Attachment 003 - APP Checklist.pdf

CESO Form A-01, Mar 15

U.S. Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan, Form A-01

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

In lieu of a fully-developed APP, for Limited-Scope Service, Supply and R&D Contracts (e.g. grass mowing, park attendant, rest room cleaning, etc.), the Contracting Officer (KO) and local Safety and Occupational Health Office (SOHO) may allow an Abbreviated APP to be developed and submitted for acceptance. 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.

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

1. Signature sheet

a. Includes the name, title, signature, and phone number of the Plan Preparer.

(Qualified person, i.e. corporate safety staff person, QC)

2.Background information

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d(1). Includes the Brief Project Description.

d(2). Includes 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. Includes a Description of the Work to be Performed.

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

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

b. Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level - including their resumes.

c. Includes the lines of authority.

5. Training

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

b. Includes any periodic retraining/recertification requirements.

Abbreviated Accident Prevention Plan, Form A-01

Date of Inspection

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

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

7a. Procedures for reporting man-hours worked.

7b. Includes procedures for 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 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 (excessively long 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 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 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 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, bums and chemical irritants.

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. Power tools/equipment must have appropriate guards and safety devices in place and operational.

Abbreviated Accident Prevention Plan, Form A-01

Date of Inspection

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

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 the 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.

Other Remarks