Attachment F.pdf

GENERAL SERVICES SITE SPECIFIC

SAFETY PLAN TEMPLATE

CONTRACTOR:

PROJECT #:

LOCATION:

INTRODUCTION

A complete and reviewed Site-Specific Safety Plan (SSSP) is required for all County of San Diego General Services (GS) contracted projects. This plan must be submitted and reviewed before operations commence. The plan must be reviewed by the GS Project Manager and Safety Coordinator.

A separate SSSP is required for each contract and worksite location. The SSSP is intended to drive the safety planning process well ahead of the start of the project. This will ensure that the contractor has thoroughly thought through the scope of work and identified the associated hazards and safety controls.

In conjunction with routine and non-routine job hazard analysis/job briefings (JHA), a site- specific safety plan describes the methodologies for identifying and analyzing safety risks dealing with major process steps, operations, facilities, approaches for mitigating identified risks, and the process for reporting safety events to the necessary parties including GS Project Management.

The SSSP must be kept current as part of the project and available via posting at the job site either in a notebook or in a protective pouch posted at the construction site entrance. The SSSP shall be reviewed and made available to all persons involved, who must understand and comply with its requirements. The contractor shall conduct a Project/Site Safety orientation with sign in sheets of personnel who attended to convey the content of this plan to those who will be working within the construction area related to the project and contract. This must be done for all persons prior to them working on the project.

The Contractor shall be solely responsible for initiating, maintaining, and supervising all safety precautions and programs in connection with the performance of the contract. The Contracting Officer’s Representative shall not have control over, shall not be in charge of, and shall not be responsible for construction means, methods, techniques, sequences, or procedures, or for safety precautions and programs in connection with work, since these are solely the Contractor’s responsibility. The SSSP shall be compatible with and incorporate the Contractor’s safety management system, safety manual(s) and other safety documents.

Acknowledgement

I (Name)

, as a representative of (Company) certify on (Date) that I have read and understand the requirements of the California Code of Regulations, Title 8 Safety Orders, completed a walk-through of the jobsite, completed applicable area hazard assessments(s) and applicable Job Hazard Analysis related to the scope of work of this project and attest that my firm and its subcontractors will comply with the requirements of the contract and referenced Cal-OSHA standards as applicable to the scope of work.

Attachemet F

PROJECT INFORMATION

Project Name and #: Project Location:

Project Description:

Project Start Date: Project End Date:

PROJECT CONTACTS

GENERAL SERVICES CONTACTS:

Title Name Cell Phone/E-mail Project Manager Construction Inspector Safety Coordinator Building Maintenance Sup.

CONTRACTOR NAME:

Project Manager Superintendent Site Safety Officer

SUBCONTRACTOR NAME:

PROJECT TASKS AND HAZARDS

Job Hazard Analysis: Contractor shall prepare Job Hazard Analysis (JHA) for all routine and non-routine tasks.

PROJECT SAFETY CONTROL MEASURES

Controls Applicable or N/A

Action if Applicable

Demolition Attach demolition plan and procedures to be used while demolition takes place in occupied buildings to include protection of occupants.

Traffic Control Flaggers / lane closure or access restricted

Attach traffic control plan, including diagram, identifying how flaggers will be used and specifying signage and illumination as appropriate (Ref. Uniform Manual on Traffic Control)

Environmental Protection / Stormwater Potential for spills, protection of storm drains and building drains

Attach a description of what releases might be anticipated and how prevention and mitigation will occur.

Dust Fumes and Odor Control Sheet rock, soil, asbestos, silica dust, sanded paints, grinding, welding, paints, thinners, etc.

Attach a description of how dust, fume and odor control is managed throughout the project and identify what types of dusts will be generated, associated exposure limits and any special monitoring that will occur.

The goal is 100% control of dust, fumes and odors.

Scope of Work:

Control Measures Applicable

Action if Applicable

Site Control /Barricades/ Signage Powder actuated tools, lasers, construction site danger or caution tape, trenching, hole and wall openings, trenches, etc.

Attach a description of what controls will be implemented to assure control of construction zones, mechanical and/or electrical rooms, corridors, floors above and below the construction zone. Describe any additional signage that will be used and where it will be located. Attach description.

Material / Equipment Staging

Location of materials and contractor vehicles Attach diagram identifying locations where materials or equipment delivered or staged onsite will be located.

Waste Disposal General debris, recycling materials contaminated waste and hazardous waste

Attach a list of wastes that will be generated while working at County Facilities. Determine the location and size of debris boxes/dumpsters/ recycling containers or how waste is to be managed.

Control of Hazardous Energy Lock out/tag (LOTO) out of electrical, chemical, pneumatic, pressure, thermal, mechanical, etc.

Describe how hazardous energy is controlled throughout the project: identify what type of energies and any special monitoring/equipment that will occur/be used.

Describe and include copy of LOTO policy and procedures.

Emergency Response Accidents/ Injury Response Trained responders, first aid supplies, use of EMS, nearest medical facility

Identify and attach a map to the medical facilities that injured workers will be transported to. Identify and list the resources that that will be available on site. This would include first aid kits, fire extinguishers, trained responders. Post procedures for dealing with on-site emergencies including contacting outside resources.

Fire Protection / Prevention Building fire systems coordination, hot work, general construction storage of flammable materials

List any fire system impairment needed for this project. (Smoke detectors, fire alarm, sprinkler systems) Identify hot-work permits.

List any combustible/flammable materials used and how they will be managed.

Control Measures Applicable

Action if Applicable

Evacuation Assembly areas, egress routes.

Identify under what conditions evacuation of the immediate work site would occur.

Specify who will issue evacuation notice and/or how evacuation will occur if necessary. Identify assembly area.

Hazardous Materials Release Spoil piles, refrigerants, chemicals brought on site, vehicles etc.

Describe what hazardous materials will be brought on site or what may be generated as part of the work process. Attach current Safety Data Sheets (SDS) for all materials brought onto County property. Include methods to control releases or spills or exposure to building occupants and work crews.

Required Postings:

Safety and Health Protection, Forklift Use, Code of Safe Practices, Employee Access to Records, OSHA 300, Cal/OSHA Registration, Citations

All postings required and applicable by health and safety regulations must be visible on site or readily available.

Other List any other special procedures and controls that pertain to the area or type of work being done that are not covered under the above categories. List

SPECIAL WORK PLANS / PROCEDURES

Activity Applicable

N/A Work Plan, Procedure or Controls

Asbestos / Lead Abatement

Attach Plan

Hot Work (Welding) Attach Plan Confined Space Entry Attach Plan Hoisting, Rigging, Heavy & Critical Lifts (Crane Use)

Attach Plan

Elevated Surface Work, Fall Protection

Attach Plan

Energized Electrical Work Attach Plan + GS Energized Electrical Work Permit

Excavation / Trenching Attach Plan(which includes protective system)

SPECIAL WORK PLANS / PROCEDURES

Activity Applicable N/A

Work Plan, Procedure or Controls

Penetrations / Coring Attach Plan Heat Illness Prevention Attach Plan Add other activities as required

TRAINING DOCUMENTATION

By signing the acknowledgement statement of this plan, the Contractor certifies that employees have been trained in the following safety procedures and in accordance with Cal- OSHA regulations and their company safety management system and policy and procedures.

Evidence of training with employees’ names shall be submitted to GS with this SSSP.

Qualification Yes, or N/A (If yes for heavy equipment, list equipment and operators authorized.

List Employees

Aerial Lift Operator Confined Space Competent Person

Crane Operator Trench Competent

Fall Protection Competent

Forklift Operator Certification

First Aid/CPR AED

Heavy Equipment Operator Certification

Scaffold User / Erector Competent Person

Asbestos & Lead

OSHA 10 Hour Certification

OSHA 30 Hour Certification Additional Certifications

PLAN REVIEW

The Site-Specific Safety Plan (SSSP) must be reviewed by the GS Project Manager and Safety Coordinator before work can begin on any GS Project. Depending on the scope of work, the plan may require review by additional GS or County staff.

Name: Title: GS Project Manager

Signature: Date:

Name: Title: GS Safety Coordinator

Additional review may be required by Management, Building Maintenance, or Construction Inspection Staff. This will be determined by the Project Manager.

Additional Reviews:

Name: Title:

Name: Title:

Version: 3

Revised/Updated: April 2025