Attachment F- Site Specific Safety Plan-final (1).pdf

ATTACHMENT F

1 Site Specific Safety Plan

Project Title

VRE Contract Number

Contractor’s Name

Location(s) of Project

Project Duration Period

Description of Scope of Work

(Large Projects*)

Contractor’s Project Safety Manager (include name, qualifications, planned schedule on project and detailed description of duties:

*A large project is defined as having a total contract value in excess of $5million dollars or whenever work includes one or more of the following:

• Bridge work above tracks

• Tunnel work below tracks

• Cranes and rigging where required crane capacity is greater than 50-tons

• Confined space entry

• Excavations greater than 4-feet

2 Site Specific Safety Plan

How to complete this plan:

Evaluate each subject topic and determine if it is required. If required, place a checkmark in the “yes” column and provide specific details in the “remarks” column. If more space is needed, find the blank

Attachment A page, at the end of the document, and make as many copies as necessary. Remember to use the item number from the “item #” column to associate any supplemental remarks.

If you don’t believe the category will be a factor in your project, check “N/A” and move to the next section.

Check marks under the “no” section will require remarks

Section 1 General Safety Plan Information

Item # Subject Required? Description/Response

Site Safety on VRE/Railroad Property N/A [ ]

GS1 Describe your plan for providing safety training for employees.

Yes No

GS2 Describe your plan for continued training and enforcement of compliance (formal and informal) of employees

GS3 Describe your plan for handling waste materials.

3 Site Specific Safety Plan

GS4 Describe your planned security procedures for preventing damage or theft of in-place work, property, and equipment owned by VRE or the Contractor.

GS5 Describe your emergency procedures to manage site emergencies, evacuations, extreme/sudden weather and other circumstances

GS6 What type of PPE will be used for this project?

GS7 Describe your plan for providing Personal Protective Equipment (PPE) to employees and visitors who may arrive without PPE.

4 Site Specific Safety Plan

GS8 Will any special PPE be required, i.e respirators? If yes, what type?

GS9 Will eye wash and shower stations need to be set up on the jobsite?

GS10 Has personnel received training for special PPE requirements?

GS11 Is there verification of medical respiratory protection clearance available to the VRE Project Management Team?

GS12 Will respirators be worn on a voluntary basis?

GS13 Is a de-con area required for suiting up/down?

GS14 Will perimeter barricades be used?

GS15 Will caution/danger signage be needed?

GS16 Will Hot Work (welding/cutting/grinding/soldering/electrical) need to occur?

Permission to conduct Hot Work is required from VRE before taking place.

GS17 Will Hot Work (welding/cutting/grinding/soldering/electrical) permits be required?

GS18 Will fire blankets/protective shields/screens be required?

GS19 Are fire-watch personnel properly trained?

GS20 Describe your After-Work watch plan

GS21 Will any utility interruption permit or railroad/municipality-issued dig tickets be required?

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Section 2 Railroad Operating Environment

Item # Subject Required? Description/Response

Roadway Worker Protection

(RWP)

(49 CFR 214 Subpart C)

N/A [ ]

RR1 Will work be confined to VRE track territory?

Yes No If no: Amtrak [ ] CSX [ ] NS [ ]

RR2 Describe your plan to ensure all employees who will perform service in an area where RWP training is required receive proper training.

RR3 Describe your plan to ensure ongoing compliance with applicable RWP regulations and host railroad/VRE requirements.

RR4 Describe your plan to coordinate with the host railroad Employee in Charge to establish protection or to establish acceptable work windows.

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RR5 Describe your plan to check for, investigate, and discipline violations of Roadway Worker Protection requirements.

Item # Subject Required? Description/Response

Blue Signal Protection

(49 CFR 218 Subpart B)

N/A [ ]

RR6 Will work be confined to VRE territory? Yes No If no: Amtrak [ ] CSX [ ] NS [ ]

RR7 Will individual blue tag cards with photos of isuee be distributed to applicable staff?

RR8 Describe your plan to coordinate with the VRE yard manager or host railroad point of contact to establish blue signal protection or to establish acceptable work windows.

RR9 Describe your plan to establish and maintain proficiency in Blue Signal Protection requirements among staff.

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RR10 Describe your plan to check for, investigate, and discipline violations of Blue Signal Protection.

Item # Subject Required? Description/Response

Bridge Worker Safety

(49 CFR 214 Subpart B)

N/A [ ]

RR11 Contractor has full understanding and ensures full compliance with all applicable elements of 49 CFR 214 Subpart B prior to starting work.

Yes No

RR12 Contractor has a program in place that requires training in, adherence to, and use of safe procedures associated with climbing techniques and procedures to be used on or about the bridge structure.

RR13 Will scaffolding be involved in the work and will it fully comply with the requirements of 49 CFR 214.109?

RR14 Will fall protection systems be involved in the work and will it fully comply with the requirements of 49 CFR 214.109 and all other applicable requirements?

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RR15 Will water that may pose a drowning risk or greater in depth than four (4) feet will be present at the worksite? If yes, a plan shall be developed to manage compliance with this hazard.

Section 3 Life Saving Commitments – Stored Energy

Item # Subject Required? Description/Response

Lockout/Tagout (LOTO) N/A [ ]

SE1 Will LOTO be required? Yes No If yes, Contractor Superintendent will inspect LOTO source and ensure LOTO procedures are followed.

SE2 Are LOTO procedures available?

SE3 Has a responsible person been assigned for overseeing LOTO requirements?

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Item # Subject Required? Description/Response

Pipe and Vessel Pressure Testing N/A [ ]

SE4 Will any pipe/vessel pressure testing be required?

Yes No

SE5 Will pipe/vessel testing be performed within design specifications?

SE6 Has a Pressure Testing Safety Plan been developed and approved?

Note- Pressure Testing Safety Plans may be requested by VRE Project Management Team for approval.

Hydrostatic is the preferred testing method.

Item # Subject Required? Description/Response

Compressed Gas N/A [ ]

SE7 Will cylinders be brought on site? Yes No Type of cylinders and quantity:

SE8 Are there plans for safe use and storage on site?

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Section 4 Life Saving Commitments – Fall Protection

Item # Subject Required? Description/Response

Ladders/Scaffolding N/A [ ]

FP1 Will ladders be required? (All ladders shall have a min 300 lb rating)

Yes No Metal ladders will be approved by VRE Project Management Team.

FP2 Will scaffolding be required?

(Scaffold tags and inspections are required when scaffolding is used)

Provide person(s) name, contact information and training verification.

FP3 Will fall protection be required? List equipment to be used.

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Fall Protection, Leading Edge

Work, Elevated Surfaces (no safety monitors)

N/A [ ]

FP4 Has a Fall Protection Rescue Plan been developed? If yes, attach and describe the plan.

Yes No

FP5 Will fall protection be required? (No safety monitors). 100% protection > 6 feet is required.

Systems to be used:

FP6 Are competent/qualified persons identified to perform system and equipment inspections, identify hazards and anchor points as needed?

Provide individual’s name, qualifications/certifications and contact information.

Item # Subject Required? Description/Response

Roof Work N/A [ ]

FP7 Will roof access be required? Yes No Attach Fall Protection Plan and Emergency Rescue Plan (Primary and alternate plan to be submitted prior to commencing work)

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FP8 Is there a plan to get materials on/off roof in place?

FP9 Has a method for securing materials to prevent “blow offs” been identified?

FP10 Are chemicals or flammable/combustible materials going on roof?

This is required to be approved by VRE Project Management Team.

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Fall Protection, Leading Edge

Work, Elevated Surfaces (no safety monitors - 29 CFR 1926.502(h))

N/A [ ]

FP11 Will fall protection be required?

(Mandatory for all unprotected edges and sides, 6 feet and higher above lower level)

Yes No Systems to be used:

FP12 Has a Fall Protection Rescue Plan been developed?

Describe and attach the plan.

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FP13 Are competent/qualified persons identified to perform system and equipment inspections, identify hazards and anchor points as needed?

Provide individual’s name, qualifications and contact information.

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Section 5 Life Saving Commitments – Cranes & Rigging

Item # Subject Required? Description/Response

Cranes & Rigging N/A [ ]

CR1 Will crane operations be required? If yes, discuss with your PM team about the need to have a Crane Operations and Safety Plan established and available for inspection.

Yes No

CR2 Have all overhead lines been identified and has a plan been established to communicate and/or mark their presence?

CR3 Will any special lifting devices be needed?

CR4 Will any Critical Lifts take place? A Critical Lift meets any of the following criteria: 1) exceeds 75% of the capacity of the crane or derrick; 2) requires more than one crane or derrick; 3) involves lifts over people or critical work processes.

Discuss with the VRE Project Management Team about the need to develop a critical lift plan and activity summary.

CR5 Has all rigging equipment been inspected?

Submit verification of inspection training to the VRE Project Management Team (prior to commencing work).

CR6 Is all equipment appropriate for the task(s)?

CR7 Have all required safety inspections been completed?

Be prepared to make inspection logs completed for equipment/lift devices available to the VRE Project Management Team.

CR8 Will traffic control be provided?

(pedestrian, passenger & vehicular)

Be prepared to provide flaggers’ names and evidence of training to the VRE Project Management Team.

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Section 6 Life Saving Commitments – Confined Spaces

Item # Subject Required? Description/Response

Confined Spaces* *OSHA Definition

N/A [ ]

CS1 Will any confined space work be performed? Note: Atmospheric testing must be conducted and documented daily prior to entry into a Confined Space.

Yes No

CS2 Will any Confined Space Entry permits be required?

CS3 Have affected personnel been trained for Confined Space entry?

CS4 Will external rescue team services be used? If yes, specify the name of the provider.

CS5 Have all entry procedures been provided and documented?

Be prepared to provide Confined Space Plan to VRE Project Management Team.

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Section 7 Life Saving Commitments – Excavations

Item # Subject Required? Description/Response

Excavations N/A [ ]

EX1 Will equipment be brought on site? If yes, specify type.

Yes No

EX2 Will any work activities involve excavations greater than four feet?

EX3 Will a trench box/shoring be needed?

EX4 Does fencing/barricade need to be installed?

Section 8 Life Saving Commitments – Mobile/On Track Equipment

Item # Subject Required? Description/Response

Mobile Equipment / Powered

Industrial Fork Trucks / Lifts /

Booms / Ballast Regulators /

N/A [ ]

ME1 Will any mobile powered equipment be required?

Yes No If yes, list types to be brought on site and keep daily/shift inspection logs on the equipment.

ME2 Will you be using any special attachments? Ex. Jibs, manlifts, etc.

ME3 Are operators trained/certified for operations of equipment?

Be prepared to produce verification of training to VRE Project Management Team.

ME4 Is there a plan for fuel transfer/storage or battery changes?

Spill kit/containment pad required containing 80% equipment capacity.

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Section 9 Life Saving Commitments – Caught-In/Struck-By

Item # Subject Required? Description/Response

Caught-In/Struck-By N/A [ ]

OF1 Are employees familiar with pinching and crushing point locations?

Yes No

OF2 Are special precautions taken when working around belts, pulleys, chains, etc.?

OF3 Are employees aware of the hazards associated with overhead loads and swing radius?

OF4 Are vehicles equipped with appropriate back-up alarms, horns and lights?

OF5 Is contractor prepared to comply with the requirement to provide a spotter for all vehicles reversing with restricted rear vision?

Section 9 Life Saving Commitments – Chemical Hazards

Item # Subject Required? Description/Response

Chemical Hazards N/A [ ]

CH1 Are MSDS/SDS available at job site and available for inspection by the VRE Project Management Team?

Yes No

CH2 Are employees trained to handle/use and store specific materials?

CH3 Does storage and use meet all internal, VRE, state and federal regulations?

CH4 Do employees working with OSHA regulated chemicals have proper training for the job? (silica, RCS’, Etc..)

Be prepared to produce evidence of successful training to VRE Project Management team.

CH5 Are there any additional exhausts or fans needed during application/curing time?

CH6 Will sealant be applied to this job? Please specify quantity and job type.

CH7 Will this require off-hours application to avoid contact with passengers.

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CH8 Will any flammable gases and/or liquids be used?

CH9 Have provisions for their storage been made?

CH10 Will appropriate containers be utilized?

Safety Cans are required.

CH11 Are secondary containment and spill kits required?

CH12 Will designated smoking areas be identified?

CH13 Have the appropriate number of fire extinguishers been identified?

CH14 Have emergency phone numbers been identified and plan to be posted in a conspicuous location?

CH15 Is there a plan for waste disposal in places that are capable of being rain and leak proof?

CH16 Are all characterization, containerization, segregation, storage and disposal requirements understood?

CH17 Is there a plan for water/wastewater discharges in place?

Be prepared to make plan available to VRE Project Management Team.

CH18 Is an Erosion Control Plan in place? Be prepared to make plan available to VRE Project Management Team.

CH19 Is there a Spill Plan in place? Be prepared to make plan available to VRE Project Management Team.

Section 10 Life Saving Commitments – Drug & Alcohol Prohibition

Item # Subject Required? Description/Response

Drug & Alcohol N/A [ ]

DA1 Contractors and subcontractors must agree to the zero-tolerance drug and alcohol prohibition (influence, use, possession) from all VRE contract work.

Yes No

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Appendix A – Supplemental Information Sheet

Use this page to provide supplemental content to any of the elements above. Reproduce this portion as many times as is needed.

Section # Item # Subject