EXHIBIT_13_CESHC.pdf

Fermilab 013100 - CESH Certifícate Rev. 06/2020

013100 CESHC INSTRUCTIONS 1 of 2

Construction Environmental, Safety & Health Certification

(CESHC)

INSTRUCTIONS

This Construction Environmental, Safety & Health Certification (CESHC) is required for each construction project at DOE’s Fermi National Accelerator Laboratory site (Fermilab). See Technical Specification 013100 for further information.

This document is a template for the CESHC designed to assist construction subcontractors in describing project conditions and developing project-specific hazards and controls information.

The CESHC template is available in electronic format to facilitate editing.

The prime subcontractor may either flow down this requirement to each of its subcontractors; or serve as a control and coordination point, requiring all subcontractors’ activities to be conducted under the prime subcontractor’s solitary CESHC.

Subcontractors must submit the completed CESHC to the FRA Procurement Office, which will distribute the document for review and concurrence by the FRA ES&H and Project Management teams prior to work commencing. The CESHC is intended to be a living document, which may be updated as necessary throughout a project as information changes or as the project progresses (e.g. – as additional Task/trade Hazard Analyses are developed, subcontractors added, etc.).

All of the sections in are required to be completed for each construction project, regardless of the size or complexity. Enter information in all of the fill-in blocks that are applicable. For those that are not applicable, enter “N/A” or other suitable explanation.

Rev. 06/2020

013100 CESHC INSTRUCTIONS 2 of 2

PROJECT GOVERNANCE / EMERGENCY INFORMATION

Section 1 – Project Description and Emergency Contacts Fill in the names and telephone numbers of the contact personnel for this particular project. In accordance with Title 10 of the Code of Federal Regulations, Part 851 (10 CFR 851), the Subcontractor must have a designated on-site safety representative who is knowledgeable of the project’s hazards and has the authority to correct unsafe conditions or behavior. This is either the Field Superintendent or a designated Subcontractor’s Safety Representative as delineated in Technical Specification 010010. Attach the qualifications of your safety representative’s resume’ for this project. If you have subcontractors performing work on this project, list their contact information. Update as necessary throughout the project.

Section 2 – Subcontractor Policy Statement Enter your Company’s health and safety policy statement. At minimum, your policy should include:

• Specify if Subcontractor’s ES&H Program is required and if a dedicated Subcontractor Safety Representative is required.

• Specify if a Quality Control Plan (Reference Technical Specification 010010 if a dedicated Quality Control Representative is required.

• A statement if occupational exposure monitoring is required and if so, that it complies with

10 CFR 851.

• Specify what occupational (industrial hygiene sampling) monitoring may be required.

Section 3 – 10 CFR 851 Acknowledgement Because Fermilab is a Department of Energy site, your company must meet the Department of Energy requirements of Title 10, Code of Federal Regulations, Part 851, “Worker Safety and Health Program” (Link to 10 CFR 851). It is your responsibility to ensure you have read and understand the actual regulatory requirements. Specify medical surveillance and qualifications.

This may include Occupational exposure monitoring.

https://www.gpo.gov/fdsys/granule/CFR-2012-title10-vol4/CFR-2012-title10-vol4-part851

013100 CESHC 1 of 4 Rev.06/2020

(Project Name)

(Subcontractor’s Name)

Construction Environmental, Health & Safety Certification

SECTION 1 - PROJECT DESCRIPTION & EMERGENCY CONTACTS

Subcontract / Project Number Enter subcontract and/or task order number

Project Start / End Dates Start: Complete:

Project Location Enter the work location(s) at Fermilab

Scope of Work Enter breakdown and description of work activities

FOR ALL EMERGENCIES CALL:

Fermilab Emergency Contact number: x3131 - or - (630) 840-3131 from a cell phone.

For all incidents, injuries, property damage, near-misses, work-induced illness or chemical over-exposures, the following personnel MUST be immediately contacted upon scene stabilization, but in all cases within one hour:

PROJECT TEAM & PERSONNEL CONTACT INFORMATION

Subcontractor Project Manager Enter the name of subcontractor Project

Manager Enter number: xxx-xxx-xxxx Enter: user@domain

Subcontractor Site Superintendent

Enter the name of subcontractor's Site Superintendent

Enter number: xxx-xxx-xxxx Enter: user@domain

Subcontractor Health & Safety Representative **

Enter the name of subcontractor health & safety representative

Enter number: xxx-xxx-xxxx Enter: user@domain

Subcontractors - Company Name Name of Designated Safety Representative ** Phone Number

Enter Subcontractor company name Enter name of individual** Enter number: xxx-xxx-xxxx

Enter Subtier company name Enter name of individual** Enter number: xxx-xxx-xxxx

Enter Subtier company name Enter name of individual** Enter number: xxx-xxx-xxxx ** If required, attach a description of qualifications, or resume’, for each Safety Representative per Technical Specification 010010.

CESHC REVIEWS

Reviewed & Approved by:

(Subcontractor)

CESHC Reviewed & Accepted by: (FRA) CESHC Reviewed & Accepted by:

(FRA)

Enter Subcontrator - Company Officer Enter FRA CC/TM Name Enter FRA ES&H Name

Signatures and dates

013100 CESHC 2 of 4 Rev.06/2020

FRA has identified several medical facilities. Highlight on the map the appropriate subcontractor designated facility. If the subcontractor would like to use another or different facility, please include map and address location of facility.

A location map and address of the Subcontractor’s occupational medical facility Hospital Route is attached to this CESH Certificate and posted at the work site.

013100 CESHC 3 of 4 Rev.06/2020

SECTION 2a – Subcontractor’s ES&H Program 2a Subcontractor’s ES&H Program Required See Technical Specification 013100, Article 1.9 Yes No 2b Dedicated Subcontractor Safety Representative required, see Technical Specification 010010 (If yes, Subcontractor Safety Representative resume’ required, reference Article 1.5)

Yes No

SECTION 2b – Subcontractor’s Quality Control Plan (Program) if Section 014100 is required 2c Subcontractor’s Quality Control Plan (Program) Required Yes No 2d Dedicated Subcontractor Quality Control Representative required Yes No

Section 2c - Occupational Exposure Monitoring and Qualifications Occupational Exposure Monitoring Will you be using materials or engaging in an activity that potentially may produce occupational exposures at 10 to 50% of the occupational exposure limits? (e.g., silica, hexavalent chromium, lead, etc.)

Reference Section 10 for additional information.

If yes, you will need to:

1. Comply with 10 CFR 851, Appendix A, Section 6.

2. Provide your industrial hygiene provider contact information.

Certified Industrial Hygienist (CIH) or IH Technician under the supervision of a CIH.

.Enter the name and address of your company's IH provider for this project

Section 2d - Industrial Hygiene Sampling Yes No

Asbestos

Asphalt fumes

Diesel Exhaust

Fiberglass Insulation

Hexavalent Chromium

Lead

Naphtha (Coal Tar)

Noise

Non-Ionizing Radiation

Silica

Solvents

Temperature Extremes (Heat or Cold)

013100 CESHC 4 of 4 Rev.06/2020

Welding, Cutting & Brazing

Other: (List...)

SECTION 3 - ACKNOWLEDGMENT of 10 CFR 851 As a subcontractor to FRA, while your workers are physically located at Fermilab you must meet the requirements of Title 10, Code of Federal Regulations, “Energy”, Part 851, “Worker Safety and Health Program” (10 CFR 851). As such, you must be aware of, and comply with, the requirements of this regulation. (Link to 10 CFR 851)

Acknowledgment I, (the author of this CEHSC), certify that that I have read the requirements of 10 CFR 851 and attest that my firm and its sub-tier contractors will comply with the requirements of 10 CFR 851.

MEDICAL SURVEILLANCE AND QUALIFICATION

Occupational Medicine Will you have any employees that will work on-site at Fermilab for 30, eight-hour days in a 12-month period, or are enrolled for any length of time in a medical or exposure monitoring program required by federal, state, or local regulations (including hearing conservation, respiratory protection, lead exposure)?

If yes, you will need to:

1. Comply with the occupational medicine requirements of 10 CFR 851, Appendix A

2. Provide your occupational medicine provider contact information

Clinic / Physician Enter the name and address of your company's occupational medicine provider for this project

Enter telephone number:

xxx-xxx-xxxx

Enter e-mail address:

user@domain

Required Medical Surveillance Task-specific medical testing

DOT/Commercial Vehicle Blood Lead Hearing Conservation Respirator User Fit for Duty Other(s) List other(s) Substance Abuse Testing

List specific task(s) requiring medical surveillance https://www.gpo.gov/fdsys/granule/CFR-2012-title10-vol4/CFR-2012-title10-vol4-part851