Attachment (1) Draft_PWS_130t Crane Inspection.pdf

MORGAN.ANDRE.S

TEVEN.1039683160

Digitally signed by

MORGAN.ANDRE.STEVEN.10396

83160 Date: 2021.04.27 09:26:45 +09'00' 27 April 2021DRAFT

DRAFT

o o DRAFT

• DRAFT

• DRAFT

CUI//FEDCON [when filled in]

ATTACHMENT

RESUME OF KEY PERSONNEL

(SAMPLE FORMAT)

Name of Key Personnel:

Key Personnel Position:

A. Qualification: (To be filled out by the Contractor per description in Annex 2)

Name of company/organization Branch/Contract title Position in the branch/contract Period of being in the position Duties related to key personnel position (Describe in detail.)

Name of company/organization Branch/Contract title Position in the branch/contract Period of being in the position Duties related to key personnel position (Describe in detail.)

Name of company/organization Branch/Contract title Position in the branch/contract Period of being in the position Duties related to key personnel position (Describe in detail.)

(Attach additional sheet if necessary.)

B. Completed courses:

Japan Construction Occupational Safety and Health Association safety course Course Title Date of certificate (Month/Year)

Koji Shunin Course Course for Construction Site Managers List other courses if any.

C. Copy of prime contractor’s employment certificate.

CUI//FEDCON [when filled in]

YES NO

Date:

Location (To include building / pier number or specific information to identify work location):

Date:

To use a tag line, If rotation of the load being lifted is hazardous.

To pay attention always, while the crane operator is controlling the crane.

To ensure that proper signals are used at all times.

To ensure that side loading is prohibited at crane operation.

To prevent that a personnel ride on a load.

To ensure that the start and stop of crane operation is performed smoothly (no sudden acceleration or deceleration).

Is wire rope condition within the criteria of OEM manual?

If operating near electric power lines, are the rules and guidelines understood and adhered to?

If the lift is a critical lift, are all regulations understood and signed to critical lift plan?

I certify obeying about the following check items during crane operation.

To ensure that the hook is set at center of the load for minimizing swing.

To confirm whether the load will be being secured and balanced well before lifting more than a few inches.

Are obstructions and accessible areas within the swing area barricaded to prevent injury or damage?

Is the lift and swing path clear of obstructions?

Are personnel prevented from standing or passing under a suspended load?

Is rigging gear undamaged and acceptable for the application?

Are all of safety device (Limit Switch) of crane worked properly?

Is end connection of hoist wire rope being installed in accordance with OEM manual properly?

Is the load to be lifted on the plan within the crane manufacturer's rated capacity in its present configuration?

Is the crane level and on firm ground?

Are outriggers fully extended and down?

Is the entire surface of the outrigger float being supported by outrigger block which has sufficient strength?

When outrigger is deployed, is the clearance between wheel and ground level in compliance with OEM manual?

Is the swing radius of the crane counterweight clear of people?

CONTRACTOR CRANE OPERATOR'S DAILY CHECKLIST ( FOR CONTRACTOR )

Check Items

Is the Certification of Compliance, P-1, in the operator’s cab with the current operator’s name listed?

Does the operator know the weight of the load to be lifted?

CUI//FEDCON [when filled in]

ATTACHMENT 5.1-(4) C

CUI//FEDCON [when filled in]DRAFT

CUI//FEDCON [when filled in]DRAFT

CONTRACTING OFFICER’S POINT OF CONTACT PHONE

(Government Representative)

PRIME CONTRACTOR/PHONE /

START DATE END DATE

CRANE OR ALTERNATE MACHINE SUPPLIER/PHONE(if different from prime contractor)

COMPANY OFFICIAL SIGNATURE

COMPANY OFFICIAL NAME/TITLE /

(or in the contractor’s on-site office for rigging operations)

Figure P-1

2. The operators noted above have been trained and are qualified for the operation of the above noted crane(s) or alternate machine(s).

2.

3. All safety devices and operator aids are enabled and functioning properly and the operators noted above have been trained not to bypass safety devices and operator aids during lifting operations.

3.

4. The operators, riggers and company officials are aware of the actions required in the event of an accident as specified in the contract.

DATE

POST ON CRANE (OR ALTERNATE MACHINE) (IN CAB OR VEHICLE)

5. Signal persons used in construction work are qualified in accordance with 29 CFR 1926.1428.

29 CFR 1926.1428.

6. Riggers are qualified in accordance with NAVFAC P-307, paragraph 11.1.k.

CERTIFICATE OF COMPLIANCE EXPERATION DATE:

CRANE OR ALTERNATE MACHINE NUMBER (I,e.,ID number)

NAVFAC P-307 11.1.k

7. All personnel working on the job site have been trained to not stand under a load or in the fall zone of a suspended load unless specifically allowed by USACE

EM 385-1-1.

USACE EM 385-1-

CRANE OR ALTERNATE MACHINE OPERATOR'S NAME(S)

I certify that

1. The above noted crane or alternate machine and all rigging gear conform to applicable OSHA regulations (host nation regulations for naval activities in foreign countries) and applicable ASME B30 or other standards. The following OSHA regulations and ASME or other standards apply:________________________________________________________

APPENDIX P – CONTRACTOR CRANE (OR ALTERNATE MACHINE USED TO LIFT SUSPENDED LOADS) AND RIGGING

GEAR REQUIREMENTS

CERTIFICATE OF COMPLIANCE

This certificate shall be signed by an official of the company that provides cranes (or multi-purpose machines, MHE, or construction equipment used to lift loads suspended by rigging gear) or rigging gear for any application under this contract. Post a completed certificate on each crane or alternate machine (or in the contractor’s on-site office for rigging operations) brought onto Navy property.

4.

1. OSHA

ASME B30

OSHA ASME .

CONTRACT NUMBER

LOCATION (To include building / pier number or specific information to identify work location. In case a contract involves multiple work locations, list all of them)

CRANE/RIGGING OPERATION PERIOD

CRANE OR ALTERNATE MACHINE MANUFACTURER/TYPE/CAPACITY / /

CUI//FEDCON [when filled in]

ATTACHMENT 5.1-(4) E

Ｄ

Signature of Person in Charge

CUI//FEDCON [when filled in]

ATTACHMENT 5.1(4) F

HOT WORK PERMIT

緊急の際は直ちに （軍電）または （携帯電話）へ連絡する。

ATTACHMENT 5.1(4) F

HOT WORK PERMIT

Within 100 feet of any fuel operations

REQUIRED D TE/PERIOD OF HOT WORK

From:

FACILITIES BRANCH TEL: 252 4122/4152/4129

CFAS SAFETY OFFICE TEL: 252 2701(CFAS 252 2719/3512

OPERATION OFFICE TEL: 252 4135/4136

FLC 113209(12 05)Rev

HOT WORK REQUEST

Date

安全部 )

CUI//FEDCON [when filled in]

ATTACHMENT 5.1(4) F

HOT WORK PERMIT

(Use the back of page if you need additional space)

(Use the back of page if you need additional space)

CUI//FEDCON [when filled in]

Direct cause:

Indirect causes:

Direct cause:

Indirect cause:

CUI//FEDCON [when filled in]

CRANE AND RIGGING ACCIDENT REPORT

Accident Category: Crane Accident Rigging Accident Reporting Activity:

UIC:

Copy To: Navy Crane Center Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Activity Responsible for the Accident:

UIC:

Report No:

Accident Location: Accident Date: Time:

BOS Contractor: Yes No If Yes, Contract No: Contractor Equip. Yes No Crane No: Crane Type: Category: Crane OEM:

Crane Capacity: Hoist Capacity: Weight of Load on hook: Weather:

Complex Lift or Complex Non-Crane Rigging Operation? Yes No

Lost Work Days? Yes No Fatality or Permanent Disability? Yes No Material/ Property Cost Estimate:

Accident Type (check all that apply):

Personal Injury Overload Two Blocked Power Line Contact

Dropped Load Derail Crane Collision Damaged Crane

Damaged Rigging Gear Damaged Load Load Collision Other: Specify

Cause of Accident (check all that apply):

Improper Operation Equipment Failure Inadequate Visibility

Improper Rigging Switch Alignment Inadequate Communication

Track Condition Procedural Failure Other: Specify Responsibility (check all that apply):

Crane Walker Rigger Operator Signal Person

Maintenance Management/Supervision Other: Specify

Crane Function:

Travel Hoist Rotate Luffing Telescoping Other N/A

Is this accident indicative of a recurring problem? Yes No

If yes, list Accident Report Nos.:

ATTACH COMPLETE AND CONCISE SITUATION DESCRIPTION AND CORRECTIVE/PREVENTIVE ACTIONS TAKEN AS ENCLOSURE (1). Include root cause and contributing factors. Assess damages and define responsibility. For equipment malfunction or failure, include specific description of the component and the resulting effect or problem caused by the malfunction or failure. List immediate and long term corrective/preventive actions assigned and respective codes.

INCLUDE: Printed Name, Code and Date.

Preparer: Phone: E-mail: Code: Date:

Concurrence Code: Date:

Concurrence WHE Program Manager (if Applicable) Code: Date:

Certifying Official (Crane Accident Only):

(when filled in) Figure 12-1 (1 of 2)

(when filled in)

CRANE AND RIGGING ACCIDENT REPORT INSTRUCTIONS

This form is designed for e-mail transmission, and with enclosures shall be the official document. Electronic submission will be accepted but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is m_nfsh_ncc_accident@navy.mil.

1. Accident Category: Indicate either crane accident or rigging accident.

2. Reporting Activity/UIC: The activity and unit identification code responsible for reporting the accident.

3. Activity Responsible for the Accident/UIC: Self-explanatory.

4. Report No.: The activity assigned accident number (e.g., Activity UIC-FY-CA-01).

5. Accident Location: The detailed location where the accident took place (e.g., building 213, dry dock 5).

6. Accident Date: The date the accident occurred.

7. Time: The time (24 hour clock) the accident occurred (e.g., 1300).

8. Is the responsible party a BOS Contractor? Check yes or no. If yes, enter contract number.

9. Was the crane/equipment owned by a contractor? Check yes or no.

10. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

11. Crane Type: The type of crane involved in the accident (e.g., mobile, bridge), if applicable.

12. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

13. Crane OEM: The original equipment manufacturer of the crane (e.g., Samsung, Grove, P&H), if applicable.

14. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

15. Hoist Capacity: The capacity of the hoist involved in the accident at the max radius of the operation, if applicable.

16. Weight of Load on Hook: The weight of the load on the hook, if applicable.

17. Weather: The weather conditions at time of accident (e.g., wind, rain, cold).

18. Complex lift: Was the crane or rigging gear being used in a complex lift? Check yes or no.

19. Lost Work Days? Check yes or no.

20. Fatality or Permanent Disability: Check yes or no.

21. Material/Property Cost Estimate: Estimate total cost of damage resulting from the accident.

22. Accident Type: Check all that apply.

23. Cause of Accident: Check all that apply.

24. Responsibility: Check all that apply.

25. Crane Function: Check all functions in operation at time of accident. Check N/A if a rigging gear accident.

26. Is this a recurring problem? Check yes or no. If yes, list Accident Report numbers.

27. Preparer: Printed name must be provided.

28. Concurrences: Printed name must be provided.

29. Certifying Official (Crane Accidents Only): Printed name must be provided.

Enclosure (1)

Brief Description: No more than one paragraph summarizing the resultant incident.

Root Cause and Detailed Description: Provide the relevant background in a descriptive timeline of preconditions leading up to the event, as well as a detailed description of the event.

Corrective Actions: List all short term and long term corrective actions that are taken to prevent recurrence of the incident. Short Term Corrective Actions are those actions taken that will allow return to work in short time frame.

Long Term actions are more ‘programmatic’ in nature and typically include: process revision, changes in training, ‘mistake proofing’, etc.

NOTE: This report may be generated utilizing activity approved software provided all information required above is included.

Figure 12-1 (2 of 2)

Figure 12-2 (1 of 2)

NEAR MISS AND UNPLANNED OCCURRENCE REPORT

Near Miss Category: Crane Near Miss Rigging Near Miss

Unplanned Occurrence Reporting Activity:

UIC:

Copy To: Navy Crane Center Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Activity Responsible for the Near Miss:

UIC:

Report No:

Location: Near Miss Date: Time:

BOS Contractor: Yes No If Yes, Contract No: Contractor Equip.

Yes No

Crane No: Crane Type: Category: Crane OEM:

Crane Capacity: Hoist Capacity: Weight of Load on hook: Weather:

Complex Lift or Complex Non-Crane Rigging Operation? Yes No

Is this near miss indicative of a recurring problem? Yes No

In the space below, include a description of the event, root cause and corrective actions taken to prevent recurrence:

Brief description:

Root cause:

Corrective Actions:

INCLUDE: Printed Name, Code and Date unless otherwise specified.

Preparer: Phone: E-mail: Code: Date:

CRANE AND RIGGING NEAR MISS INSTRUCTIONS

This form is designed for e-mail transmission and with enclosures and signatures shall be the official document.

Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is m_nfsh_ncc_accident@navy.mil.

1. Near Miss Category: Indicate crane near miss, rigging near miss, or unplanned occurrence.

2. Reporting Activity/UIC: The activity and unit identification code responsible for reporting the near miss.

3. Activity Responsible for the Near Miss/UIC: Self-explanatory.

4. Report No.: The activity assigned near miss number (e.g., Activity UIC-FY-CA-01).

5. Location: The detailed location where the near miss took place (e.g., building 213, dry dock 5).

6. Near Miss Date: The date the near miss occurred.

7. Time: The time (24 hour clock) the near miss occurred (e.g., 1300).

8. Is the responsible party a BOS Contractor? Check yes or no. If yes enter contract number.

9. Is the crane/equipment owned by a contractor? Check yes or no.

10. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

11. Crane Type: The type of crane involved in the near miss (e.g., mobile, bridge), if applicable.

12. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

13. Crane OEM: The original equipment manufacturer of the crane (e.g., Samsung, Grove, P&H), if applicable.

14. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

15. Hoist Capacity: The capacity of the hoist involved in the near miss at the max radius of the operation, if applicable.

16. Weight of Load on Hook: If applicable, the weight of the load on the hook.

17. Weather: The weather conditions at time of accident (e.g., wind, rain, cold).

18. Complex lift: Was the crane or rigging gear being used in a complex lift?

19. Is this a recurring problem? Check yes or no. Identify any other similar near misses or accidents.

20. Brief Description: No more than one paragraph summarizing the resultant incident.

21. Root Cause and Detailed Description: Provide the relevant background in a descriptive timeline of preconditions leading up to the event, as well as a detailed description of the event.

22. Corrective Actions: List all short term and long term corrective actions that were/will be taken to prevent recurrence of the incident. Short term corrective actions are those actions taken that will allow return to work in short time frame. Long term actions are more ‘programmatic’ in nature and typically include:

process revision, changes in training, ‘mistake proofing’, etc.

NOTE: This report may be generated utilizing activity approved software provided all information required above is included.

Figure 12-2 (2 of 2)

ATTACHMENT 5.1(4)-K

CUI//FEDON [when filled in]

In consideration of the premise and the sum of____________________ lawful money of the United States of America (hereafter called the “Government”)_______________________ of which has already been paid and _____________ _____________

_ ( ¥ __________) of which is to be paid by the Government under the above-mentioned contract, the undersigned Contractor does, and by the receipt of said sum shall, for itself, its successors and assigns, remise, release and forever discharge the Government, its officers, agents, and employees, of and from all liabilities, obligations and claims whatsoever in law and in equity under or arising out of said contract.

, this release has been executed this ________ day of ______________________ 20 _____

WITNESS: (Contractor)

___________________________________________ BY: _________________________________________________

___________________________________________ TITLE: ______________________________________________

I, ___________________________________, certify that I am the _______________________________ secretary of the corporation named as Contractor in the foregoing release; that ____________________________________ who signed said release on behalf of the Contractor was then _____________________________________ of said corporation; that said release was duly signed for and in behalf of said corporation by authority of its governing body and is within the scope of its corporate powers.

(Corporate Seal) _____________________________________________________

CUI//FEDCON [when filled in]

ACCEPTANCE OF CONTRACTOR’S QUALITY APPROACH DOES NOT LIMIT CONTRACTING

OFFICER FROM REQUIRING ADDITIONAL MEASURES IF PERFORMANCE IS

UNACCEPTABLE.

CUI//FEDCON [when filled in]

CUI//FEDCON

ATTACHMENT 5.1-(6)

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

CUI//FEDCONDRAFT

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

CUI//FEDCONDRAFT

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

113661

Applicable Serial No.

CUI//FEDCON

ATTACHMENT 5.1-(6)

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO

OEM MANUAL AND PARTS LIST FOR KA-1300R (SLEWING RELATED) INCLUDING 130 TON CRANE PHOTO