A.03.09 Exhibits.docx

SECTION J

LIST OF ATTACHMENTS EXHIBITS

EXHIBIT A, Items to be delivered at least one week prior to Pre-Work Conference EXHIBIT B, Vicinity Map EXHIBIT C, Accident Prevention Plan (APP) Outline EXHIBIT D, Safety Forms OSHA Form 300; Accident Investigation Report ENG 3394 EXHIBIT E, Quality Control Plan EXHIBIT G, Sample Invoice EXHIBIT H, Partial list of Park Attendant forms and records EXHIBIT I, Task Order, DD 1155 EXHIBIT J, Contract Discrepancy Form, CELRH 1140 EXHIBIT K, Vehicle Operations CELRH 2796, CELRH 2813, ENG Form 9400, ENG Form 4866

EXHIBIT A

ITEMS TO BE DELIVERED AT LEAST ONE EEK PRIOR TO PRE-WORK CONFERENCE

ITEMS TO BE DELIVERED AT LEAST ONE WEEK PRIOR TO PRE-WORK CONFERENCE

Contractor shall provide documents as outlined in Exhibit A at least one (1) week prior to the pre-work conference, including but not limited to the following:

a. Quality Control Plan. A suggested outline for the Contractor’s Quality Control Plan is in Exhibit E.

b. Contractor Quality Control Inspector. List of Quality Control Inspectors.

c. Contractor Representatives. List of names of Contractor Representatives.

d. Accident Prevention Plan. A suggested outline for the Contractor’s Accident Prevention Plan is in Exhibit C. See Section C-1.9 for APP requirements.

e. Emergency Contacts. A prioritized list, including phone numbers, of those persons (normally Contractor Representatives) to call in case of emergencies.

f. Operators. A list of names of qualified equipment/vehicle operators, including experience, training, and qualification to operate specific equipment.

g. Certificate of Insurance. See Section H.

h. Security Requirements. See Section H.

EXHIBIT A PAGE 1 OF 1

EXHIBIT B VICINITY MAP

EXHIBIT B PAGE 1 OF 1

EXHIBIT C

ACCIDENT PREVENTION PLAN (APP) OUTLINE

APPENDIX A

Minimum Basic Outline for Accident Prevention Plans

k. Abbreviated APP for Limited-Scope Service, Supply and R&D Contracts. If service, supply and R&D contracts with limited-scopes are awarded, the contractor may submit an abbreviated APP in lieu of a full APP. The abbreviated APP shall address the following areas at a minimum. If other areas of the EM 385-1-1 are pertinent to the contract, the contractor must assure these areas are addressed as well. The non-mandatory Abbreviated APP Form, Form A-01 (or similar) may be used to insure each area of required information has been provided.

(1) Title, signature, and phone number of the plan preparer.

(2) Background Information to include:

(a) Contractor;

(b) Contract number;

(c) Project name;

(d) Brief project description,

· Note: The project description shall provide a means to evaluate the work being done (see AHA requirements in 01.A.14), associated hazards involved and a RAC assigned to each. The overall RAC for the activity must be determined (based on highest task RAC) and accepted at the appropriate level in order for work to proceed.

(e) Description of work to be performed, and

(f) Location of work being performed, to include a map.

(3) Statement of Safety and Health Policy detailing their commitment to providing a safe and healthful workplace for all employees.

(4) Responsibilities and Lines of Authorities – to include a statement of the employer’s ultimate responsibility for the implementation of his SOH program; Identification and accountability of personnel responsible for safety at all levels to include designated site safety and health officer (SSHO) and associated qualifications. The District SOHO will be asked to review the qualifications for acceptance.

(5) Training - new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements.

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EXHIBIT C PAGE 1 OF 6

(6) Procedures for job site inspections - assignment of responsibilities and frequency.

(7) Procedures for reporting man-hours worked and reporting and investigating any mishaps required by Section 01.D.

(8) Emergency Planning. Employees working alone shall be provided an effective means of emergency communication. This may be cellular phone, two-way radio or other acceptable means. The selected means of communication must be readily available and must be in working condition.

(9) Drinking Water provisions, toilet and washing facilities.

(10) First Aid and CPR training (at least two employees on each shift shall be qualified/certified to administer first aid and CPR) and provision of first aid kits (types/size).

(11) Personal Protective Equipment (PPE).

(a) ) Work Clothing - Minimum Requirements. Employees shall wear clothing suitable for the weather however minimum requirements for work shall be short-sleeve shirt, long pants (excessively long or baggy pants are prohibited) and leather work shoes. If analysis determines that safety-toed (or other protective) footwear is necessary (i.e., mowing, weedeating, chainsaw use, etc), they shall be worn.

(b) Eye and Face Protection. Eye and face protection shall be worn as determined by an analysis of the operations being performed, however, all involved in chainsaw use, chipping, stump grinding, pruning operations, grass mowing, weedeating and blowing operations shall be provided safety eyewear (Z87.1) as a minimum.

(c) Hearing Protection. Hearing protection must be worn by all those exposed to high noise activities (to include grass mowing and trimming, chainsaw operations, tree chipping, stump grinding and pruning).

(d) Head Protection. Hard hats shall comply with ANSI Z89.1 and shall be worn by all workers when a head hazard exists, per Section 05.D.

(e) High Visibility Apparel shall comply with ANSI/ISEA 107, Class 2 requirements at a minimum and shall be worn by all workers exposed to vehicular or equipment traffic.

(f) ) Protective Leg chaps shall be worn by all chainsaw operators.

(g) Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts, abrasions, punctures, burns and chemical irritants.

(h) If work is being performed around water and drowning is a hazard, PFDs must be provided and worn as appropriate.

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EXHIBIT C PAGE 2 OF 6

(12) Machine Guards and safety devices. Power tools/equipment must have appropriate guards and safety devices in place and operational.

(13) Hazardous Substances. When any hazardous substances are procured, used, stored or disposed, a Hazard Communication Program must be in place and MSDSs (SDSs) shall be available at the worksite. Employees shall have received training in hazardous substances being used. When the eyes or body of any person may be exposed to corrosives, irritants or toxic chemicals, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within 10 seconds of the worksite.

(14) Traffic control shall be accomplished in accordance with DOT’s MUTCD.

(15) Control of Hazardous Energy (Lockout/Tagout). Before an employee performs any servicing or maintenance on any equipment where the unexpected energizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of this energy. > See Section 12.

(16) High hazard activities should not be encountered on these types of jobs. If they are (i.e., driving/operating equipment on slopes, working from/in boats, etc), a determination shall be made by the KO and local SOH Office as to whether an abbreviated APP is applicable. If so, they shall be fully addressed in the APP. AHAs are required on work activities which include high hazard activities.

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U.S.Army Corps of Engineers Safety Inspection Checklist Abbreviated Accident Prevention Plan Date of Inspection

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 XX September 2014.The references Included In this checklist correspond to the applicablesections of EM 385-1-1.

If service, supply and R&D contracts with limited scopes are awarded, the contractor may submit an abbreviated Accident Prevention Plan. This APP shall address the following areas at a minimum. If other areas of the EM 385-1-1 are pertinent to the contract, the contractor must assure these areas are addressed as well.

1. Signature sheet

a. Includes the name, signature, and title of the Plan Preparer (Qualmed person, i.e. corporate safety staff person, QC)

b. Includes the name, signature,and tiUe of the Plan Approver {e.g.

owner, company president, regional vice presiden

c. Includes the name{s), signature(s), and title{s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel(contractor))

2.Background information

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d. Includes the Brief Project Description.

e. Includes the Location of the Project {map).

f. Includes a means to evaluate the work being done (see AHA requirements in 01.A.13) and associated hazards involved.

g. Addresses the identified hazards involved and the control measures to be taken.

3. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthfulworkplace for all employees.

4.Responsibilities and Lines of Authorities a.Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level - including their resumes.

b.Includes the lines of authority.

5. Training- new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements

6.Procedures for job site inspections - assignment of responsibilities and frequency

7.Procedures for reporting man-hours worked and reporting and investigating any accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR)

8.Emergency Planning. Employees working alone shall be provided an effective means of emergency communication. This may be cellular phone, two-way radio or other acceptable means. The selected means of communication must be readily available and must be in working condition.

9.Drinking W ater provisions, toilet and washing facilities.

10.First Aid and CPR training (at least two employees on each shift shall be qualified/certified to administer first aid and CPR) and provision of first aid kit (types/size).

11.Personal Protective Equipment

a. Work Clothing - Minimum Requirements. Employees to wear clothing suitable for the weather; minimum requirements for work shall be short-sleeve shirt, long pants (excessivelylong or baggy pants are prohibited) and leather work shoes. If AHA determines safety-toed (or other protective) footwear is necessary (i.e., mowing, weed eating, chain saw use, etc), they shall be wom.

b.Eye and Face Protection. Eye and face protection shall be worn as determined by an analysis of the operations being performed HOW EVER, all involved in chain saw use, chipping,stump grinding, pruning operations, grass mowing, weed eating and blowing operations shall be provided safety eyewear (Z87.1) as a minimum.

c. Hearing Protection. Hearing protection must be worn by all exposed to high noise activities {includes grass mowing/trimming, chainsaw operations, tree chipping, stump grinding and pruning) d.Head Protection. Hard hats shall comply with ANSIZ89.1 and shall be wom by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in {b) e.High Visibility Apparel shall comply with ANSI/ISEA 107, Class 2 requirements at a minimum and shall be worn by all workers exposed to vehicular or equipment traffic.

f.Protective Leg chaps shall be wom by all chainsaw operators.

g. Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts,abrasions, punctures, bums and chemicalirritants.

h. If work is being performed around water and drowning is a hazard, PFD's must be provided and worn as appropriate.

12.Machine Guards and safety devices. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.

13. Hazardous Substances. W hen any hazardous substances are procured, used, stored or disposed, a hazard communication program must be in effect and MSDSs shall be available at the worksite. Employees shall have received training in hazardous substances being used. W hen the eyes or body of any person may be exposed to corrosives, irritants or toxic chemicals, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within 10 seconds of the worksite.

14. Traffic control shall be accomplished in accordance with DOrs MUTCD.

15. Control of Hazardous Energy (Lockout/Tagout). Before an employee perfonns any servicing or maintenance on any equipment where the unexpected unergizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of

16. Driving, working on (i.e., working with equipmenUmowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly.

EXHIBIT D

SAFETY FORMS OSHA FORM 300; ACCIDENT INVESTIATION REPORT ENG 3394

Exhibit D

Exhibit D

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EXHIBIT E

QUALITY CONTROL PLAN

CONTRACTORS QUALITY CONTROL PLAN

1. INSPECTION OF SERVICES.

a. Scheduled Inspections. At the beginning of each shift, the Park Attendant shall inspect the work performed by the previous shift. The inspection shall include the following:

1) Review of permits issued. Permits shall be checked for accuracy of arrival and departure dates, fees collected, required information recorded, and proper filing. Permits and fees collected shall also be reconciled.

2) Reconciliation of Register of Campers (computer and/or "clipboard) and actual campground conditions.

3) Fund security and compliance with safety and security requirements.

4) All other items listed on the attached inspection form.

b. Unscheduled Inspections. If the Contractor is not the primary Park Attendant, the Contractor or his Representative shall make unscheduled inspections, using the following form and above criteria. Unscheduled inspections shall be made a minimum of every week.

c. Records and Filing. All inspections shall be documented and maintained in a file at the Entrance Station. Files shall be available for COR inspection at any time.

2. DEFICIENCIES AND CORRECTIVE ACTION. Errors in User Permits and other records shall be corrected immediately, and documented as required. Notices and reminders shall be posted as necessary to draw attention to repeated errors.

3. INSPECTORS and CONTRACTOR REPRESENTATIVES. A list of names and phone numbers of authorized Inspectors and Contractor Representatives shall be provided at the Pre-Work Conference.

4. SECURITY PROVISIONS. The Contractor shall cooperate with the Government in providing for the security of Government property. Some of the security measures expected include:

a. All gates and doors which were opened to allow Contractor personnel access for work shall be closed and locked upon leaving. Only authorized Contractor personnel or Government personnel shall be permitted to enter secured areas. A government employee shall be informed immediately if any unauthorized person enters a secured area.

b. Keys shall be removed from vehicles when not in use. Keys shall not be left in view of the public.

c. Secure or maintain constant surveillance on all pilferable items to prevent theft. Provide control to ensure that Government furnished equipment, property, or materials are utilized only for contract purposes.

d. Security of User Fees Collections.

1) Money handling shall be done out of sight of visitors, to the greatest extent possible.

2) The Entrance Station shall be secured (doors locked, windows blocked) when counting fees and preparing transmittals.

3) The Contractor shall make full use of the Entrance Station safe. Large bills and collections greater than $200 shall be deposited.

4) The Contractor and their employees shall not discuss use fees or procedures with anyone.

5) Maximum practical use shall be made of Government- provided safes, bank deposit systems, etc., to minimize the amount of cash on hand at any one time.

6) To the extent possible, more than one individual should have control of user fee collections and submissions. Daily records shall be maintained of Self Deposit receipts and collections, when such systems are in use.

7) All records are subject to inspection by the Government.

e. The Contractor shall report any suspicious activity in accordance with the Emergency Phone List and the Park Attendant Handbook. The Contractor shall fully cooperate with any investigations by the Corps of Engineers, or State or Local Law Enforcement Agencies

QUALITY CONTROL CHECKLIST FOR PARK ATTENDANT SERVICES

Visitor Registration

Fee Collection

Fund Security

Campground Register & Visitor Records

Customer Care & Visitor Assistance

Campground Inspections

Gates Operated Correctly

Handouts Distributed

Reporting Incidents, Etc.

Log Book

Cooperation with Others

Attendant’s Appearance

Entrance Station Appearance

Entrance Station Security

Use Fee Transmittal

Safe Work Habits and Equipment

1 – Work Done Correctly 2 – Errors Found (Explain problem, correction, and prevention of repeat problem) 3 – Work Not Begun X – Work Not Scheduled

EXHIBIT G

SAMPLE INVOICE

EXHIBITG SAMPLE INVOICE FORMAT

FROM: Contractor's Name INVOICE NO: Address City, State Zip Phone Number

INVOICE FOR MONTH OF: DATE OF INVOICE: CONTRACT NUMBER:

TO: Resource Manager Summersville Lake 2981 Summersville Lake Road Summersville, WV 26651

100 hours Worked of

$1000.00

1000 hours Scheduled For Year

Total Invoice $1000.00

EXHIBIT G

EXHIBIT H

PARTIAL LIST OF PARK ATTENDANT FORMS AND RECORDS

PARK ATTENDANT'S FORMS AND RECORDS

1. Request for Refund of User Fees (ORD FL 1988-R)

2. Campground Register (Names of Campers/Visitors)

3. Campground Daily Log (Accidents, Incidents, etc.)

4. Telephone Log

5. Recreation User Fee Program Hand Receipt

6. Property Loan Receipt (ENG 4900R)

7. Annual Day Use Pass

8. Golden Age Passport

9. Self-Deposit User Permit (ENG 4839)

10. Transmittal Form (ENG 3313)

11. Transmittal Form (UFC-AO-2)

12. Deposit Form (SF 215)

13. See Training Manual for other applicable forms.

EXHIBIT I

TASK ORDER,

DD 1155

EXHIBIT J

CONTRACT DISCREPANCT FORM,

CELRH 1104

EXHIBIT K

VEHICLE OPERATIONS,

CELRH 2796,

CELRH 2813,

ENG FORM 4900-R,

ENG FORM 4866

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