Attch J-4 SSSP Template.docx

Template Guidance Chapter 1 of this template aligns with Chapter 2 of the KNPR 8715.7; Chapter 2 of this template aligns with Chapter 3 of the KNPR 8715.7.

The contractor should provide any enclosures (appendices or attachments) that the plan calls for. This may include training certifications, JHAs, demolition plans, etc. These are contractor-specific, so no example formats are provided in this template.

Template Appendix sections have been provided to maintain document formatting and structure. Insert blank pages when pasting information that goes across multiple pages. If submitting an appendix as an attachment, please indicate this information on the main appendix header page.

Section elements with a form field in this template denote areas the contractor needs to provide the specifically requested information. Some fields throughout the template are auto filled for common, repeating information (e.g., company name).

The “PROJECT-SPECIFIC SAFETY & HEALTH ELEMENTS” checklist has “yes” or “no” checkboxes to select the applicability of each element to the project. You’ll also find a dropdown box next to each Chapter 2 section header that will be used to re-verify the applicability of that section to the project. Please select either “applicable” or “not applicable” from the dropdown, which should match the checklist selection.

Project-Specific Safety and Health Plan (PSHP)

Contract Details

[Project Title] Project Title:

Project Control Number (PCN)

[Project Location(s)] Project Location(s)

[Company] Company Name

The following listed Official has [Company] authority for approval of this PSHP for the above-listed project.

Signature

Attachment J-4 Project-Specific Safety and Health Plan (PSHP)

PROJECT SAFETY & HEALTH PLAN - standard REQUIREMENTS

CHAPTER 1 MANDATORY ELEMENTS (KNPR 8715.7 Chapter 2)

General Project/Safety & Health Information

Contractor Employee Safety and Health Training

Accident/Incident (Mishap/Class Call) Reporting

First Aid & Medical

Emergency Action Plan (EAP)

Hazard Communications

Job Hazard Analysis

Weather Policy

Construction Site Safety

Temporary Structures, Trailers, and Work Areas

Controlled Areas

Safety System(s) (Permanently Installed)

Pre-Task Meetings

Safety Meetings

Worksite Inspections

Heat Stress

Clothing

These topics are required for all PSHPs and are included in the template.

PROJECT-SPECIFIC SAFETY & HEALTH ELEMENTS CHECKLIST (KNPR 8715.7 Chapter 3)

Select “Yes/No” for each element and add any that are unique to the project (e.g., work over water, tower climbing, etc.). The PSHP Template has sections for each topic and any marked “Yes” must be included in the plan submitted for review. These elements are aligned in order of appearance in Chapter 3 of KNPR 8715.7.

TABLE OF CONTENTS

List of Tables

Table 1: Project SubContractors Table 2: WIND LIMITATIONS TABLE Table 3: Operator and signalperson Roster

Safety and Health Section - General General Project/Safety and Health Information The [Company] Project Specific Safety and Health Plan (PSHP) is a detailed plan of safety and health information, requirements, and regulations that will be followed while conducting all work under the NASA/KSC Procurement Office contract number [Contract Number], [Project Title], located at: [Project Location(s)].

The work this PSHP covers includes <<describe the general scope/statement of work to be performed on this project.>> This plan is written to address the safety and health aspects of this project’s work requirements. Our company policies and procedures, along with Federal, NASA/KSC, state, and local specific safety and health requirements were used in developing this plan.

This plan applies to all [Company] and subcontractor personnel on the site. [Company] and (site supervisor) are responsible for ensuring all employees follow the applicable safety and health regulatory requirements to include this PSHP.

All work under this contract will be performed safely so as not to create a hazard to personnel health or property (NASA and contractor). All work will be conducted per the NASA and KSC provisions contained in the contract, all applicable sections of OSHA regulations, and other applicable local, state, and federal laws.

[Company] Select from Dropdown sub-contractors performing work on this project.

This list includes other sub-contractors hired by our project sub-contractors. This list will be updated when any new sub-contractor(s) are selected and hired.

Table 1: Project SubContractors

Employee Training

1. All [Company] personnel and sub-contractors (hereafter referred to as “employees”) will watch the KSC’s Construction Contractor General Hazards Familiarization safety video (Click: KSC-QF111KSC). Completion of this requirement will be documented on an employee training attendance sheet and retained as objective evidence of training completion.

1. All employees engaged in jobsite activities will have received the required training to safely perform those activities.

1. A record of employee training signed by the competent or authorized trainer, and any required certification documents, will be provided in Appendix A. The record contains, at a minimum, the employee’s name, authorized training provider, training title, date received, and expiration date. This record certifies that our employees have received all required training for their assigned tasks and will be updated when assigned tasks change and before new employees or sub-contractors begin work on the jobsite.

1. Before permitting new employees to perform work on the site, the Site Supervisor ( ) will verify the employees have completed all required safety and health training.

<<Add any additional notes in this space>>.

Accident/Incident (Mishap/Close Call) Reporting

1. [Company] will notify the Contracting Officer Representative (COR) or the NASA Project Manager (PM) and the assigned NASA safety specialist immediately (within 1 hour) after a mishap, regardless of severity, to ensure proper recordkeeping.

1. In case of a serious injury, employees will immediately notify the site supervisor and call 911 or (321) 867-7911 (cell phone on KSC) or (321) 853-0911 (cell phone on CCSFS). Ambulances are on call 24 hrs./day, 7 days a week on both KSC and Cape Canaveral Air Force Station (CCSFS).

In case of an accident or mishap, the [Company] site supervisor will ensure immediate action is taken to secure potentially dangerous conditions (e.g., disconnect electrical power, secure machinery) to protect employees. The scene of an accident or mishap will be secured and remain intact until released by NASA Safety, KSC Security (when applicable), and the CO or COR.

The site supervisor will ensure all potential incident witnesses and affected equipment remain until released by the proper NASA authority.

The site supervisor will provide to the COR, CO, and KSC Institutional Safety Division a KSC Incident Report (KDP-F-3645, NASA Direct Construction Contractor Mishap Report) by hand, e-mail, or fax (321) 867-1120 within 4 hours of the mishap/close call. If the report is sent by non-secure means, all personal identification of an injured employee will be removed (e.g., name, social security number).

[Company] will investigate less severe mishap or close call incidents (unless directed otherwise by the NASA Safety Office) to identify the root cause(s) and provide the CO with a written report within 30 days of the mishap or close call by completing page 2 of the KSC Incident Report (KDP-F-3645, NASA Direct Construction Contractor Mishap Report) which will include the investigation findings and proposed or completed corrective actions.

[Company] understands that NASA may appoint an observer or investigating authority for any incident.

[Company] will (per contract requirements) cooperate with any Government incident investigation.

[Company] will perform a trend analysis of their mishaps/close calls to show potential reoccurring safety issues and share the analysis results with all worksite employees.

First Aid and Medical

1. Before starting work, [Company] will make provisions for prompt medical attention in case of employee injury and brief all employees on the process. Emergencies will be reported by dialing 911, (321) 867-7911 (cell phone on KSC) or (321) 853-0911 (cell phone on CCSFS).

1. All emergency contact telephone numbers will be posted at the jobsite in an area accessible and conspicuous to all personnel.

1. For non-emergency, walk-in medical care, employees may report to the KSC Occupational Health Facility (OHF) located at the corner of 2nd St. SE and C Ave. SE during normal office hours (0700 – 1600 hrs.). After hours or on weekends, call the numbers listed in this section. Emergency Medical Services (EMS) personnel will evaluate for first aid or transport to the nearest medical facility.

1. The site supervisor(s) will:

1. Ensure employees know to report any injury to their supervisor as soon as possible following a mishap or close call.

Ensure employees report to the nearest Occupational Health Facility (OHF) facility during clinic hours; After-hours or on weekends call the numbers listed in this section and EMS will evaluate for first aid or transportation to the nearest medical facility if necessary.

Follow the requirements for KSC Accident/Incident (Mishap/Close Call) Reporting.

Ensure any employee that is transported off-Center after-hours reports to the OHF the next duty day the OHF is open and follows all follow-up visit directions.

Ensure the employee is compliant with restrictions as ordered by the physician.

[Company] will ensure that for any work where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body will be provided within the work area for immediate emergency use. This equipment will meet the requirements of 29 CFR 1926.50 and ANSI 358.1.

Emergency Action Plan (EAP)

1. For all work conducted inside a facility, [Company] will assign an emergency point-of-contact (POC) before the beginning of work. Should evacuation of any area be necessary for reasons other than severe weather (e.g., hurricane, tornado), employees will follow the facility evacuation procedures and meet the POC at the marshaling area or at least 200 feet from the hazard. The site supervisor or designated POC will ensure the accountability of employees. The POC will brief employees on evacuation and marshaling areas on the first day of work.

1. The site supervisor or designated POC will notify the KSC on-scene Commander if all employees are not accounted for. Employees will not return to work inside or within 200 feet of the facility until the on-scene commander gives the “ALL CLEAR.”

Hazard Communications Use this space to describe your approach to implementing the requirements of the OSHA Hazard Communication Standard (29 CFR 1910.1200) as it applies to your scope of work on KSC. The description needs to include information on employee training, identification of hazardous materials to be brought to the Center, and Safety Data Sheets (SDS) for the materials. These items may be included as an appendix or submitted under separate cover to the COR.

Job Hazard Analysis (JHA)

1. [Company] has developed job hazard analyses (JHAs) for each element of our work on this contract. The completed JHA(s) are included in Appendix B.

1. The JHA(s) have, at a minimum, each of the following elements:

1. Task (Activity) Description: Specifies the work to be performed such as operating machinery, equipment, and powered hand tools.

1. Hazard Description: Identifies the hazards related to the work being performed such as flying debris, dust, wood chips, and metal shavings getting into the eyes.

1. Hazard Controls: The preventive measures taken to eliminate or mitigate the hazard to an acceptable operational level. For example: knowing and using the manufacturer’s operating, maintenance, safety procedures, training requirements, and the use of personal protective equipment (PPE) when needed (e.g., ear protection, goggles, face shield, safety shoes, and work gloves).

JHAs will be reviewed, updated, and discussed with employees when changes occur in work tasks, alternate equipment is being used, or when alternate methods of performing the task are being considered (e.g., using aerial lifts in place of scaffolding).

Weather Policy

1. [Company] will ensure employees on the jobsite are protected from adverse weather conditions including winds above 35 knots, heavy rain/hail, tornados, or the potential for lightning within five nautical miles that could affect the area within 30 minutes.

1. The site supervisor will have a means of emergency communication and a reliable method for receiving the KSC weather advisories and warning alerts during work performance. [Company] will receive these alerts from a weather warning pager or text message received on a cell phone. [Company] will coordinate these actions through the project CO or their designee.

1. The site supervisor will alert employees of adverse weather conditions and heat stress advisories in the area and will take proper action to protect employees when alerted.

[Company] will adhere to the work restrictions based on the wind limitations in Table 2.

Table 2: WIND LIMITATIONS TABLE Steady State

17.38 knots (20mph) 22 knots (25 mph) No erection of, or work on, floats, spiders, or scaffolding

30 knots (34.5 mph) 35 knots (40.3 mph) No work on facility roofs, structure tops, unprotected areas, or outside handrails (materials on roofs are secured or removed).

35 knots (40.3 mph) 40 knots (46 mph) Contractor Supervisors will immediately conduct a walk down of their area for unsecured items.

40 knots (46 mph) and above 45 knots (51.7 mph) and above Immediate actions will be taken to secure at ground level all loose or unanchored items, equipment, supplies, and materials.

[Company] will follow wind advisories and warnings issued by the 45th Space Wing Weather Office unless an Alternate Wind Advisory Plan is developed per the KNPR 8715.7 Weather Policy requirements and is approved by the COR and NASA Safety.

Lightning Restrictions

1. A Phase I Lightning Watch means that conditions are favorable for lightning to occur in the indicated areas within 30 minutes. A Phase I Lightning Watch is intended to provide personnel with sufficient lead time to secure their operations before the forecasted lightning begins. During Phase I Lightning Warnings, task leaders and employees will prepare to safely halt any operations that may be affected if a Phase II Lightning Warning is announced (i.e., be prepared to safely halt operations that expose personnel to lightning hazards or that must be halted if a Phase II Lightning Warning is announced).

1. Phase II Lightning Warning means that lightning was observed or is forecasted to occur within 5 nautical miles. Individuals will act to protect themselves from the dangers of lightning upon being notified of a Phase II Lightning Warning. Employee access to roofs or top levels of structures is prohibited. Electrical systems maintenance and any other operation requiring personnel risk of lightning exposure are prohibited.

Tornado Notification

1. Tornado Watch: Conditions exist for a tornado. Prepare for a tornado warning.

1. Tornado Warning: A tornado has been sighted. Employees will immediately take cover in approved structures.

Hurricane Condition (HURCON) Policy During the Atlantic Hurricane Season (June 1 through November 30), Florida is subject to extreme destruction associated with hurricanes. [Company], our employees, and subcontractors will follow instructions from the CO and adhere to the KNPR 8715.7 Weather Policy and the NASA/KSC Hurricane Policy.

Construction Site Safety

1. The site supervisor will ensure the safety of all personnel from all organizations while within the boundaries of the KSC. This is to include control of who is on-site, PPE requirements, special conditions, and restrictions that will be followed while on site.

1. A site supervisor will always be on-site during construction. If the site supervisor cannot remain at the site, a designated alternate site supervisor with the responsibilities, accountability, and authority of the absent supervisor will be appointed. If such an individual is not appointed, all construction work will be halted until the site supervisor returns. The site supervisor and alternate site supervisor for this project are:

1. Site Supervisor(s): ( ) Alternate Site Supervisor: ( ) [Company] will allow only qualified/certified employees to operate equipment and machinery. A qualified operator is one knowledgeable of the equipment’s/machine’s operations, operations manual, limitations, restrictions, and safety requirements.

Employees will not use cell phones/texting devices while operating equipment (including hand tools, machinery, and heavy equipment) or driving vehicles (hands-free only in vehicles).

All employees are encouraged to send suggestions or report issues about project and facility safety and health to the project site supervisor, the NASA/KSC assigned Safety Specialist, or by calling the KSC Institutional Safety Division at (321) 867-SAFE (7233) without fear of retribution.

Employees performing work in or transitioning through a construction site controlled by another contractor will follow the safety and health requirements of that worksite and apply common sense to avoid injuries. In addition, when working in the vicinity of or transitioning through an area where KSC operations are in progress, employees will follow the safety and health requirements and direction of the NASA controlling authority of the area.

The site supervisor will always have a means of communication to contact emergency services, and emergency numbers will be posted at the worksite in a location where all employees have access. The site supervisor will develop a means of communication to distribute information throughout the worksite (e.g., handheld radios, bulletin boards).

Temporary Structures, Trailers, and Work Areas

1. All temporary structures and trailers will be marked with our company’s name and an emergency contact phone number.

1. Trailers will be preapproved by the KSC CO and the Facility Manager for siting and parking provisions.

1. [Company] will tie down trailers and equipment if they will be stationary for more than two weeks with an anchorage that complies with KSC-PLN-1904, Trailer/Equipment Tiedown Plan, for the Kennedy Space Center. A dig permit will be requested and approved before installing any below-grade anchorage.

1. The worksite for this project will be marked by posted signs containing the following information:

1. Company Name Site Supervisor’s name and contact phone number Contractor Safety Supervisor’s name and contact phone number (if applicable) NASA/KSC Project Contracting Officer’s (CO) name and contact phone number NASA/KSC Contract Officer Representative’s (COR) name and phone number NASA/NASA Safety phone number (321-867-SAFE) Controlled Areas [Company] employees will not enter posted controlled areas, nor will the integrity of any installed protective system (e.g., guardrails, safety signs, warning lights) be made inoperable, without proper written approval from the CO in consultation with the proper facility management and the KSC Institutional Safety Division.

Safety Systems – (Permanently Installed)

1. [Company] employees will protect and in no way invalidate the integrity of any installed safety systems or personnel safety devices such as firefighting equipment and sensing devices, fire alarm centers, fire water supply, guard rails, safety chains, warning lights, and safety signs. Prior CO approval will be obtained when access to device-guarded systems is needed.

1. In the event [Company] or NASA/KSC decides (with CO [or designee] and NASA Safety concurrence) that it is necessary to temporarily remove or invalidate any personnel safety devices to perform a task, alternate means of protection will be documented, approved (by the CO and NASA Safety), and implemented before removing or invalidating any permanently installed safety devices or equipment.

Pretask Meetings [Company] will conduct a pretask meeting and communicate all job-related safety issues to all employees before the start of each workday, when a task changes during operations, before any hazardous task, or before any confined space entry. When a task involves a confined space entry, completion of this meeting will be noted on the confined space entry permit. This meeting at a minimum will cover:

1. Work tasks planned for the day including sequence and hazard management.

1. Weather issues that could affect that day’s work.

1. PPE required for that day’s work task(s).

1. Safety hazard awareness (from JHA).

Safety Meetings

1. The first meeting will occur before beginning work on the first day of the job. If a break of more than five days occurs during the performance of the contract, the site supervisor or the alternate site supervisor will conduct a safety meeting on the first day back on the job.

The site supervisor or alternate site supervisor will conduct and document weekly safety meetings for all employees at the jobsite. The meeting will discuss safety and health-related issues and any incidents (and any corrective actions taken) that have occurred at the site.

The documentation of safety meetings will include a summary of the items covered, the date and location of the meeting, the name and signature of the person conducting the meeting, and a roster of attendees.

Documentation of these safety meetings will be kept at the construction site for review.

Worksite Inspections [Company]

1. [Company] will conduct or ensure a daily inspection of the jobsite, materials, and equipment is conducted to identify and mitigate existing or potential hazards. This inspection will be performed by a designated competent person.

1. At least weekly, the site supervisor will document the completion of these inspections and note any findings and mitigations.

The worksite inspections will be performed by a competent person who can identify existing and predictable hazards in the surroundings or working conditions that are unsanitary, hazardous, or otherwise dangerous to employees and who has the authorization to take prompt corrective measures to eliminate them.

NASA Safety

1. [Company] understands the jobsite is subject to inspection by NASA Safety and Health personnel at any time.

1. [Company] understands that safety violations will be documented. The site supervisor will work with KSC Construction Safety Specialists, the CO designated representative (COR), and CO (depending on severity) to implement corrective action(s).

Heat Stress [Company] and subcontractor heat stress prevention policy:

1. Enter method(s) for receiving KSC weather warnings

1. Describe your training and education for heat stress hazards, risk factors, effects of heat stress, signs, and symptoms awareness, and the actions to take if someone has symptoms or observes others in distress.

1. Describe your approach for supplying potable water, work breaks, and any other accommodations for preventing heat-stress-related illnesses.

Clothing

1. All employees conducting work on this project will wear appropriate clothing. Appropriate clothing consists of, at minimum, long pants, a short-sleeved (sleeves at least four inches in length) or long-sleeved shirt (no tank tops), and the proper style of shoe determined by the type of work being performed. Overly loose-fitting, torn, or ragged clothing will not be acceptable.

The site supervisor will check daily that workers have the proper clothing suitable for tasks and the hazard level of work being performed.

Fire retardant clothing will be worn for designated tasks that present a potential for arc flash, flash fire, or explosion to minimize the effects of arc flash, flash fires, and burns from contacting hot equipment and material. This is also addressed in the sections for electrical and welding work CHAPTER 1: Project-Specific Safety and Health Section Cranes and Lifting Operations Is this section applicable to the scope?

1. A list of certified mobile crane operators and signal persons is provided in Table 3.

Table 3: Operator and signalperson Roster

All cranes and lifting equipment are certified for operational use by <<enter appropriate authorizing agency(s)>>.

The working area around any lifting operation will be controlled by <<enter means of control>>. Only personnel essential to the lifting operation will be inside the controlled area. If the controlled area cannot be maintained, the lifting operation will be discontinued.

All crane operations will follow the NASA/KSC Adverse Weather requirements and this plan. When moving cranes, adhere to the crane manufacturers’ wind limits for both operations and positioning.

[Company] will submit a written lift plan to the COR and the KSC Institutional Safety Division for all crane lifting operations per KNPR 8715.7, Cranes and Lifting Operations.

Cranes will not be used to hoist employees on a personnel platform unless a written plan is provided to the COR and KSC Institutional Safety Division for review and concurrence.

Cranes left outdoors will be secured by the operator when operations are complete. Cranes of any height will be lowered during the hours of darkness. If this is not possible, the crane will be lit per Federal Aviation Administration (FAA) regulations.

Mobile Elevating Work Platforms – Is this section in scope?

1. [Company] employees will receive formal training in mobile elevating work platforms (MEWP) before being allowed to use any MEWP identified in the equipment section of this PSHP.

1. Employees will have fall protection qualifications consistent with those set forth by OSHA, KSC-STD-0033, and validated as current by [Company] (or our subcontractor for their employees) before operating any MEWP.

1. Training documentation is provided in Appendix A.

Equipment - (Is this section in scope?)

1. All [Company] and subcontractor-owned, leased, and rented specialty or heavy equipment proposed for use on the contract including, but not limited to, forklifts, lulls, cranes, earth moving equipment, MEWPs, and other power industrial trucks are as follows:

1. Use this space to list equipment (Hit "Enter" for a new numbered line) All operators of the listed equipment are trained per manufacturer protocols and OSHA requirements. Documentation of training is included in Appendix A per the training and applicable equipment sections.

Demolition - (Is this section in scope?)

1. [Company] will submit a site-specific demolition plan for review and approval to the COR and NASA Safety. All demolition will be performed under the supervision of a competent person. Depending on the scope of demolition, [Company] may also require a Professional Engineer (PE) to be on staff and involved in the development of the plan.

Competent Person Name PE Name Excavation – (Is this section in scope?)

1. [Company] recognizes that all soil on KSC and CCSFS is classified as Type C.

All excavation will be supervised under the guidance of a competent person. The competent person assigned to this project is: Competent Person Name [Company] will have an approved Utility Locate/Excavation Permit Request (EPR: (nasa.gov)) anytime any ground is dug into for any reason, to any depth. Permits will remain on-site for the duration of the permit. Any deviations from the approved excavation routing will be approved through the same request process in advance. Adherence to excavation permit conditions is mandatory.

All excavations within 24 inches of a marked/located utility line will be hand dug in all directions.

When called for on the dig permit, pilot trenches will be hand dug for all underground utility work along the centerline of new trenches and down to the elevation of the bottom of the new utility. The pilot trench will be carefully opened to determine the existence and location of any existing active underground utilities which will be protected and kept in service.

Machine excavation may begin only after it is ensured that the pilot trench has satisfactorily located and protected all such existing utilities.

A record of daily inspections will be kept at the jobsite.

Electrical Safety - (Is this section in scope?)

1. Describe the protocols for work on or near any electrical system(s) per the KNPR 8715.7, Electrical Safety section requirements.

1. Describe your protocols for developing a task-specific electrical risk assessment, completed by a qualified person per the KNPR 8715.7 Electrical Safety section.

1. The qualified person for electrical safety assigned to this project is Qualified Person Name.

Lockout/Tagout (Control of Hazardous Energy) - (Is this section in scope?)

1. [Company] will control the unexpected release of energy in construction by applying LOTO using the KSC Form 20-165 as the primary tag.

If [Company] or our subcontractor(s) perform servicing and maintenance of NASA-owned or operated equipment, they will use established procedures for that system or equipment performing work requiring LOTO using the KSC Form 20-195 and 20-195A as the primary tag and identifier.

The [Company] authorized person(s) for project tasks requiring servicing and maintenance of equipment is/are:

1. Authorized Person(s) (Hit "Enter" for a new numbered line) Recordkeeping [Company] and subcontractors will keep an inventory of all locks, LOTO tags, and Danger tags including the location with an equipment identifier where they are applied using KSC Form 28-915, Lockout Lock and Lockout Tag Inventory Record, and KSC Form 28-914, Danger Tag Use Control Log.

Fall Protection - (Is this section in scope?)

General

1. [Company] will comply with all fall protection requirements found in KNPR 8715.7 and KNPR 8715.3-1.

1. [Company] will use appropriate fall protection when work is being performed at heights at or above six feet. If a hazard exists below six feet onto which an employee could fall, the same fall protection requirements will be followed.

1. All activities requiring fall protection will be supervised under the guidance of a competent person. The designated competent person for this project is Competent Person Name.

When beyond the scope of a competent person, site-specific fall protection equipment, anchorages, and lifelines will be selected by a designated qualified person. The designated qualified person for this project is: Qualified Person Name Other employees serving in user or special roles (e.g., safety monitors) are:

1. Use this space to list employees. (Hit "Enter" for a new numbered line) Fall Hazard Survey and Mitigation Planning

1. [Company] and our subcontractors will survey the project area for fall hazards and create a written plan to mitigate all fall hazards (i.e., a Fall Hazard Mitigation Plan).

[Company] Fall Hazard Mitigation Plans will be submitted to the COR and NASA Safety for review and concurrence. [Company] understands that the NASA KSC Fall Protection Program Manager (FPPA) may also review these plans as part of an ongoing effort to survey and document fall hazards across KSC/CCSFS.

At a minimum, the Fall Hazard Mitigation Plan(s) will include:

1. Official Facility Number Brief work task description and frequency The specific location of the hazard Specific fall hazard(s) an employee will be exposed to during the work task Hazard Mitigation(s) (e.g., Fall Arrest, Fall Restraint, Warning Lines, Specialized PPE, weather stoppage parameters) Applicable anchor strength(s) and fall clearance checks/calculations Rescue Plan Fall Protection Competent Person responsible for the initial creation or approval of the plan Scaffolding - (Is this section in scope?)

1. [Company] designated competent person for the erection and inspection of any scaffolding systems on this project is: Competent Person Name Scaffolding inspection will be documented and available to employees that access the scaffold. A tag will be affixed to the scaffold for ease of review.

Fire Protection and Prevention - (Is this section in scope?)

Site-Specific Fire Protection Program [Company] has a site-specific fire protection program (Appendix C) that complies with NFPA 241, “Safeguarding construction alteration and demolition operations” to ensure fire prevention protocols are followed throughout all phases of construction. Firefighting equipment used on this project includes:

1. Use this space to list equipment (Hit "Enter" for a new numbered line) Hot Work Permits - (Is this section in scope?)

[Company] will obtain a KSC Hot Work Permit(s) from Kennedy Fire Services before any:

1. Hot work for demolition, modification, or new construction that includes welding, cutting, burning, open flame and heat-producing operations, soldering, heat sealing, or any spark-producing operation (e.g., grinding). (KSC Form 2-271) Hot work for roof construction or repair using “tar kettle” or “torch-down” operations (KSC Form 2-272).

Handling and Storage of Flammable Liquids - (Is this section in scope?)

1. Flammables and any other volatile material will be removed from worksites at the end of each day and stored in an area previously approved by the CO/COR and the KSC Fire Prevention Office or removed from the installation.

All hazardous material spills will be reported immediately by calling 911, (321) 867-7911 (cell phone on KSC), (321) 853-0911 (cell phone on CCSFS), the CO/COR, Environmental Point of Contact (EPOC), and NASA Safety.

Stored containers will be sealed or covered.

Leaking containers will be removed from the storage area or taken to a safe location outside the building and the contents transferred to an undamaged container.

Wiping rags, drop cloths, paint brushes, and rollers will be stored in covered metal containers at the end of each working day.

Welding and Cutting Operations - (Is this section in scope?)

[Company] will ensure a KSC Hot Work Permit(s) (KSC Form 2-271) is obtained from Kennedy Fire Services before any hot work for demolition, modification, or new construction that includes welding, cutting, burning, open flame and heat-producing operations, soldering, heat sealing, or any spark-producing operation (e.g., grinding).

Pressure Vessels and Pressurized Systems – (Is this section in scope?)

1. [Company] will design, operate, maintain, and test contractor-owned pressurized systems (e.g., gas lines) and pressure vessel systems (PVS) temporarily used at KSC per the applicable standards listed in NASA-STD-8719.17, NASA Requirements for Ground-Based PVS, Chapter 5, Table 6, Application of National Consensus Codes, Standards, and Laws to PVS.

[Company] will design and build contractor-developed PVS designed and built for permanent installation at KSC in compliance with NASA-STD-8719.17 and KNPR 8715.3-1, Chapter 7.

Industrial Hygiene - (Is this section in scope?)

1. [Company] will comply with KNPR 1840.19, KSC Industrial Hygiene Program to provide employees with an environment in which occupational health hazards are identified, evaluated, and eliminated or controlled in such a manner that personnel will not suffer adverse health effects due to their employment.

1. When required by the scope of work, [Company] will develop site-specific plans to address the safety and health of personnel for any of the following safety and health program elements:

1. Method(s) used to conduct workplace inspections and review of operations/procedures to identify all expected exposures to hazardous conditions (e.g., noise) and hazardous materials (e.g., chemicals, lead, asbestos).

1. Confined space entry procedures

1. Hazardous material handling protocols

1. Hearing conservation requirements

1. Respiratory protection requirements

1. Personal protection equipment (PPE) requirements Method(s) to ensure SDS for materials used in the workplace are reviewed to identify health hazards, symptoms of exposure, and requirements for safe use of the material.

Method(s) to ensure [Company] employees are aware of hazardous materials and physical agents that may cause injury or illness in the work area, understand the requirements for safe work with these materials and agents and know what actions to take in an emergency (e.g., chemical spill or release).

Process Safety Management - (Is this section in scope?)

1. In areas covered by the OSHA Process Safety Management (PSM) Standard, employees will receive an awareness briefing on PSM before any work occurs and records of the briefing are to be provided to the COR.

The site supervisor will inform the project COR and the assigned Safety Specialist of any unique hazards to the facility presented by the contractor's work or of facility hazards found during the contractor’s work.

Radiation Protection - (Is this section in scope?)

[Company] will comply with KNPR 1860.1, KSC Ionizing Radiation Protection Program, KNPR 1860.2, KSC Non-Ionizing Radiation Protection Program, and applicable Federal, state, and local regulations for these types of activities.

This section applies to all [Company] employees and subcontractors for the use of ionizing or non-ionizing radiation-producing equipment, devices, materials, or operations such as radiographic projectors, lasers, radiofrequency (RF)/microwave transmitters, XRF (X-ray fluorescent) detection systems, or radioactive materials.

Work Zone Maintenance of Traffic - (Select Applicability From Dropdown) If applicable, use this space to explain the details of the MOT, who developed it and their qualifications, where it will apply (physical location), and where to find the plan (Appendix D).

Appendix/Attachment A Appendix/Attachment B Training records

Appendix/Attachment C Job hazard analyses

Appendix/Attachment D Site-Specific Fire Protection Program

Appendix/Attachment E MOT Plan image1.wmf