Exhibit G - APP ENG Form 6293.pdf

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ENG FORM 6293, AUG 2023

Page of

ENG FORM 6293, AUG 2023

Page of U.S. Army Corps of Engineers (USACE)

ACCIDENT PREVENTION PLAN (APP) WORKSHEET

For use of this form, see EM 385-1-1; the proponent agency is CESO.

This form serves as a guide. It does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Occupational Health Requirements Manual. The references included in this form correspond to the applicable chapters of EM 385-1-1. No work will begin onsite until the accident prevention plan (APP) is developed according to the EM 385-1-1, reviewed to ensure minimum requirements are met, and approved by the appropriate personnel identified in “Part 1 -Signatures”

PART 1 - SIGNATURES

Plan Preparer - For example: Qualified Person (QP), Competent Person (CP), or project Quality Control (QC).

Plan Approver - Corporate Safety Official Plan Concurrence - For example: Industrial hygienist, Project Manager, Superintendent, Site Safety & Health Officer, Quality Control, etc.

PART 2: PROJECT INFORMATION

PART 3: PRIME CONTRACTOR INFORMATION

PART 4: SOH COMMITMENT AND POLICY

5. Prime contractor is responsible for the implementation and enforcement of the SOH program for contractor employees, subcontractors, suppliers, and visitors at the site of work?

6. Prime contractor will require subcontractors, suppliers, and visitors to comply with the APP and EM 385-1-1?

7. No work will be performed unless a designated SSHO is present on the site of work.

8. A list of all known subcontractor(s) and supplier(s) are listed in Appendix 2.

9. If all subcontractor(s) and supplier(s) are not known at the time of initial APP submittal, Appendix 2 will be updated and resubmitted to the KO/COR for acceptance prior to the start of any work activities.

10. All subcontractors will have a copy of the APP, applicable AHAs and will be required to comply with them.

11. Subcontractors and suppliers at the site of work will abide by the EM 385-1-1, this APP, and all AHAs.

12. This APP and AHAs will be available to all workers at the site of work.

PART 5: TRAINING

1. All employees will be trained according to applicable EM 385-1-1, federal, state, and local requirements prior to the commencement of work.

2. The following personnel are identified and designated as personnel responsible for SOH on this project. Add the following documentation to Appendix 3 of this worksheet: 1) SSHO designation letter (ENG Form 6282), 2) instructor signed OSHA 30-hour card (or course completion certificate if within 90 days of having completed the OSHA 30-hour training), and 3) proof of 24 hours of competency of SOH training within the last 3 years for the personnel identified below. (EM 385-1-1, Chapter 2, 2-3 Personnel Qualification/Training):

(Check and list names of personnel being designated)

PART 6: SOH INSPECTIONS

1. All applicable inspections required by EM 385-1-1, contract, federal, state, and local requirements will be completed.

2. The following personnel are assigned to conduct inspections, the type of inspection and frequency for the worksite. At minimum the SSHO must conduct daily site inspections.

Who will conduct inspection?

Frequency?

What type of inspection?

What type of inspection?

3. Employees that conduct inspections will have technical proficiency needed to perform inspections. Proof of inspector's training/qualification is included in Appendix 3.

4. Deficiencies will be documented and tracked as required by this EM 385-1-1?

PART 7: ACCIDENT REPORTING AND INVESTIGATION

1. Exposure data (man-hours worked) will be reported to KO/COR as required by the contract?

2. All accidents will be reported as soon as possible according to EM 385-1-1?

3. All accidents occurring incidentally to an operation, project, or facility for which the EM 385-1-1 is applicable will be thoroughly investigated and analyzed. Corrective actions to prevent reoccurrence will be implemented as soon as reasonably possible. The KO/COR will be notified when corrective actions are completed.

4. Accident notification will be provided to the KO/COR as stated below:

ACCIDENT TYPE

KO/COR NOTIFICATION TIME

Fatality, permanent and partial disability, or property damage over $600,000 Immediately, no later than (NLT) 8 hours All other accidents and near misses Immediately, NLT 24 hours

PART 8: SOH OVERSIGHT

1. A risk management process that meets or exceeds the requirement of the EM 385-1-1 will be implemented on this project site?

2. Hazardous conditions and unsafe acts will be immediately corrected?

3. APP and AHAs will be prepared by a QP or CP according to the EM 385-1-1 prior to the start of any work activities on the site of work (as much as the information can be known at that point in time).

4. The plans and AHAs will be updated throughout the life of the project to include changes in personnel, equipment, conditions, etc. Additional revisions must be incorporated as necessary to reflect changing site conditions, construction methods, personnel roles and responsibilities and construction schedules.

5. No activity/work will be started at the site of work until the APP is reviewed and submitted to the KO/COR for acceptance, with the site-specific plans and procedures required by the EM 385-1-1 to complete the project?

6. APP and AHAs will be provided to and reviewed by all workers involved in the activity prior to work?

7. Workers will sign AHA(s) to concur with identified job steps and controls needed to mitigate hazards?

PART 9: SEVERE WEATHER PLAN

1. The SSHO or designated onsite personnel is responsible for checking the weather conditions at a minimum of twice a day?

PART 10: ACTIVITY HAZARD ANALYSIS (RISK MANAGEMENT)

4. Anticipated High-Risk Activities: (See examples below, check all that apply):

5. Detailed project-specific hazards and controls will be provided utilizing AHAs for each activity/DFOW.

6. No work will begin on an activity/DFOW until the initial AHA addressing the project-specific hazards has been developed, reviewed, and accepted by the KO/COR. (See EM 385-1-1 Chapter 2 section 2-6).

7. AHAs are living documents and are intended to be created, utilized in the field, and updated (by the workers) as necessary.

8. Workers/crews will have accepted AHA(s) that reflects current site conditions, personnel, equipment, control measures, etc.

while the work is being performed?

9. AHA will be used by the contractor personnel to assure work is being performed consistent with the AHA?

10. Once the activity has been completed, the AHA will be available and kept onsite for the length of the contract.

11. AHAs for unknown work activities will be submitted to the KO/COR prior to work and attached to Appendix 4 of this document.

12. Who has the authority to accept residual risk on AHA(s)? (List below) Category of Risk Extremely High Risk Approval Authority (Name and Title) High Risk Medium Risk Low Risk

PART 11: REQUIRED PROJECT SITE-SPECIFIC PLANS AND PROCEDURES

1. Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the contractor will ensure that all applicable SOH risks and associated compliance plans are in place.

2. Include all project-specific compliance plans, as applicable to the work being performed, and as identified below. The plans will incorporate project-wide procedures to control hazards to which the employees of all project employers may be exposed.

3. These plans and procedures will be coordinated with all project employers and be included in project-specific emergency response and evacuation procedures.

4. Address each of the plans in the outline below in the order that they are listed.

Option 1: If a plan is applicable, develop and attach it to Appendix 5. Submit to the KO/COR with this worksheet for acceptance prior to work.

Option 2: If a plan is applicable, but all of the minimum required information for the plan is not yet known, provide justification next to each plan title, and provide an expected date the plan will be created, reviewed, and attached to Appendix 5. Submit to the KO/COR with this worksheet for acceptance prior to work.

Option 3: If a plan is not applicable because of the nature of the work to be performed, provide justification next to each plan title.

Minimum plans required by EM 385-1-1 Justification for Option 2 and Option 3 Select Option Reference EM 385-1-1 paragraph:

Exposure Control Plan 3-7.a AED Program 3-7.b Construction Site Plan 4-7.a Access/Haul Road Plan 4-7.b Hearing Conservation Program 5-7.a Respiratory Protection Program 5-7.b Hazard Communication (HazCom) Program 6-7.a Process Safety Management (PSM) Program 6-7.b Lead Compliance Plan 6-7.c Asbestos Management Plan 6-7.d Ionizing Radiation Safety Plan 6-7.e Radiofrequency Plan 6-7.e Abrasive Blasting Plan 6-7.g Thermal Stress Management Plan 6-7.h Mold Remediation Plan 6-7.i Silica Compliance Plan 6-7.j Fatigue Management Plan 6-7.k Night Operations Lighting Plan 7-7 Traffic Control Plan 8-7 Fire Prevention Plan 9-7.a Wildland Fire Management Plan 9-7.b Housekeeping Plan 10-7 Electrical Safety Plan 11-7 Assured Equipment Grounding Conductor Program 11-7.b Energy Control Plan 12-7.a Hazard Isolation Procedures 12-7.b Demolition Plan 17-7 Emergency Plan for Marine Activities 19-7.a Severe Weather Plan for Marine Activities 19-7.b Float Plans 19-7.c Tow Plans 19-7.d Fall Protection and Prevention Plan 21-7.a Rescue Plan 21-7.b Scaffold Work Plan 21-7.b Rope Access Work Plan 23-7 Excavation and Trenching Plan 25-7 Fire Prevention and Protection Plan 26-7 a & f Compressed Air Work Plan 26-7 a & b Contingency Response Plan 26-7 a & c Emergency Rescue Plans and Equipment 26-7 a & d Ventilation and Dust Control Plan 26-7 a & e Formwork and Shoring Plan 27-7.a Masonry Bracing Plan 27-7.b Steel Erection Plan 28-7.a Site Layout Plan 28-7.b Explosive Site Safety Plan 29-7.a Master Blasting Plan 29-7.b Vibrations Monitoring Plan 29-7.c Dive Operations Plan 30-7.a & d Emergency Management Plan 30-7.a & e Safe Practices Manual 30-7.b Snorkeling Plan 30-7.f Tree Maintenance and Removal Plan 31-7 Construction Safety and Phasing Plan 32-7.a Safety Plan Compliance Document 32-7.b Aviation Pre-Accident Plan 33-7 Standard Lift Plan 34-7.b Confined Space Plan 34-7.b & c Standard Lift Plan - Floating Plan 34-7.c Critical Lift Plan 34-7.d Pile Driving 34-7.e Housekeeping Plan 35-7.a Extermination Plan 35-7.b Site Safety and Health Plan 36-7.a Comprehensive Work Plan 36-7.b Emergency Response Plan 36-7.c

PART 12: PROJECT SITE COORDINATION

PART 13: REQUIRED APPENDICES Indicate if each of the following items are, or are not, attached to this plan.

Appendix 1. Project Map Appendix 2. Subcontractor/Suppliers Appendix 3. Personal Qualifications and Designations Appendix 4. Activity Hazard Analysis Appendix 5. Site-specific plans and procedures Appendix 6. Any additional plans, procedures, etc. can be added to this appendix and will be coordinated with the KO/COR.

1.0 darwin.chen@usace.army.mil 2023-08-08 Forms Design Team Darwin Chen 2023-08-30

ACCIDENT PREVENTION PLAN (APP) WORKSHEET

ACCIDENT PREVENTION PLAN (APP) WORKSHEET