________________________ 890-181 Utility Line Duct LF 890-187 Utility Vault - Four or More

Transformers

SF _______ _______ __________________________

FIRE PROTECTION:

Code Nomenclature Unit of Measure Amount Cost Description

843-314 Fire Protection Water Main LF 843-315 Fire Hydrants EA _______ _______ __________________________

880-211 Closed Head Automatic Sprinklers SF _______ _______ __________________________

HD _______ _______ __________________________

880-212 Open Head Deluge System (normally found only in aircraft hangers)

SF _______ _______ __________________________

HD _______ _______ __________________________

880-221

Automatic Fire Detection System (fire alarm control panels with associated equip - strobes, lights, bells, heat detectors and pull boxes)

SF _______ _______ __________________________

EA _______ _______ __________________________

880-222 Manual Fire Alarm System - pull boxes only EA _______ _______ __________________________

880-231 CO2 Fire Suppression System EA _______ _______ __________________________ 880-232 Foam Fire Suppression System EA _______ _______ __________________________

880-234 Halon 1301 Fire Suppression System EA _______ _______ __________________________

880-233 Other Fire System EA _______ _______ __________________________ Choose whichever applies.

SECURITY:

Category Code Nomenclature Unit of

Measure Amount Cost Description

872-841 Security Alarm System EA _______ _______ __________________________ 872-247 Fence Security/Vehicle Barriers LF/LM _______ _______ __________________________ 872-248 Fence Interior LF/LM _______ _______ __________________________ 872-845 Security Alarm System EA _______ _______ __________________________

FACILITY INFRASTRUCTURE:

Code Nomenclature Unit of

Measure Amount Cost Description

824-464 Gas Lines (piping) list size and type (plastic, steel) in description block

LF _______ _______ __________________________

831-169 Sewage Septic Tank - tank size KG _______ _______ __________________________

832-266 Sanitary Sewer - list size line and type material LF _______ _______ __________________________

842-245 Water Distribution Mains - list size and type LF _______ _______ __________________________

851-143 Curbs & Gutters LF _______ _______ __________________________

851-145 Driveway - list type, Asphalt, Concrete, Gravel SY _______ _______ __________________________

851-147 Road - list type, Asphalt, Concrete, Gravel

SY _______ _______ __________________________

LF _______ _______ __________________________

852-261 Vehicle Parking, Operations SY _______ _______ __________________________ 852-262 Vehicle Parking, Non-Org SY _______ _______ __________________________

852-289 Sidewalk - list thickness and type of material SY _______ _______ __________________________

871-183 Storm Drain LF _______ _______ __________________________ 872-245 Fence, Boundary LF _______ _______ __________________________ 872-247 Fence, Security LF _______ _______ __________________________ 872-248 Fence, Interior LF _______ _______ __________________________ 890-269 Cathodic Protection System EA _______ _______ __________________________

NOTE: Generally, this 1354 Checklist for Category Codes to identify a Facility Infrastructure will suffice without have to reference the entire AF Category Codebook. However sometimes you will have to consult the AF Category Codebook or Real Property office for assistance.

ITEMS OFTEN FOUND IN SPECIALIZED FACILITIES

(Special Purpose)

INDUSTRIAL SHOP AREAS:

Code Item UM Amount Cost Description

RPIE Air Compressors HP _______ __________________________ RPIE Hoists, Cranes-Fixed TN _______ __________________________ RPIE Hydraulic Lifts TN _______ __________________________ RPIE Emergency Shower EA _______ __________________________

? Fixed Spray Paint Booth SF _______ __________________________ 890-158 Loading and Unloading Platform SF _______ _______ __________________________ 832-255 Industrial Waste Main LF _______ _______ __________________________ 890-144 Compressed Air Distribution LF _______ _______ __________________________

NOTE: Identify RPIE. Size, Amount or unit of measure (there is No Category Code for RPIE items).

CHAPEL:

Category Code Item UM Amount Description

RPIE Pews EA _______ __________________________ RPIE Altars EA _______ __________________________ RPIE Lecterns EA _______ __________________________ RPIE Pulpit EA _______ __________________________

THEATER:

Code Item UM Amount Description

RPIE Theater Seats Secured to Floor EA _______ __________________________

RPIE Stage and Auditorium Curtains EA _______ __________________________

BILLETING /TLF/VOQ:

Code Item UM Amount Description

RPIE Built-in Household Dishwasher EA _______ __________________________ RPIE Garbage Disposal EA _______ __________________________ RPIE Range Hood with Exhaust Fan EA _______ __________________________ RPIE Water Softener (house hold type) EA _______ __________________________

MWR FACILITIES:

Code Item UM Amount Description

RPIE Dishwashers (built-in) EA _______ __________________________ RPIE Walk-in Refrigerators (built-in) EA _______ __________________________ RPIE Garbage Disposal Unit EA _______ __________________________ RPIE Range Hood with Exhaust Fan EA _______ __________________________ RPIE PA Systems (built-in) EA _______ __________________________ RPIE Vault (built-in) EA _______ __________________________ RPIE Stage and Auditorium Curtains EA _______ __________________________

RPIE Playground Equipment (permanently affixed) EA _______ __________________________

RPIE Bowling Alley Lanes, Approaches, Ball Returns EA _______ __________________________

890-158 Loading and Unloading Platform SF _______ _______ __________________________

Post Office:

Category Code Item UM Amount Description

RPIE Post Office Lock Boxes EA _______ __________________________

ADDITION or ALTERATION to a FACILITY:

Item Yes No

a. Outside dimensions of addition _______ _______

b. Foundation _______ _______

c. Floors _______ _______

d. Walls _______ _______

e. Roof _______ _______

f. Utility plants or systems added, replaced, or removed _______ _______

g. Real property installed equipment removed, added, or replaced

h. Demolition costs _______ _______

i. Addition or deletion of related facilities _______ _______

j. Addition or deletion of porches, sheds, balconies, mezzanines, etc.

k. Real property installed equipment (RPIE) removed, installed, or replaced with a larger or smaller unit

NOTE: Whenever a project calls for an Addition to an Existing Building or Facility. Use the 1354 checklist above paying close attention to f, g, h, and k.

REAL PROPERTY INSTALLED EQUIPMENT: are those items of government-owned or leased accessory equipment apparatus and fixtures that are essential to the function of the real property and are permanently attached to, integrated into or are on government owned or leased property.

NOTE: RPIE cannot be on an organizational account known as the TA (Table of Allowance) for it to be a RPIE item i.e., an authorized dishwasher (clipper) in the Dinning Facility should be on their organizational Table of Allowances and cannot be a RIPIE item. However a dishwasher in the housing area, or billeting is definitely a RPIE item. The difference is the Dinning Facility is authorized a dishwasher on their TA therefore it cannot be RIPIE.

Item UM/Size Amount Description Commode Dehumidifiers Elevators Evaporative Coolers CFM Exhaust Fan Forced Air Heating Heating Plant Under 750 MB MB Hot Water Heater GAL Lavatory Other Heating Refrigerated Drinking Fountain Theater-type Seats Secured to Floor

Urinal Utility Sink

Examples of NON-RPIE Items:

Note: Not All-Inclusive

Air Dryers/Compressors supporting communication lines Portable Buildings, Air Conditioners, Water Chillers Bicycle Storage Lockers/Metal Lockers (removable) Projection Screens Compressed Natural Gas Dispensing Systems Sawdust Collectors Emergency Power Systems (EPS) Stationary Acetylene Generators HEMP/TEMPEST shielding equipment Systems Furniture Ice-Making Machines Venetian Blinds Intercom Equipment Walk-In Coolers (if free standing) Prewired Workstations Window Shades Power Conditioning Continuation Interfacing Equipment (PCCIE) – this includes Uninterrupible Power Supply

(UPS)

Compressed Air System and Water Cooling/Recycling System

Public Address System Satellite Cable Television Antennas

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Date:

Location:

A. TOTAL LOAD

lbs lbs lbs lbs lbs lbs lbs lbs lbs.

ft.

ft.

ft. G. PRE-LIFT CHECKLIST (YES) N/A ft.

lbs.

lbs.

deg.

deg.

lbs.

12. Lift is % of the Crane's rated capacity

13. If Jib/Ext. is to be used:

Length ft.

Offset ft.

14. Rated Capacity of Jib/Ext. lbs C. HOIST ROPE Main Aux 1

Size:

lbs.

lbs.

6. Shackle Rated Capacity(s) _________________

Aux 2

1. # of Parts

2. Rope Diamter

3. Capacity

5. Shackle Size(s):

8. Signal Person Qualifications

2. Rigging Inspected

3. Crane Set-up

4. Overhead Hazard Check

5. Swing Check

6. Counterweight Check

7. Operator Qualifications

15. Site Control

16. Signatures

14. Traffic Hazard Check

11. Load Test

12. Tag Lines

13. Wind Conditions

(NO)

1. Crane Inspected

YES / NO

1. Certified Operator?

2. Option?

3. Certified for Type, Class & Capacity?

4. Designated in writing by emp

YES / NO

YES / NO

B. CRANE F. OPERATOR QUALIFICATIONS

YES / NO

Note: Bearing Pressure Calculations must be attached on Page 3.

Note: If Obstructions are present they must be shown on Page 4.

E. CRANE PLACEMENT (Mobile Cranes Only)

YES / NO

YES / NO

1. Load Weight

3. Wt. of Main Block

Note: Source of load weight (Drawings, Calcs, etc.) must be attached on Page 2.

Note: If Elelctrical Hazards are present they must be shown on Page 4.

Note: Ground Condition Calculations must be attached on Page 3.

1. Hitch Type(s)

2. No. of Slings:

3. Sling Type:

4. Sling Assembly Capacity:

D. RIGGING

9. Rigger Qualifications

10. Load Chart in Crane

6. Wt. of Jib/Ext. (erected/stowed)

7. Wt. of Hoist Rope

8. Other:

1. Type of Crane

3. Radius (Maximum)

4. Radius (Minimum)

5. Boom Length (Maximum)

6. Boom Length (Minimum)

8. Crane Capacity (Min Radius)

9. Boom Angle (Maximum)

USACE District:

Prepared By:

CRITICAL LIFT PLAN

U.S. Army Corps of Engineers

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

6. Other?

Apr-13 Page 1 of 6

PSF

H. SIGNATURES

2. Rigger

1. Crane Operator

3. Signal Person

4. Lift Supervisor

5. Other

6. Other

7. Crane Capacity (Max Radius)

5. Travel with Load Required?

4. Obstructions to Lift or Swing?

3. High Voltage or Electrical Hazards?

2. Ground Conditions Suitable for Load?

1. Maximum Bearing Pressure

11. Gross Load of Crane

4. Wt. of Lifiting Beam

5. Wt. of Sling/Shackles

TOTAL WEIGHT

Mobile Hydraulic Truck

10. Boom Angle (Minimum)

2. Wt. of Aux. Block

2. Maximum Crane Capacity

A "critical lift" can be defined as any non-routine crane lift requiring detailed planning and additional or unusual safety precautions.

Critical lifts include lifts made where the load weight is greater than 75% of the rated capacity of the crane; lifts which require the load to be lifted, swung or placed out of the operator's view (except Change 6 exemption) ; lifts made with more than one crane; lifts involving non-routine or technically difficult rigging arrangement; hoisting personnel with a

FORM 16-3

Critical Lift Plan

Show here or attach calculations, drawings, etc.

CRITICAL LIFT PLAN

U.S. Army Corps of Engineers

Page 2 of 6Apr-13

LOAD CALCULATIONS

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

Show here or attach calculations, drawings, etc.

U.S. Army Corps of Engineers

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

BEARING PRESSURES & GROUND CONDITIONS

Apr-13 Page 3 of 6

Show here or attach load chart

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

LOAD CHART

Apr-13 Page 4 of 6

Show here or attatch operator qualifications

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

OPERATOR, RIGGER, SINGAL PERSON QUALIFICATIONS

Apr-13 Page 5 of 6

Show here or attach site plan and sequencing

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

SITE PLAN

Apr-13 Page 6 of 6

REAL PROPERTY INVENTORY

ITEM TALLY TOTAL

COMMODES

LAVATORIES

URINALS

EXHAUST FAN (9")

EXHAUST FAN

(OTHER)

WATER COOLER

HOTWATER HEATER

MOP SINK

AC PLANT

LS 5 TN. 5-25 TN. 25-100 TN. OVER 100 TN.

AS (WINDOW TYPE)

FIRE ALARM SYSTEM

MANUAL HALON SPRINKLER

EMERGENCY LIGHTS

UNIT HEATER

STRIP HEATER

COOLING TOWER

WALK-IN COOLER

AIR CURTAIN

EYE WASH

SHOWERS

BOILER

GAS FIRED OIL FIRED STEAM

FUEL TANK

UNDERGROUND OUTSIDE

WASH BASIN

AIR COMPRESSOR

HOISTS

INVENTORY BY: DATA:

RECONCILED BY: DATA:

INVENTORIED BY: DATE:

RECONCILED BY: DATE:

DIRECTORATE OF ENGINEERING & HOUSING

EXCAVATION PERMIT

FB Reg 420-13 DATE

1. CLEARANCE IS REQUIRED TO PROCEED WITH WORK AT

ON WORK ORDER NO _________________________ CONTRACT NO

2. METHOD OF EXCAVATION A.HAND B.POWER SHOVEL C. DITCHER D. OTHER (SPECIFY)

3. SCOPE OF WORK (DEPTH, WIDTH, LENGTH, LOCATION, AND SKETCH AS APPLICABLE)

IF CONTRACT A COPY OF APPLICABLE DRAWINGS OR SKETCHES MUST BE ATTACHED.

4. DATE CLEARANCE REQUESTED 5. TERMINATION DATE OF CLEARANCE (60 DAYS UNLESS SPECIFIED)

6. REQUESTING ORGANIZATION OR COMPANY 7. PHONE NUMBER 8. SIGNATURE (REQUESTING OFFICIAL)

9. EXCAVATION CLEARANCE APPROVAL

UTILITY REMARKS SIGNATURE OF APPROVING DATE

OFFICIAL

ELECTRICAL

UNDERGROUND

DISTRIBUTION

STEAM OR HTW

DISTRIBUTION

CHILLER

DISTRIBUTION

SEWER LINES

WATER

DISTRIBUTION

NATURAL GAS

DISTRIBUTION

TELEPHONE (DOIM)

OTHER

TELEPHONE (CT&T)

FB Form 1605 DIGGING WILL NOT BE PERMITTED UNLESS SIGNED 1 May…