CTR078665 Site Specific Health and Safety Plan.pdf

Site Specific Health and Safety Plan

(Demolition of Right of Way Parcel

Parcel# 7-12414 & 7-12373)

Site Specific Health and Safety Plan

MP Environmental Services, Inc.

1.0 – Project Description & Contacts

Developed for: ADOT – Right of Way

City / State Phoenix, Arizona

Project Location 7029 W Wier Ave., Phoenix, AZ; 6802 W. Romley Ave., Phoenix, AZ

General Scope of Work, Project Description

Demolition and site improvement at the above listed locations.

Project Personnel Name Phone Number(s) Email

MP Office Paula Wilson 602-278-6233 pwilson@mpenviro.com MP Operations Manager Shane Wilson 602-278-6233 swilson@mpenviro.com MP Project Manager Brendan Mills 928-240-0236 bmills@mpenviro.com MP Site Contact Brendan Mills 928-240-0236 bmills@mpenviro.com MP Safety Representative Bruce Utter 480-307-4855 bruceu@mpenviro.com Customer Site Contact Brendan Mills 928-240-0236 bmills@mpenviro.com Corporate Safety Manager Mike Killeen 661-742-4705 mkileen@mpenviro.com

2.0 – Subcontractor Statement

Only subcontractors familiar with MP’s policies and procedures will be utilized. All subcontractors will have completed MP’s Subcontractor Safety and Pre-Qualification Questionnaire and will provide information on the following programs:

Incident rate Short Service Employee program Behavior-Based Safety program Job Safety Analysis program Drug and Alcohol program Motor Vehicle Safety program Insurance Information Regulatory Compliance Training Incident and Injury Reporting

3.0 – Incident, Injury and Illness Management

First Aid/Minor Treatment Treat onsite and if needed follow up with Occupational Clinic.

Name

Address

Phone

Minor Treatment Facility

NextCare Urgent Care Az 7650 S. 59th Ave., Phoenix, AZ

602-476-8888

Emergency Treatment Facility

Dignity Health = Az General Hospital

7171 S. 51st Dr. Laveen Villiage, AZ

623-584-5100

Local Law Enforcement

Local Fire Department

Incident Response

*Maps attached

Emergency Incident Procedures:

Step 1: Notify Site Safety and size-up situation based on available information.

Step 2: Notify ADOT Project Manager.

Step 3: As necessary, request assistance from outside sources and /or allocate personnel and equipment resources for response.

Step 4: As appropriate, evacuate site personnel and nearby public and contain hazards.

Step 5: Prepare Incident Report.

Emergency Injury Procedures:

Step 1: Get medical attention for the injured person immediately.

Step 2: Notify Site Safety and ADOT Project Manager.

Step 3: Depending on the type and severity of the injury, notify the Regional Occupational

Physician.

Step 4: Notify the injured person’s Human Resources office.

Step 5: Prepare the Incident Report.

4.0 Security Measures

Report any security concerns to site contact Brendan Mills.

5.0 - Safety Meetings, Audits, Observations and Inspections

Safety Meetings: Daily Tailgate Meetings, Monthly Safety Meetings

Observations: Conducted by MP Safety Department/Supervisors Daily

Audits: Conducted by MP Safety Department/Supervisors Weekly

Inspections: Conducted by MP Operators, Drivers, Techs and Supervisors Daily.

6.0 – Project Characterization

Work Activity Task Description JSA Description Permits Obtain Dust Permit / File NESHAP

Mob and setup

Mobilize equipment and personnel to project site, Perform Hazard Assessment and review HASP and Permits with crew.

Demolition Demolition/Removal of structures, fencing, trees, trash, concrete, etc.

Site Stabilization Stabilize and firm project site

Demobilize Pick up site area and secure equipment for transit to next site.

Repeat and final transit to MP yard.

Check all of the hazards below that apply to this project.

List mitigations and additional PPE required.

Hazard Mitigation / Additional PPE

☐ Ammonia Nitrate

☐ Asbestos

☐ Benzene

☐ Blood Borne Pathogens

☐ Burns

☐ Carbon Monoxide

☐ Coal Tar Mastic

☐ Cold

Required site PPE will include: hard hats, high visibility apparel, work boots, gloves.

☒ Dust Dust control measures / Obtain Dust Permit

☐ Epoxy Resins

☒ Falling Objects Proper PPE, Site awareness, Aware of surroundings, Communication

☐ Fiberglass

Grinding

Dusts

Hazard Mitigation / Additional PPE

☐ H2S

☐ Heat

☐ Hydrocarbon Liquid

☐ Hydrofluoric Acid

☐ Lube Oils

☐ Noise (>85dBA)

☐ N.O.R.M.

☐ Oxygen (lack of)

☐ Paint Dust

☐ PCB’s

☐ Sewage

☐ Silica Sand

☐ Solvents

☐ Water

7.0 - Project Support Features, Site Control & Logistics

List description for the following facilities and equipment.

Facility/Equipment Description

Portable Restrooms/wash stations

Supplementary Illumination N/A

Emergency Eyewash/Shower

First Aid Supplies Located in each truck

Fire Extinguishers Located in each truck

Hazardous Material Storage N/A

Spill Containment/Clean-up N/A

Other:

Other:

8.0 – Required Training and Qualifications

Training Records Location:

MP Corporate Offices – Bakersfield, CA

Yes No Training

☐ ☐ Abrasive Blasting

☒ ☐ Basic New Employee Orientation

☒ ☐ Behavior Based Safety

☒ ☐ Blood borne Pathogens

☒ ☐ Emergency Evacuation (Drills, Muster Points)

☒ ☐ Emergency Response Plan

☒ ☐ Fire Safety

☐ ☐ First Aid (CPR, EMS)

☒ ☐ Hazard Identification and Awareness

☒ ☐ Hazmat Training

☒ ☐ Hearing Conservation Program

☐ ☐ Hot Work

☐ ☐ Industrial Hygiene Exposure Monitoring

☒ ☐ Near Miss Reporting

☒ ☐ Personal Protective Equipment

☐ ☐ Radiation Control

Yes No Training

☒ ☐ Respiratory Protection Program

☒ ☐ Safety Observation/Audit

☒ ☐ Signs and Barricades

☒ ☐ Heavy Equipment Operator Training

☒ ☐ Back Injury Prevention

☐ ☐ Benzene, Asbestos, Lead, and H2S Awareness

☒ ☐ Body Positioning Training

☒ ☐ Confined Space Entry

☒ ☐ Defensive Driving/Driving Safety

☒ ☐ Electrical Safety

☒ ☐ Excavation and Trenching

☒ ☐ Fall Protection

☐ ☐ Fire Watch

☐ ☐ Flammable and Toxic Material Handling

☒ ☐ Hazard Communication (SDS), Labeling, etc.

☒ ☐ Hazardous Energy / Electrical Lock-Out Tag-Out

☒ ☐ HAZWOPER Training

☒ ☐ Heat and Cold Stress Prevention

☐ ☐ Incident Investigation and Reporting

☒ ☐ Job Safety Analysis

☐ ☐ Powder Actuated Tools

☒ ☐ Respiratory Control

☐ ☐ Safety Equipment Usage

☐ ☐ Scaffolding Safety

☐ ☐ Welding/Cutting

☐ ☐ Other:

☐ ☐ Other:

☐ ☐ Other:

☐ ☐ Other:

☐ ☐ Other:

☐ ☐ Other:

☐ ☐ Other: