ANNEX 0200000_ATTACHMENTS.pdf

Solicitation No.

N40192-20-R-9004

VEHICLE LEASE FOR VARIOUS

DEPARTMENT OF DEFENSE (DOD)/

FEDERAL ACTIVITIE ON NAVAL BASE

GUAM

ANNEX 0200000 ATTACHMENTS

DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS

TABLE OF CONTENTS

ATTACHMENT NUMBER ATTACHMENT TITLE

J-0200000-01 DEFINITIONS AND ACRONYMS

J-0200000-02 DIRECTIVES, INSTRUCTIONS, AND REFERENCES

J-0200000-03 FORMS

ATTACHMENT J-0200000-01

DEFINITIONS AND ACRONYMS

Definition Description

Contractor QM Compo-nent of QMS

The QM component evaluates whether the service or product meets the contract perfor-mance objectives and standards. QA is based on a written plan describing the evaluation approach and techniques that will be applied.

Contractor QC Compo-nent of QMS

The QC component evaluates the production process based on a written plan. The plan contains the Contractor production procedures and work processes, quality checks con-ducted during production, and a methodology to adjust processes as indicated by the quality checks.

The Contractor shall establish and maintain a QC inspection system in accordance with the FAR Clause 52.246-4, INSPECTION OF SERVICES – FIXED PRICE, to ensure that the work performed conforms to the contract requirements. The Contractor shall maintain a file of all scheduled and performed QC inspections, inspection results, and dates and details of corrective and preventive actions. The file shall be the property of the Government and made available during the Government’s regular working hours.

The file shall be turned over to the ACO within five calendar days of completion/termi-nation of the contract. This inspection system also applies to Indefinite Quantity items.

Direct Material Costs The actual vendor invoice charges for materials used for performance of work under this contract. Direct material costs shall include transportation charges when such charges are included on the invoice by the vendor, as well as any discounts allowed for prompt payment and discounts or rebates for core value or salvage value that accrue to the Con-tractor. When questions arise concerning the cost of materials, material costs will be based on the lowest of quotes provided by the Contractor from at least three different commercial vendors for the direct material cost. The Government retains the right to ob-tain additional quotes in questionable situations. The lowest price will be used.

Equipment Tangible asset that is functionally complete for its intended purpose, durable, and non-expendable.

Facility A building or structure designed and created to serve a particular function.

Frequency Of Service Annual (A). Services performed once during each 12-month period of the contract at in-tervals of 335 to 395 days.

Biennial (B). Services performed once during each 24-month period of the contract at internals of 670 to 790 days.

Daily (D5). Services performed once each calendar day, Monday through Friday, in-cluding holidays unless otherwise noted.

Daily (D7). Services performed once each calendar day, seven days per week, including weekends and holidays.

Monthly (M). Services performed 12 times during each 12-month period of the contract at intervals of 28 to 31 calendar days.

Quarterly (Q). Services performed four times during each 12-month period of the con-tract at intervals of 80 to 100 calendar days.

Semiannual (SA). Services performed twice during each 12-month period of the con-tract at intervals of 160 to 200 calendar days.

Semimonthly (SM). Services performed 24 times during each 12-month period of the contract at intervals of 14 to 16 calendar days.

Three times weekly (3W). Services performed three times a week, such as Monday, Wednesday, and Friday.

Twice weekly (2W). Services performed twice a week, such as Monday and Thursday or Tuesday and Friday.

Weekly (W). Services performed 52 times during each 12-month period of the contract at intervals of six to eight calendar days.

Definition Description

Functional Assessment

Plan (FAP)

(Formerly “Surveillance Guide”) The matrix plan for assessing KTR’s work against measurable performance standards.

Government Perfor-mance Assessment

The Government shall conduct performance assessments (PA) of Contractor perfor-mance to ensure services and products comply with contract requirements and payment is proper. The Government may use several methods and frequencies based on Contrac-tor performance. The Government’s Performance Assessment Plan (PAP) may be pro-vided to the Contractor after contract award for information and constructive interaction.

The Government may alter its plan at any time at its discretion.

Hazard Communication

(HazCom) A written program created by the Contractor that lists hazardous materials used to provide services within this contract, container labeling, inventory, etc.

Hazardous Waste Hazardous substances as defined in 40 CFR 261 and in Guam Environmental Protection

Agency regulations.

Non-Recurring Work Non-Recurring work consists of Unit Price Task which may be ordered by the Govern-ment as separate items or in combinations of items from the Schedule of Non-Recurring

Work (Bid Schedule) in Section J on an as-needed basis. This work is required with an irregular frequency and will be ordered on a form DD 1155, Order for Supplies or Ser-vices.

Liquidated Damages

(LD)

An amount paid by the Contractor to the Government to compensate for damages in-curred as a result of late or incomplete performance.

Maintenance And Re-pair

The preservation or restoration of a piece of equipment, system, or facility to such condi-tion that it may be effectively used for its designated purposes. Maintenance/repair may be adjustment, overhaul, reprocessing, or replacement of constituent parts or materials that are missing or have deteriorated by action of the elements or usage, or replacement of the entire unit or system if beyond economical repair.

R. S. Means A data collection and organization system developed by R. S. Means Company which can be used to prepare accurate, dependable construction estimates and budgets in a vari-ety of ways. The Contractor shall use the latest edition. Material prices are based on a national average and computed labor costs are based on a 30-city national average. An estimate prepared using this data is called a "Means estimate"; data may simply be re-ferred to as "Means".

Monthly On-Site Labor

Report

A compilation of all Contractor and subcontractor employee-hours involved in deliver-ing contract services on a Government property.

Objectionable Provoking disapproval or opposition; offensive.

Performance Assess-ment

A method used by the Government to provide some measure of control over the quality of purchased goods and services received.

Performance Assess-ment Representative

(PAR)

The individual(s) assigned as a Technical Point of Contact (TPOC) / Subject Matter Ex-pert (SME) to the COR to perform duties as the on-site representative who assesses Con-tractor performance. The PAR periodically observes Contractor performance, reviews delivered services, reviews quality management corrective actions, periodically assesses and documents Contractor performance on PAWs and the MPAS, and communicates findings as necessary with the Contractor, SPAR, and COR.

Performance Assess-ment Board (PAB)

Comprise of key technical and administrative installation personnel appointed by the

KO; periodically reviews performance documentation for the evaluation period (nor-mally, per quarter); prepares and forward summary report of findings/recommendations to KO.

Definition Description

Performance Assess-ment Plan (PAP)

(Formerly termed, “QA Plan”) Provides common framework for performance assess-ment. Contains an administrative and procedural section that describes procedure for how to adjust sample size, validate customer complaints, summarize monthly perfor-mance assessment, and withhold payment for non-performance or unsatisfactory work;

also includes PARC, FAP, and PAW.

Performance Assess-ment Rating Criteria

(PARC)

An adjectival description used to assess contractor performance.

Performance Assess-ment Worksheets

(PAW)

(Formerly “Evaluation Worksheets”) are spec item unique forms used to document and report Government observations of KTR performance.

Performance Based Ser-vice Acquisition

(PBSA)

Focuses on acquisition strategies, methods, and techniques that describe and communi-cate measurable outcome rather than direct performance processes. It is structured around defining a service requirement in terms of performance objectives and provides contractors the latitude to determine how to meet those objectives.

Performance Objective

(PO)

An “end state” the contractor is to achieve. Objectives are often expressed in terms of specific accomplishments by an organization, levels of service provided to customer, or improvements in performance of some activity when measured against an established baseline.

Performance Standard The measurable targeted level or range of performance that the Government will moni-tor. Achievement of a performance standard will either demonstrate directly that the

Contractor has met the contract performance objective or will enable the Government to infer with a high degree of confidence that the Contractor has met the contract perfor-mance objective.

Property Administrator An authorized representative of the Contracting Officer who is responsible for adminis-tering contract property requirements, terms and conditions of the contract

Property Management

Program

A Government program established for the purpose of reviewing and approving the Con-tractor’s Property Management Plan and System through performance of a system analy-sis whenever government property is in the possession of the Contractor.

Quality Control (QC) A method used by the Contractor to control the quality of goods and services produced.

Qualified Person One who, by possession of a recognized degree, certificate, or professional standing, or extensive knowledge, training, and experience, has successfully demonstrated his/her ability to solve or resolve problems related to the subject matter, the work, or the project.

Quality Management

System (QMS)

The Contractor shall establish and maintain a complete QMS program that consists of

Quality Control (QC) and Quality Assurance (QA) in accordance with the provisions specified herein. The Contractor’s QMS Program shall provide an effective and efficient means of identifying and correcting problems throughout the entire scope of operations.

The Contractor’s QMS Program shall address the following:

Accurate documentation of work processes, procedures, and output measures.

A systematic procedure for assessing compliance with performance objectives and standards.

Accurate documentation of quality inspections conducted throughout the execution of work.

Assessment-driven corrective actions and process adjustments as appropriate in a timely manner.

The Contractor shall provide a Quality Management Plan (QMP) for Government ap-proval. The QMP shall incorporate both quality control and quality assurance elements.

The Contractor is responsible to ensure that services and products delivered through this

ATTACHMENT J 0200000-01

Definition Description contract meet contract requirements. The Contractor shall develop, implement, and maintain a proactive QM program to evaluate and document that performance objectives and standards have been achieved.

The QM Program shall include: (a) periodic monitoring of required work tasks to pro-vide quality checks on performance drivers such as internal processes, materials, em-ployee skills, and equipment (b) a process for investigation and corrective action when needed, and (c) a process for responding to Government complaints and communicating actions taken.

The Contractor and the Government will meet at a Performance Assessment Board

(PAB) to discuss key performance indicators collected. Specific attention will be de-voted to trend analysis. It is the Contractor’s responsibility to investigate and determine the source of the identified performance deficiencies. The Government and the Contrac-tor will jointly develop corrective actions required to solve problems.

Response Time The time allowed the Contractor after initial notification of a work requirement to be physically on the premises at the work site with appropriate personnel, tools, equipment, and materials, ready to perform the work required.

Safety Officer A person responsible for the safety, management, surveillance, inspection and enforce-ment of safety issues and programs. A qualified safety officer shall possess experience and knowledge in safety and health and shall be deemed qualified by the NAVFAC

Marianas Technical Branch Manager. The safety officer’s function shall be totally sepa-rate from that of the CQC.

Senior Performance As-sessment Representa-tive (SPAR)

That individual designated by the KO to be ultimately responsible for the monitoring of

Contractor performance.

Submittal Product data, samples and administrative submittal presented by the Contractor for re-view and approval by the Government. Contract clause “Material and Workmanship” and “Contract Drawings, Maps and Specifications” apply to all submittals. Submittals shall be provided to the Government in a timely manner (see J-1503010-12).

Task Order (T.O.) A task order (DD Form 1155) is a document issued to the Contractor by the Contracting

Officer to order work from the Indefinite Quantity (IQ) portion of the contract. Also known as a Delivery Order.

Unit Priced Labor

(UPL) Hour

The unit price bid by the Contractor to perform one hour of work-in-place. With the ex-ception of direct material and construction equipment costs, the unit price includes all in-direct and direct costs associated with performing work. The price includes the Contrac-tor’s hourly composite trade wage, adjusted to allow for workforce productivity; costs for pre-expended bin materials, union agreements, crew sizes, hand tools, payroll bur-dens and fringes, overtime, job (field) overhead (including clerical support, supervision, inspection, fees, taxes, licenses, permits, and insurance), general and administrative

(home office) overhead, and profit. Additionally, time for job preparation, safety standby personnel, and similar indirect labor elements are included.

ATTACHMENT J 0200000-01

Acronym Title

ACO Administrative Contracting Officer

BW Biweekly

CDR Contract Discrepancy Report

CIA Controlled Industrial Area

CMMS Computerized Maintenance Management System

COR Condition of Readiness or Contract Officer Representative

DBH Diameter at Breast Height

DoD Department of Defense

DoN Department of Navy

DRMO Defense Reutilization Management Office

EPA Environmental Protection Agency

EPCRA Emergency Planning and Community Right-to-Know Act

FAR Federal Acquisition Regulation

FFP Firm Fixed Price

FIFRA Federal Insecticide, Fungicide, and Rodenticide Act

FSC Facility Support Contract

GFE Government-furnished Equipment

GFF Government-furnished Facilities

GFM Government-furnished Materials

GPWS Guide Performance Work Statements

HCA Head Contracting Agency

HACCP Hazard Analysis Critical Care Point

ICP Integrated Contingency Plan

IDIQ Indefinite Delivery Indefinite Quantity

IPM Integrated Pest Management

IPMIS Integrated Pest Management Information System

IPMP Integrated Pest Management Plan

KO Contracting Officer

LAN Local Area Network

M Monthly

MSDS Material Safety Data Sheets

NAVFAC Naval Facilities Engineering Command

NAVHOSP Naval Hospital

NAVMED Navy Medical

NAVSUP Naval Supply

NMCI Navy Marine Corps Intranet

NOSC Navy-On-Scene Coordinator

OSD COLS Office of the Secretary of Defense Common Output Level Standards

PAP Performance Assessment Plan

PAR Performance Assessment Representative

PAW Performance Assessment Worksheet

PEO Program Executive Officer

PM Project Manager, Preventative Maintenance

PRCSP Permit Required Confined Space Program

PWS Performance Work Statement

Q Quarterly

QC Quality Control

SC Security Clearances

SIK Subsistence in Kind

SM Semimonthly

Acronym Title

SPAR Senior Performance Assessment Representative

TE Technical Exhibit

USCINCPACREP United States Commander in Chief Pacific Representative

USNH United States Naval Hospital

USNHGUAMINST United States Naval Hospital Guam Instruction

VIQ Variation in Quantity

WBS Work Breakdown Structure

ATTACHMENT J-0200000-02

DIRECTIVES, INSTRUCTIONS, AND REFERENCES

Reference Title

EM 385-1-1 U.S. Army Corps of Engineers Safety and Health Requirements

P.L. 91-596 Occupational Safety and Health Act

UFGS 01 35 26 Unified Facilities Guide Specifications

PWCGUAMINST 4100.6B Energy Management Plan

PWCGUAMINST 11320.1B Fire Protection and Fire

PWCGUAMINST 12792.1A Equal Employment Opportunity(EEO) Program, Policy, Organization and Re-sponsibilities

OICCMAR/PWCGUAMINST,

5100.3A

Safety and Occupational Health Manual

OICCMAR/PWCGUAMINST,

53701.H

Standards of Conduct

OICCMAR/PWCGUAMINST,

5560.1

Vehicle Traffic and Parking Control Regulations for NBG

ATTACHMENT J-0200000-03

FORMS

1. Transmittal Form

2. Contractor Production Report

3. Quality Control Plan Components

4. Activity Hazard Analysis

5. Accident Prevention Plan Checklist

6. Contractor Incident Reporting System

TRANSMITTAL FORM

CONTRACT NO.____________________________

CONTRACT TITLE ________________________________________

FROM: __________________________________________________________ _______________________________

(CONTRACTOR) (DATE)

TO: NAVFAC MARIANAS SUBMITTAL NUMBER ________________________ RESUBMITTAL OF SUBMITTAL NUMBER _________________________

SUBJ: SUBMITTAL FOR PROJECT ________________ ________________________ LINE ITEM _________________________________

IN ACCORDANCE WITH SPECIFICATIONS PARAGRAPH ____________________________.

TRANSMITTED HEREWITH ARE:

FOR: ( ) ACCEPTANCE OR APPROVAL ( ) CLARIFICATION ( ) SELECTION ( ) _________________________________________

IT IS HEREBY CERTIFIED THAT THE MATERIAL SUBMITTED HEREIN CONFORMS TO CONTRACT REQUIREMENTS AND CAN BE INSTALLED IN THE ALLOCATED

SPACES.

CONTRACTOR'S SIGNATURE __________________________________________________

FROM: _______________________________________________________________________________________________ ____________________

(SIGNATURE) (DATE)

TO: _____________________ ________________________________________________________________ FOR REVIEW AND COMMENT NO LATER

THAN ________________________. (MAXIMUM 5 WORKING DAYS)

(DATE)

FROM: _______________________________________________________________________________________________ __________________________

TO: ___________________________________ ( ) APPROVED: ( ) RETURNED FOR CORRECTION: ( ) SOURCE INSPECTION REQUIRED:

( ) APPROVED, AS NOTED: ( ) DISAPPROVED

REMARKS:

FROM: NAVFAC MARIANAS CODE ______________________________________________________________________ ___________________________

(SIGNATURE) (DATE)

TO: ___________________________________________________________________________________________________________________________________

SUBMITTAL IS: ( ) APPROVED: ( ) RETURNED FOR CORRECTION: ( ) APPROVED, AS NOTED: ( ) DISAPPROVED:

REMARKS:

NAVFACMAR__5216/7 (REV. 4__2007) (Supersedes all other revisions)

Juanito.Juaneza Typewritten Text J-0200000-05

4296/1 (9/98) SHEET 2 OF 2

CONTRACTOR PRODUCTION REPORT

(CONTINUATION SHEET)

DATE

CONTRACT NO TITLE AND LOCATION

REPORT NO

WORK PERFORMED TODAY

Schedule Activity No.

WORK LOCATION AND DESCRIPTION EMPLOYER NUMBER TRADE HRS

Schedule Activity No.

LIST SAFETY ACTIONS TAKEN TODAY/SAFETY INSPECTIONS CONDUCTED SAFETY REQUIREMENTS HAVE BEEN MET.

EQUIPMENT/MATERIAL RECEIVED TODAY TO BE INCORPORATED IN JOB (INDICATE SCHEDULE ACTIVITY NUMBER)

Schedule Activity No.

Submittal # Description of Equipment/Material Received

CONSTRUCTION AND PLANT EQUIPMENT ON JOB SITE TODAY. INDICATE HOURS USED AND SCHEDULE ACTIVITY NUMBER.

Schedule Activity No.

Owner Description of Construction Equipment Used Today (incl Make and Model) Hours Used

Schedule Activity No.

REMARKS

INCLUDE ALL PERSONNEL WORK HOURS IN THE WORK PERFORMEDSECTIONON THIS SHEET

INTO THE FRONT CONTRACTOR PRODUCTION REPORT

Table of Contents List major sections identified with tabs in the order of the bulletized items following hereafter.

QC Organization Organization chart showing organization structure and lines of authority.

Names and Qualifications The names, qualifications, and classification of each member of the Contractor's Quality Control Team. The QC Manager and Alternate QC Manager must be employees of the Prime Contractor.

Duties, Responsibilities and Authorities of QC Personnel

A listing of assigned Quality Control activities for performance by the Prime Contractor, subcontractors, offsite fabricators, and suppliers.

Outside Organizations A list of outside organizations such as Architectural and Consulting Engineering Firms that will be employed by the Contractor and a description of their services.

Appointment Letters

Letters signed by an officer of the firm appointing the QC Manager and Alternate QC Manager and stating that they are responsible for implementing and managing the QC Program as QC Manager and Alternate QC Manager to implement and manage the three phases of control and their authority to stop work which is not in compliance with the contract.

Submittal Procedures A listing of procedures for scheduling and managing submittals.

Testing Laboratory Information

Performance of control testing is to be included in the QC Program. If a commercial testing laboratory is to be used, the plan must indicate both the laboratory to be used and the test methods to be employed. If technicians employed by the contractor will be performing the tests, the plan must indicate who will perform specific tests and their qualifications.

Testing Plan and Log A testing plan and log that includes the tests required, referenced by the specification number requiring the test, the frequency, and the person responsible for each test.

Procedures to Complete Construction

A listing of the procedures to identify, record and track construction deficiencies/rework items from identification through corrective action.

Documentation Procedures Documentation procedures including proposed report formats.

List Of Definable Features of Work

A list of the definable features of work (DFOW). A DFOW is a task which is separate and distinct from other tasks and has a separate control measure.

Procedures for Performing the Three Phases of Control Preparatory Phase, Initial Phase, and Follow-up Phase

Personnel Matrix A personnel matrix showing, for each section of the specification, who review and approve submittals, who will perform and document the three phases of control, and who will perform and document the testing.

Procedures for Completion Inspection

Provisions for the QC Manager to conduct completion inspections of the work and develop a "punch List" of items which do not conform to the contract requirements. Perform a second completion inspection to ascertain that all "punch list" items have been corrected and so notify the gov't.

Turn Over Procedures

To include but not limited to: Warranty information, O & M manuals, system operation and sequence verification, instruction and training procedures, pre-final inspection to include the Government, final inspection to include client/customer "punch list", "punch list" correction and verification, turnover of extra materials and spare parts, turnover of keys, and turnover of completed as-built drawings.

QUALITY CONTROL PLAN COMPONENTS

MINIMUM PLAN REQUIREMENTS

Activity Hazard Analysis (AHA) Activity/Work Task: Overall Risk Assessment Code (RAC) (Use highest code)

Project Location: Risk Assessment Code (RAC) Matrix

Contract Number: Probability

Date Prepared:

Severity

Frequent Likely Occasional Seldom Unlikely

Catastrophic E E H H M Prepared by (Name/Title):

Critical E H H M L Marginal H M M L L

Reviewed by (Name/Title):

Negligible M L L L L

Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above)

“Probability” is the likelihood to cause an incident, near miss, or accident and identified as: Frequent, Likely, Occasional, Seldom or Unlikely. RAC Chart

E = Extremely High Risk“Severity” is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible H = High Risk

M = Moderate Risk

Notes: (Field Notes, Review Comments, etc.)

Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA. L = Low Risk

Job Steps Hazards Controls RAC

Equipment to be Used Training Requirements/Competent or

Qualified Personnel name(s) Inspection Requirements

JMH 2009

Accident Prevention Plans (APP) Appendix A EM 385-1-1

(15 SEPTEMBER 2008 edition)

FEAD/ROICC/FSC/OICC offices with the new safety requirements of EM 385 dated 15 SEPTEMBER 2008 assist our Contractors in learning how to properly develop an Accident Prevention Plan which will meet the US Army Corps of Engineers Safety and Health Requirements Manual EM 385-1-1 15 September 2008 Appendix A requirements as a minimum plan. Many of the Accident Prevention Plans (APP) that have been submitted/accepted are not in the correct format or do not address all the requirements of Appendix A.

Special new note For LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS, for example, mowing (only), park attendant, rest room cleaning, the Contracting Officer and SOHO may allow an ABBREVIATED APP (customized APP requirements and waive the more stringent elements of this section). See 01.A.11 and Appendix A, paragraph 11.

An Accident Prevention Plan (APP) is a safety and health policy and program document. APP shall be job-specific and shall also address any unusual or unique aspects of the project or activity for which it is written. The APP shall interface with the employer’s overall safety and health program, and a copy shall be available on the work site. Any portions of the overall safety and health program that are referenced in the APP shall be included as appropriate.

ANSI/ASSE A10.38 should be referenced for Programmatic Issues.

Most contracts awarded within NAVFAC are under the guidelines of the EM 385-1-1 concerning contract safety requirements. All NAVFAC FEAD/ROICC/OICC/FSC contractors will adhere to the EM 385-1-1 requirements for Accident Prevention Plans. The APP shall be developed by qualified personnel and then signed in accordance with Appendix A, paragraph 1. The Contractor shall be responsible for documenting the Qualified person’s credentials.

“Qualified person: one who, by possession of a recognized degree, certificate, or professional standing, or extensive knowledge, training, and experience, has successfully demonstrated his/her ability to solve or resolve problems related to the subject matter, the work, or the project.”

The Contractor shall address each of the elements/sub-elements in the outline contained in Appendix A in the order that they are provided in the manual. If an item is not applicable because of the nature of the work to be performed, the Contractor shall state this exception and provide a justification. > See Appendix A.

Accident Prevention Plans that are submitted shall follow the guidelines of Appendix A of the EM 385-1-1 or they will found not acceptable and sent back to the contractor for re-submittal. The contractor can not start work on a contract until the Accident Prevention Plan has been submitted and found acceptable. A copy shall be available on the work site. The APP shall be written in English by the Prime Contractor and shall articulate the specific work and hazards pertaining to the contract.

The APP shall contain appropriate appendices (for example, a SSHP for hazardous waste site cleanup operations, a Lead Compliance Plan when working with lead, or an Asbestos Hazard Abatement Plan when working with asbestos). The APP shall also implement in detail the pertinent requirements of this manual. Before initiation of work at the job site, an APP shall be reviewed and found acceptable by the GDA.

“Accepted/Acceptable: a term denoting when a written procedure, practice, method, program, engineering design, or employee qualification criteria submittal, which, after a cursory review by a GDA, is determined to generally conform to safety and health or contractual requirements.

Acceptance or acceptability of such submittals in no way relieves the submitting entity from \ensuring employees a safe and healthful work environment or complying with all contractual requirements and good engineering practices.”

For contract operations, the Contractor's APP shall be job specific and should include work to be performed by subcontractors.

In addition, the APP should state measures to be taken by the Contractor to control hazards associated with materials, services, or equipment provided by suppliers.

Updates to the APP shall be reviewed and approved by the GDA

“Approved: a method, equipment, procedure, practice, tool, etc., that is sanctioned, confirmed, as acceptable for a particular use or purpose by a person or organization authorized to render such approval or judgment.”

Steps for putting the Accident Prevention Plan Together.

1. You will need a three ring binder that will contain your Accident Prevention Plan.

2. You will need tab sheets numbered 1 through 10. The tab sheets will be used to separate the 10 sections shown in Appendix A.

3. You will need to have an index page installed as the first page of your plan.

4. Next insert tab sheet number one.

5. Next comply with section #1 a. b. and c. When you have completed these items insert them into your tab # 1 section.

6. Next insert tab sheet number two.

7. Next comply with section #2 a. b. c. d. When you have completed these items insert them into your tab #2 section

8. By now as you can see each tab section has sub statements within them that will be inserted into each section. Follow this procedure until all 10 sections are completed. Upon completion put together the correct number of Accident Prevention Plans required by your contract to be submitted to the and forward the copies to the Office in Charge of Construction.

By complying with Appendix A of the EM 385-1-1 you will have an Accident Prevention Plan which will meet the requirements of your contract and the Accident Prevention Plan can be modified for reuse with other NAVFAC contracts which may be awarded to your company

YES NO N/A

1. SIGNATURE SHEET. Title, signature, and phone number of the following:

a. Plan preparer (Qualified Person, Competent Person, such as corporate safety staff person, QC);

b. Plan must be approved, by company/corporate officers authorized to obligate the company;

c. Plan concurrence (e.g., Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC). Provide concurrence of other applicable corporate and project personnel (Contractor).

2. BACKGROUND INFORMATION. List the following:

a. Contractor;

b. Contract number;

c. Project name;

d. Brief project description, description of work to be performed, and location; phases of work anticipated (these will require an AHA).

3. STATEMENT OF SAFETY AND HEALTH POLICY.

Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. The Contractor’s written safety program goals, objectives, and accident experience goals for this contract should be provided.

4. RESPONSIBILITIES AND LINES OF AUTHORITIES. Provide the following:

a. A statement of the employer’s ultimate responsibility for the implementation of his SOH program;

b. Identification and accountability of personnel responsible for safety at both corporate and project level. Contracts specifically requiring safety or industrial hygiene personnel shall include a copy of their resumes.

Qualifications shall include the OSHA 30-hour course or equivalent course areas as listed here:

(1) OSH Act/General Duty Clause;

(2) 29 CFR 1904, Recordkeeping;

(3) Subpart C: General Safety and Health Provisions, Competent Person;

(4) Subpart D: Occupational Health and Environmental Controls, Citations and Safety Programs;

(5) Subpart E: PPE, types and requirements for use;

(6) Subpart F: understanding fire protection in the workplace;

(7) Subpart K: Electrical;

(8 Subpart M: Fall Protection;

(9) Rigging, welding and cutting, scaffolding, excavations, concrete and masonry, demolition;

health hazards in construction, materials handling, storage and disposal, hand and power tools, motor vehicles, mechanized equipment, marine operations, steel erection, stairways and ladders, confined spaces or any others that are applicable to the work being performed.

c. The names of Competent and/or Qualified Person(s) and proof of competency/qualification to meet specific OSHA Competent/Qualified Person(s) requirements must be attached. The District SOHO will review the qualifications for acceptance;

d. Requirements that no work shall be performed unless a designated competent person is present on the job site;

e. Requirements for pre-task safety and health analysis;

f. Lines of authority;

g. Policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements) should be identified;

h. Provide written company procedures for holding managers and supervisors accountable for safety.

5. SUBCONTRACTORS AND SUPPLIERS. If applicable, provide procedures for coordinating SOH activities with other employers on the job site:

a. Identification of subcontractors and suppliers (if known);

b. Safety responsibilities of subcontractors and suppliers.

6. TRAINING.

a. Requirements for new hire SOH orientation training at the time of initial hire of each new employee.

b. 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.

c. Procedures for periodic safety and health training for supervisors and employees.

d. Requirements for emergency response training.

> See paragraph 9.b. below for a list of requirements that may require emergency response training.

7. SAFETY AND HEALTH INSPECTIONS.

a. Specific assignment of responsibilities for a minimum daily job site safety and health inspection during periods of work activity:

Who will conduct (e.g., SSHO, PM, safety professional, QC, supervisors, employees – depends on level of technical proficiency needed to perform said inspections), Proof of inspector’s training/qualifications, When inspections will be conducted, Procedures for documentation, deficiency tracking system, and

Follow-up procedures;

b. Any external inspections/certifications that may be required (e.g., USCG).

8. ACCIDENT REPORTING. The Contractor shall identify person(s) responsible to provide the following:

a. Exposure data (man-hours worked);

b. Accident investigations, reports, and logs: Report all accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR). The contractor shall thoroughly investigate the accident and submit the findings of the investigation along with appropriate corrective actions to the CO/COR in the prescribed format as soon as possible but no later than five (5) working days following the accident. Implement corrective actions as soon as reasonably possible;

c. The following require immediate accident notification:

(1) A fatal injury;

(2) A permanent total disability;

(3) A permanent partial disability;

(4) The hospitalization of three or more people resulting from a single occurrence;

(5) Property damage of $200,000 or more.

9. PLANS (PROGRAMS, PROCEDURES) REQUIRED BY THE SAFETY

MANUAL. 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 may include but not be limited to:

a. Layout plans (04.A.01);

b. Emergency response plans:

(1) Procedures and tests (01.E.01);

(2) Spill plans (01.E.01, 06.A.02);

(3) Firefighting plan (01.E.01, Section 19);

(4) Posting of emergency telephone numbers (01.E.05);

(5) Man overboard/abandon ship (Section19.A.04);

(6) Medical Support. 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 (Section 03.A.02; 03.D);

c. Plan for prevention of alcohol and drug abuse (01.C.02);

d. Site sanitation plan (Section 02);

e. Access and haul road plan (4.B);

f. Respiratory protection plan (05.G);

g. Health hazard control program (06.A);

h. Hazard communication program (06.B.01);

i. Process Safety Management Plan (06.B.04);

j. Lead abatement plan (06.B.05 & specifications);

k. Asbestos abatement plan (06.B.05 & specifications);

l. Radiation Safety Program (06.E.03.a);

m. Abrasive blasting (06.H.01);

n. Heat/Cold Stress Monitoring Plan (06.I.02)

o. Crystalline Silica Monitoring Plan (Assessment) (06.M) ;

p. Night operations lighting plan (07.A.08);

q. Fire Prevention Plan (09.A);

r. Wild Land Fire Management Plan (09.K);

s. Hazardous energy control plan (12.A.01);

t. Critical lift Plan (16.H);

u. Contingency plan for severe weather (19.A.03);

v. Float Plan (19.F.04);

w. Site-Specific Fall Protection & Prevention Plan (21.C);

x. Demolition plan (to include engineering survey) (23.A.01);

y. Excavation/trenching plan (25.A.01);

z. Emergency rescue (tunneling) (26.A.);

aa. Underground construction fire prevention and protection plan (26.D.01);

bb. Compressed air plan (26.I.01);

cc. Formwork and shoring erection and removal plans (27.C);

dd. Pre-Cast Concrete Plan (27.D);

ee. Lift slab plans (27.E);

ff. Steel erection plan (27.F.01);

gg. Site Safety and Health Plan for HTRW work (28.B);

hh. Blasting Safety Plan (29.A.01);

ii. Diving plan (30.A.13);

jj. Confined space Program (34.A);

9. RISK MANAGEMENT PROCESSES. Detailed project-specific hazards and controls shall be provided by an Activity Hazard Analysis (0I.A.13) for each major phase/activity of work.

REMARKS;

Deficiency Tracking System

Date Identified Description of deficiency

Name Responsible for correcting

Projected Resolution

Date

Date Actually

Resolved

Deficiency Tracking System Continued

MACHINERY & MECHANIZED EQUIPMENT INSPECTION & TESTING FORM

From: Prime Contractor: ______________________________________________________________________

Contract No.: _________________________________________________________________________________ Contract Title: ________________________________________________________________________________

To: Contracting Officer

Subj: INSPECTION & TESTING OF MACHINERY AND MECHANIZED EQUIPMENT

Reference: (a) U.S. Army Corps of Engineers, EM 385-1-1 (Series), Safety & Health Requirements Manual

Per EM 385-1-1(2008), paragraph 18.G.02 - “Before any machinery or mechanized equipment is placed in use, it shall be inspected and tested in accordance with the manufacturers recommendations and requirements of this manual and shall be certified in writing by a competent person to meet the manufacturers recommendations and requirements of this manual.” This inspection & testing form shall be available upon request by the GDA. > Subsequent re-inspections will be conducted at least annually thereafter; OR

Per EM 385-1-1(2014), paragraph 18.G.02 - Before any machinery or mechanized equipment is placed in use, it shall be inspected and tested in accordance with the manufacturer’s recommendations and requirements of this manual. The Competent Person (CP) is required to sign the checklist designating that it meets the manufacturer’s recommendations and requirements of this manual. All checklists will be submitted to the GDA upon completion of the inspection and will become a part of the project file. > Subsequent re-inspections will be conducted at least annually thereafter.

Inspection and testing of machinery and mechanized equipment, as required by EM 385-1-1 (Series), has been made for the following equipment:

a. Identification of equipment:

(1) Make: _________________________________ Model: _______________________________________

License/Serial Number: _______________________________________________ Year: ________________

(2) Make: _________________________________ Model: _______________________________________

License/Serial Number: _________________________ Year: _________________________________

2. The above listed equipment is CERTIFIED TO BE IN SAFE OPERATING CONDITION BY A

COMPETENT PERSON IN ACCORDANCE WITH THE MANUFACTURE’S RECOMMENDATIONS.

Every person operating a motor vehicle, machinery and mechanized equipment, ATV, UV, or other specialty vehicles, shall possess, at all times while operating such vehicle/equipment, a license/permit (proof of qualification) valid for the equipment being operated. The operator must present the license/permit to the GDA upon request.

Failure to do so will result in the immediate prohibition of the operator to operate motor vehicles.

NOTE: Manufacture specifications or owner's manual for the equipment must be on-site.

I certify that all motor vehicle, machinery and mechanized equipment listed above are certified to be in safe operating condition in accordance with the manufacture’s recommendations.

Name, Title, and signature of Competent Person making the inspection

Name: (Competent Person)_________________________________ Title: ________________________________

Signature (Competent Person) _________________________________ Date: ____________________

Copy to: Contract File

C t t "d t R on rac or nc1 en epo

1. Contract Information Prime Contractor:

Contract Number:

Task Order #:

Contractor Contact Information Name (Last, First):

Email Address:

rt s t iys em (CIRS)

Q Initial Report

Q Follow-up Report

Q Final Report

Date __ / __ / __

Incident Information Cage Code:

Installation of Incident:

Contracting Activity/ROICC Office:

Phone#:

Date Notified:

2. Incident Type (Please Check/Bold All That Apply)

OAssaulUViolent Act D Extreme Environmental Exposure

Ooiving D Falls, slip, trip, or bodily exertion

D Electrical Shock/Burns D Fires - All Types

D Equipment Installation/Repair D Hazardous Material (any type)

D . D Industrial Explosion, Non-Ordnance (Select Additional Below)

D Man over the side (No water entry)

D Man Overboard - Water Entry

D Material Handling Equipment

D Ordnance-Related (Explosive) ovehicle (Government or Private)

Industrial Incident Additional Information (Please Check/Bold All That Apply)

Oconfined Space OH and and Power Tools D Work Platforms and Scaffolding

Ooemolition/Renovation DRigging ounderground Construction, Shafts, and Caissons

D Trenching/Entrapment D Cranes and Hoisting Equipment D Concrete, Masonry, Steel Erection and Residential Construction

DTraffic Control D Floating Plant and Marine Activities DTree Maintenance and Removal

Owelding and Cutting DPressurized Equipment and System DAirfield and Aircraft Operations

Ocontrol of Hazardous Energ} OFall Protection

Contractor Incident Report System (CIRS) 26 of 36

3. General Information Incident Information

Date of Accident: Time of Accident:

Describe the accident in detail in your words: (Use the back of page if you need additional space)

Exact Location of Accident:

Were Hazardous Material(s) Involved D Yes D No If Yes, Explain What Hazardous Materials Were Involved and Why:

Who Provided Clean-up?D Onsite Osase OPublic

Activity of the injured person at the time of incident:

Personal Protective Equipment: (Check/Bold Response)

OAvailable and used

D Not related to Mishap

List PPE Used:

Contractor Incident Report System (CIRS)

D Available and not used

Owrong PPE for job

D Not Required

4. Fully Explain What Allowed or Caused the Incident: Incident Information

Direct Cause:

Indirect Cause:

Additional Action Taken: (Please Include a Begin Date and Est. End Date in Description)

Additional Action Taken: (Please Include a Begin Date and Est. End Date in Description) (Use the back of page if you need additional space)

5. Contributing Factors:

Was Visibility Restricted? D Yes D No Distance Visibility was restricted:

Unit of Measure (Check/Bold): OFeet OYards OMeters D Miles D Nautical Miles

Visibility Restricted By: (Check/Bold all that apply)

O Fog

DMist

Osmoke

D Dust

DRain

D Sandstorm

Os1eet Osnow

D Unknown Object Oother:

Lighting Conditions at Site of Mishap: Was Noise Level a Factor: Was Carbon Monoxide (CO) a

Factor:(Please Check) (Please Check) (Please Check) D Yes D No

QdequateOlnadequateOUnknown OYes D No D Unknown If Yes co Alarm Manufacturer:

Contractor Incident Report System (CIRS) 28 of 36

5. Contributing Factors: Continued Incident Information

Other Contributing Factors:

6. Attached Documents Attached Documents/Files Name/Description: Date Added: Uploaded By:

Contractor Incident Report System (CIRS) 29 of 36

1. Injured Data (if applicable) Person#

Age: Gender: Prime Contractor Company Name: Subcontractor Company Name:

(Check/Bold)

D Male D Female

2. General Information

Drug or Alcohol Involved: (Check/Bold all that apply)

ONone Ounknown DAlcohol DDrugs D Alcohol and Drugs

Who Provided First Aid? D Onsite nsase nPublic

Was Ergonomics a Factor: (Check/Bold) DYes ONo

Type of Ergonomic Injury: (Check/Bold All That Apply)

Outting D Positioning D Bending D Equipment Placement Office

DEquipment Placement Industrial D Repetitive Motion D Impact Strain

3. Injury Illness/Fatality Information

Severity of Injury/Illness: (Check/Bold)

D Fatality D Lost Workday Case Involving Days Away From Work

D Temporary Disability D Recordable Workday Case Involving Restricted Duty

D Permanent Total Disability D Other Recordable Case D Recordable First Aid Case

D Permanent Partial Disability D Non-Recordable Case DNo Injury

Where There Days Lost: Where There Days Hospitalized: Where There Days Restricted Duty:

(Check/Bold) (Check/Bold) (Check/Bold)

[}'es ONo DYes DNo DYes DNo

Part of Body Affected:

Nature of Injury or Illness:

Event or Exposure:

Source of Injury or Illness:

General Location Description:

Injury Activity Code:

Contractor Incident Report System (CIRS) 30 of 36

4. License (if applicable) Person#

Are Appropriate License and Certification/Medical Current: (Check/Bold) OYes D No

Describe or Explain:

Attach Image of License or Certification

Name/Description: Date Added: Uploaded By:

5. Training

Was all the contract-required training provided to the employee: (Check/Bold) DYes ONo

Explain:

6. Attached Documents

Attached Documents Date Added: Uploaded By: Name/Description:

Contractor Incident Report System (CIRS) 31 of 36

1. Involved Person Data (if applicable) Property Damage

Age: Gender: Contractor: Contractor:

DMale OFemale

2. Attached Documents

Attached Documents Date Added: Uploaded By: Name/Description:

3. Property Damaged

Was Anyone Injured: DYes D No I Was A Government Motor Vehicle lnvolved:OYes ONo

Estimated Lost Property Type Property ID # Detailed Description Property Use

Owned By Cost USD Days

Contractor Incident Report System (CIRS) 32 of 36

4. License (if applicable) Property Damage

Are Appropriate License and Certification/Medical Current: (Check/Bold) OYes D No

Describe or Explain:

Attach Image of License or Certification

Name/Description: Date Added: Uploaded By:

5. Training

Was all the contract-required training provided to the employee? (Check/Bold) DYes DNo

Explain:

Contractor Incident Report System (CIRS) 33 of 36

CONTRACTOR INCIDENT REPORT SYSTEM (CIRS) INSTRUCTIONS

Complete Only Sections Appropriate to Incident (Rev. 03/11 ).

GENERAL. Complete a separate report for each person who was injured in the accident pages 5-6. A report needs to be completed for all OSHA recordable accidents and property damage cases. Please type or print legibly. Appropriate items shall be Checkd/Bolded, non-applicable sections shall be marked "N/A". If additional space is needed, provide the information on a separate sheet of paper and attach to the completed form.

Mark the report: (Check/Bold) Initial: If this form is being used as initial notification of a Fatality or High Visibility Mishap. The initial form is due within 4 hours of a serious accident. A form marked 'Follow-up' or 'Final' is required within 5 days.

Follow-Up: If you are providing additional information on a report previously submitted.

Final: If you are providing a completed report and expect no changes.

Incident Information Section 1 Contract Information - Incident Information Prime Contractor: Name as it appears on contract documents.

Cage Code: If known.

Contract Number: Number as it appears on the contract documents.

Installation: Name of installation where incident occurred.

Task Order#: Insert number if applicable.

Contracting Activity/ROICC Office: Enter the name and address of the Contracting Office administering the contract under which the mishap took place (e.g. ROICC MCBH, ROICC NORFOLK, PWC GUAM, etc.).

Contractor Contact Information: (Contractor point of contact information for the individual responsible for completing the form) Self Explanatory

Section 2 Incident Type: Check/Bold most applicable category, if you select Industrial you must Check/Bold at least one additional category from the Industrial Incident Additional Information Section.

Section 3 General Information Incident Information Date of Accident: Enter the month, day, and year of accident.

Time of Accident: Enter the local time of accident in military time. Example: 14:30 hrs (not 2:30 p.m.).

Describe the Accident in Detail in your words: Fully describe the accident in the space provided. If property damage involved, give estimated dollar amount of damage and/or repair costs involved. If additional space is needed continue on a separate sheet and attach to this report. Give the sequence of events that describe what happened leading up to and including the accident. Fully identify personnel and equipment involved and their role(s) in the accident. Ensure that relationships between personnel and equipment are clearly specified. Ensure questions below regarding direct cause(s), indirect cause(s), and actions taken are answered. NOTE!