Att 02 - APP A _ NIST Safety Plan Checklist Template.pdf

Appendix A

TO BE COMPLETED BY COR

COR

DATE

YES NO N/A

X

X X X X X

NIST CHECKLIST PREPARER

The following must be addressed if it is within the scope of work of the project, this will include the providing of special licenses/training certificates that employees have completed to be designated as a competent person for the project. Job Hazard Analysis (JHA) must be submitted prior to any work beginning or a permit is issued.

Hazard Communications Policy Accident Investigation Policy to include Root Cause Analysis

Subcontractor Safety Management

NIST SAFETY PLAN REQUIREMENTS CHECKLIST

*Identify location of in submitted Safety Plan.

Emergency Response Plan

Building 2 1330 Fume Hood Replacement

Skyler Meredith

All checked items must be included in a written safety plan and be accepted by the government prior to any work starting. All requested documentation must be submitted. Job Hazard Analysis (JHA) for jobs with few task are expected to accompany the safety plan, jobs with multi-task can be submitted sequentially as the job progresses. RETURN CHECKLIST COPY WITH REQUIRED INFORMATION LOCATION IDENTIFIED IN THE RIGHT MARGIN BELOW

CONTRACT NAME

CONTRACT NUMBER

Contractor shall comply with the OSHA General Duty Clause 5(a)1 and 29 CFR 1926 & 29 CFR 1910 as applicable. Additionally the contractor is obligated to comply with USEPA, CDPH&E, NIST Boulder Laboratories Security Office, Office of Safety, Health, & Environment, and Division of Engineering, Maintenance, & Support Services.

The following are the minimal requirements that must be covered within the written safety plan:

Company's Health, Safety, & Environmental Policy.

Written Description Required

WRITTEN REQUIREMENTS

Skyler Meredith

X

X

X

X

X

X

X Fall Protection (29 CFR 1926 Subpart M): Contractor shall provide a fall protection plan and a fall rescue plan. All floor and wall openings will be guarded with approved guardrails/barricades. All employee's effected by the fall protection plan must have attended training IAW 1926.503(b) and provide copies of training certificates.

Contractor must ensure that a licensed PE has designed all fall protection systems For

Scaffolding & Ladders (29 CFR 1926 Subpart L): Contractor shall ensure that the proper ladder is being used correctly. Scaffolding other than rolling type, will be erected by a Competent Person, with scaffold grade planking, guardrails, and contractor will address fall protection measures to be used. Contractor will maintain copies of all daily scaffold inspections

Welding/Cutting/Hot Work (29 CFR 1926 Subpart J): Contractor shall ensure that all welding/cutting/hot work is done in accordance with applicable equipment safety measures. This will include use of screens and/or blanks. Contractor will coordinate to ensure COR has submitted appropriate Impairment permits and request Hot Work Permit from Safety Group. All hot work must have Hot Work Permit posted in area.

Fire Protection (29 CFR 1926 Subpart F) to include use/storage of flammable and combustible materials, use of LP Gas, use of temporary heating devices.

Material Handling (29 CFR 1926 Subpart H) Site plan for material storage. Copies of training certificates for all operators of material hoist, personnel hoist, aerial lifts. Cranes and derricks require a site and lift plan prior to lift.

PPE & Life Safety (29 CFR 1926 Subpart E) site minimum PPE consist of ANSI Approved safety glasses, hardhats, work boots, high vis shirts/vest. Then as required hearing protection, gloves, fall protection gear, and emergency eyewash for corrosive chemicals and concrete work.

Tools-Power & Hand(29 CFR 1926 Subpart I): Contractor shall provide information concerning Assured Grounding Policy. Due to the site's purpose the contractor will ensure that all electrical power tools are properly connected to GFCI's.

X

X

X

X

Electrical (29 CFR 1910 Subpart S, 29 CFR 1926 Subpart K, NFPA 70E) Contractor shall provide training documentation in accordance with the standards outlined in NFPA 70E, Article 110.6E. Contractor shall ensure workers have appropriate PPE to perform assigned work.

Permit Required Confined Space (29 CFR 1910.146): Contractor will provide training certificates for all entrants, attendants, rescue personnel. Contractor will provide permit entry system/methods, rescue plan, ventilation methods, additional PPE to be used, LOTO methods used, & air monitoring methods used. Contractor will provide completed copy of permit after work is completed. A copy of the permit must be posted at entrance will work is ongoing.

Control of Hazardous Energy (Lockout/Tagout)(29 CFR 1910.147 &

Toxic & Hazardous Substances (29 CFR 1926 Subpart Z) (29 CFR 1910 Subpart Z) Contractor shall comply with standards set forth in all sections of 1910.1001, 1926.1101, all applicable Appendix's and CDPH&E Reg 8 .

Contractor must ensure that a licensed PE has designed all fall protection systems. For roof work, contractor must obtain a Roof Permit from EMSS Safety Office.

Excavation & Trenching (29 CFR 1926 Subpart P): Contractor must perform Utility Locates prior to beginning. Contractor will provide site drawing of proposed excavation/trench. Excavation/trench greater than 4ft deep must be protected from cave-in, contractor to provide method of protection. If greater than 20ft in depth protection system/method must be designed by a licensed PE. Contractor must perform daily inspection of excavation/trench, to included hazardous atmosphere if they exist.

Contractor must provide certificate of training for Competent Person and also a rescue plan in the event of a cave-in. Contractor will work with COR to secure an excavation permit from EMSS Safety Group. All excavation/trench's must be protected by fencing or barricades.

1926.417):Contractor must adhere to NIST supplemental EMSS LOTO Procedures for existing equipment. COR & Contractor will acquire procedures from EMSS Safety Group prior to work beginning. Contractor will provide training certificates for all personnel performing LOTO work. If new equipment is being installed, contractor will utilize their own LOTO procedure until equipment is tied into NIST services.

Environmental Protection: If required Contractor will obtain Storm water Permit and submit a SWPP for acceptance. All waste generated will be disposed of properly.

Contractor is responsible for all waste, general & hazardous. Contractor will perform general housekeeping IAW 29 CFR 1910 & 1926.

Contractor shall take all necessary precautions to prevent injury to the public, building occupants, and property. This will include the use of hazard signage, fences, barricades, and any other approved methods. Contractor shall not create any obstructions when storing materials or performing assigned work. Access & egress must be maintained at all times for occupants and employees. Contractor shall provide a site drawing for locations used to store materials & equipment. This will include the use of secondary containment for hazardous materials. MSDS's must be present and all containers in use must be properly labeled with associated hazards. When requested the contractor shall provide copies of air and noise monitoring and specialty toxic material usage (Stainless steel welding, etc)

NIST utilizes a 3-Stikes & Out Policy in regards to safety violations. If safety violation is observed EMSS Safety office and Contractor Safety manager will correct (Strike 1). If same employee has another safety violation EMSS Safety office & Safety Manager will again correct (Strike 2). If that employee has another safety violation (Strike 3) the EMSS Safety office will have the employee removed from site and have employees badge privileges will be revoked by DOC Police.

Site Specific Permits Needed

General Safety Measures:

X X

X

APPENDIX 12.10.E: Exchange of Lockout/Tagout Program

Name: ______________________________________ Phone: ___________________ Address: _______________________________________________________________ Project Name/Equipment: __________________________________________________

II. □ Check here to indicate that energy control procedures for the equipment/machine have been exchanged.

Comments: _____________________________________________________________

III. After comparing the two Lockout/Tagout programs, note any additional restrictions/prohibitions below:

IV. Affected Personnel (listed below) shall understand and comply with these differences (use additional paper as needed and attach).

(Printed Name) (Signature)

Impairment Permit Hot Work Permit

I. Identification of Outside Employer:

The lockout/tagout standard requires that NIST exchange energy control procedures with outside employers who service and/or maintain NIST equipment/machines that require lockout/tagout. This form is used to notify both parties that they must comply with the restrictions and prohibitions of those procedures. This form shall be completed by the Contracting Officer’s Representative in conjunction with the outside employer’s representative. The exchange of information must occur before service/maintenance activities begin. If NIST workers will also be working on this equipment or in surrounding areas, this document must be attached to the Energy Control Procedures.

Roof Access Permit Excavation Permit Penetration Permit Storm water Protection Permit Energized Electric Work Permit

Periodic updates to the submitted safety plan or JHA's may be required if scope or techniques differ from original submission

CONTRACTOR SAFETY REPRESENTATIVE NAME & PHONE NUMBER

V. Acknowledged acceptance of the provisions of this form:

Outside Employer Representative: ____________________________ ______________ (Signature) (Date)

NIST Contact: _______________________________ ______________ (Signature) (Date)

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