B.08.02 - APPENDIX-A - EM_385-1-1 .pdf

Item Description Yes No N/A

1. Signature sheet

a. Includes the name, signature, and title of the Plan Preparer (Qualmed person, i.e. corporate safety staff person, QC)

b. Includes the name, signature,and tiUe of the Plan Approver {e.g.

owner, company president, regional vice presiden

c. Includes the name{s), signature(s), and title{s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel(contractor))

2.Background information

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d. Includes the Brief Project Description.

e. Includes the Location of the Project {map).

f. Includes a means to evaluate the work being done (see AHA requirements in 01.A.13) and associated hazards involved.

g. Addresses the identified hazards involved and the control measures to be taken.

3. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthfulworkplace for all employees.

4.Responsibilities and Lines of Authorities a.Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level - including their resumes.

b.Includes the lines of authority.

5. Training- new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements 6.Procedures for job site inspections - assignment of responsibilities and frequency CESO Checklist A-01,Sep 14

U.S.Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan

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

If service, supply and R&D contracts with limited scopes are awarded, the contractor may submit an abbreviated Accident Prevention Plan. This 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.

Remarks (Any NO or N/A Item)

Date of Inspection

Location (Plant or Facility) Contract Number

Contractor Name Project Name

Date of Inspection

7.Procedures for reporting man-hours worked and reporting and investigating any accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative

(CO/COR).

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 wom.

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 ANSIZ89.1 and shall be wom by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in {b) above 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 wom 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 chemicalirritants.

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. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.

CESO Checklist A-01,Sep 14

U.S.Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan 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 effect and MSDSs 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 DOrs

MUTCD.

15. Control of Hazardous Energy (Lockout/Tagout). Before an employee perfonns any servicing or maintenance on any equipment where the unexpected unergizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of

16. Driving, working on (i.e., working with equipmenUmowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly.

Other Remarks

CESO Checklist A-01,Sep 14

Remarks (Any NO or N/A Item)

U.S.Army Corps of Engineers Safety Inspection Checklist

Abbreviated Accident Prevention Plan

1. Signature sheet

a. Includes the name, signature, and title of the Plan Preparer (Qualified person, i.e. corporate safety staff person, QC )

b. Includes the name, signature, and title of the Plan Approver (e.g. owner, company president, regional vice president ) (HTRW activities require approval of a Certified Industrial Hygienist, a Certified Safety Professional may approve the plan for operations involving UST removal where contaminants are known to be petroleum, oils, or lubricants).

c. Includes the name(s), signature(s), and title(s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel (contractor)) (e.g. Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project

QC. )

2. Background information

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d. Includes the Brief Project Description.

e. Includes the Location of the Project (map).

f. Includes the Contractor Accident Experience (Copy of OSHA

g. Includes the Listing of Phases of Work and Hazardous Activities Requiring an Activity Hazard Analyses (AHA).

3. Statement of Safety and Health Policy. Includes a copy of the corporate safety policy. (In addition to the corporate policy statement, a copy of the corporate safety program may provide a portion of the information required by the accident prevention

4. Responsibilities and Lines of Authorities

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

b. Includes the lines of authority.

CESO Form A-02 Sep 13

Remarks (Any NO or N/A item)

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist

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 XX Sept 2014. The references included in this checklist correspond to the applicable sections of EM 385-1-1.

5. Training

a. Includes the list of subjects to be discussed with employees at safety indoctrination.

b. Includes the list of mandatory training and certifications applicable to this project (e.g., explosive actuated tools, confined space entry, crane operator, diver, vehicle operator, HAZWOPER training and certification, PPE ) and any requirements for periodic retraining / recertification.

c. Includes the identity requirements for emergency response training.

d. Includes the outline requirements (who attends, when given, who will conduct, etc. ) for supervisory and employee safety

6. Safety and Health Inspections

a. Includes the name(s) of individual(s) responsible for conducting safety inspections. (e.g., PM, safety professional, QC, supervisors, employees )

b. Includes proof of inspector's training / qualifications.

c. Indicates when inspections will be conducted.

d. Furnished sample forms upon which inspections will be recorded.

e. Indicates deficiency tracking system and follow-up procedures.

f. Includes the names of competent and / or qualified person(s) and proof of competency / qualification to meet specific OSHA competent / qualified person(s) requirements.

g. Includes any external inspections / certifications which may be required. (e.g., US Coast Guard )

7. Safety and Health Expectations, Incentive Programs, and Compliance

a. Includes the company's written safety program goals, objectives, and accident experience goals.

b. Includes a brief description of the company's safety incentive programs (if any ).

c. Includes the policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements).

d. Includes the written company procedures for holding managers and supervisors accountable for safety.

8. Mishap Reporting

a. The plan identifies how, when, and who shall complete the Exposure data (man-hours worked).

b. The plan identifies how, when, and who shall complete mishap investigations, reports, and logs.

c. The plan identifies how, when, and who shall make immediate notification of major mishaps.

CESO Form A-02 Sep 13

Remarks (Any NO or N/A item)

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

9. Plans (Programs, Procedures) required by the Safety Manual

a. Fatigue Management Plan (01.A.20)

b. Emergency response plans:

(1) Procedures & Test (01.E.01)

(2) Spill Plans (01.E.01, 06.A.02)

(3) Fire Fighting Plan (01.E.01; 19.A)

(4) Posting of Emergency Telephone Numbers (01.E.05)

(5) Man overboard/abandon ship (19.A.04)

(6) Medical Support. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (Section 03.A; 03.D)

c. Plan for prevention of alcohol and drug abuse (01.C.02)

d. Site Sanitation Plan (Section 02.B)

e. Medical Support Plan, (03.A.01; 03.A.06; 03.D)

f. Bloodborne Pathogen Plan (03.A.05)

g. Exposure Control Plan (03.A.05)

h. Site Layout Plan (04.A)

i. Access/Haul road Plan (04.B)

j. Hearing Conservation Program (05.C)

k. Respiratory Protection Plan (05.G)

l. Health Hazard Control Program (06.A)

m. Process Safety Management Plan (06.B.04)

n. Lead Abatement Plan (06.C & Specs)

o. Asbestos Abatement Plan (06.C & Specs)

p. Radiation Safety Program (06.F)

q. Abrasive Blasting Plan (06.I)

r. Heat/Cold Stress Monitoring Plan (06.J)

s. Indoor Air Quality Management Plan (06.L)

t. Mole Remediation Plan (06.L.04)

u. Chromium (VI) Exposure Evaluation (06.M)

v. Crystalline Silica Assessment (06.N)

w. Lighting Evaluation (07.A)

x. Lighting Plan for Night Operations (07.A.09) CESO Form A-02 Sep 13

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:

9. Plans (Programs, Procedures) continued.

y. Traffic Control Plan (08.C.05)

z. Fire Prevention Plan (09.A.01)

aa. Wild Land Fire Management Plan (09.L)

bb. Arc Flash Hazard Analysis (11.B)

cc. Assured Equipment Grounding Control Program (AEGCP), (11.D.05, App D)

dd. Hazardous Energy Control Plan, (12.A.01)

ee. Standard Pre-Lift Plan (LHE) (16.A.03, 16.L.15)

ff. Critical Lift Plan – LHE (16.H)

gg. Naval Architectural Analysis (16.L)

hh. Contingency Plan for Severe Weather (19.A.03)

ii. Man Overboard/Abandon Ship (19.A.04)

jj. Float Plan (19.F.04)

kk. Fall Protection Program, (21.D);

ll. Demolition/Renovation Plan (to include engineering survey), (23.A.02)

mm. Rope Access Program, (24.H.02)

nn. Excavation/Trenching Plan, (25.A.01)

oo. Underground construction fire prevention and protection Plan, (26.D.01)

pp. Compressed Air Plan, (26.I.01)

qq. Formwork and Shoring Erection and Removal plan, (27.C)

rr. PreCast Concrete Plan, (27.D) ss Lift. slab plans, (27.E)

tt. Masonry Bracing Plan, (27.F.01)

uu. Steel Erection Plan, (28.B)

vv. Explosives Safety Site Plan (ESSP) (29.A)

ww. Blasting Plan, (29.A; 26.J)

xx. Underwater Dive Operations Plan, (30.A.14, 16, )

yy. Tree Felling/Maintenance Program, (31.A)

zz. Aircraft/Airfield Construction Safety & Phasing Plan, (32.A.02) aaa. Site Safety and Health Plan (HTRW), (33.B) bbb. Confined Space Entry Program, (34.A.06, 07)

10. Risk Management Processes. Detailed project-specific hazards shall be identified and controls provided via Activity Hazard CESO Form A-02 Sep 13

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:

Other Remarks:

CESO Form A-02 Sep 13