HS Reqs and Checklist.pdf

January 2023

Health and Safety Requirements For Various Services

In Support of High-Hazard Site Projects

The activities to be performed by the selected subcontractor will require providing various support services in support of a hazardous waste site activity, and there may be some potential for subcontractor personnel to encounter hazardous waste in the performance of their tasks. Therefore, the requirements of OSHA standard 29 CFR 1910.120 (entitled Hazardous Waste Operations and Emergency Response) are applicable to subcontractor services. The Subcontractor will also be required to recognize and comply with any other OSHA or other regulatory requirements applicable to their services.

The Contractor Health and Safety Questionnaire included as Attachment 1 must be completed and included with bid submittals. Bidders should note that copies of their completed OSHA Injury and Illness annual summary Logs for the last 3 full calendar years must also be provided with submitted bids (i.e., OSHA Form 300 and Form 300A). Any bids received that do not include both a completed Questionnaire and accompanying OSHA 300A/300 Logs will be considered nonresponsive. If your organization is exempt from maintaining OSHA injury and illness documentation, a different form of documentation (containing at least the same information as the 300A/300 Logs) may be used, but this information must still be submitted with the bid.

The Checklist included below should be used to ensure that bidders comply with all Health and Safety submission requirements. The information provided as Attachment 2 (if provided) presents additional information and explanation for the bidder’s use in preparing their bid submissions and may be required of the successful bidder.

Bidder Health and Safety Submission Checklist

Item Include With

EVERY Submittal

If Part of a Proposal, Submit

With Proposal

Submit To Tetra Tech Project

Manager After Notice of Award and Prior To Mobilization

Completed Contractor Health And Safety Questionnaire X X OSHA 300A/300 Logs For Previous 3 Calendar Years (redacted if necessary)

X X

Letter from insurance carrier insurance stating the current EMR X X Current, valid certificate of insurance (i.e. ACORD Certificate or similar proof of coverage)

X X

Employee Information for Site Access X X Employee Training/Medical Surveillance Letter X X Copies of applicable employee training certificates and medical surveillance clearances (for each participating employee)

X

Chemical Inventory and Material Safety Data Sheets X

ATTACHMENT 1

CONTRACTOR HEALTH AND SAFETY QUESTIONNAIRE

Date: Telephone Number:

Fax Number:

E Mail Address:

Name of Company:

Address:

Submitted By: Title:

Type(s) of Primary Services Offered:

Your firm’s primary North American Industry Classification System (NAICS) code or Standard Industry Classification (SIC) code number: NAICS #: SIC #:

1. Has your company performed work as a subcontractor to Tetra Tech previously?

Yes No

If yes, explain the nature of the work, project location, Tetra Tech Point of Contact, and project dates (if your company has worked for Tetra Tech on multiple contracts, include this information only for the most recent job):

2. List your company’s Workers’ Compensation Experience Modification Rate (EMR) for the last 3 full years below. Put the most recent year first (i.e. 2022 or current 2023). Please attach documentation from your insurance carrier stating the current EMR. If you have different rates for interstate and intrastate, complete both of the following sections:

INTRASTATE EMRs Year 1: EMR : Carrier

Year 2: EMR : Carrier

Year 3: EMR: Carrier

INTERSTATE EMRs Year 1: EMR : Carrier

Year 2: EMR : Carrier

Year 3: EMR: Carrier

3. If you do not have any EMR information to provide, please explain (or attach additional documentation as necessary):

4. How long have you been covered by your current provider of worker’s compensation insurance?

years

5. Has there been a change in ownership in your company within the last 3 years?

Yes No

6. Does your company employ more than 10 full time employees?

Yes No

If yes, what is the average number of employees on your payroll for the last 3 years?

2022 2021

7. Using data from your OSHA 300 Logs for the last 3 full calendar years, complete the table below.

Put the most recent data first. A copy of each OSHA 300A/300 Log used to fill in the table MUST BE submitted with this questionnaire. If your organization is exempt from maintaining OSHA 300A/300 Logs, a different form of documentation (containing at least the same information as a 300A/300 Log) may be used, but this information must still be submitted.

Forms can be downloaded from OSHA: http://www.osha.gov/recordkeeping/RKforms.html

2020 2021 2022 A. Number of Fatalities (Total from column G on OSHA 300 Log) B. Number of cases that involved lost workdays and/or days of restricted work activity (Totals from columns H and I on OSHA 300 Log)

C. Total Recordable Cases (total number of entries in column A on the 300 Logs)

D. Total Man-hours worked E. OSHA Total Cases Incidence Rate* F. OSHA Lost Workday Cases

Incidence Rate*

* Instructions on calculating the OSHA Incidence Rates for Question #7:

The equations below demonstrate how to do the calculations.

Total Cases (item C) X 200,000 = OSHA Total Cases Incidence Rate (item E) Total Man-hours Worked (item D)

Lost Workday Cases (item B) X 200,000 = OSHA Lost Workday Cases Total Man-hours Worked (item D) Incidence Rate (item F)

Note: Only man-hours actually worked by direct employees of your company and temporary workers contracted and under the direct supervision of your company are to be used in calculating your OSHA Incidence Rates. Do not include any non-work hours even if these hours were paid (vacation, holidays, sick-time, etc.).

http://www.osha.gov/recordkeeping/RKforms.html

8. Please place a check beside the classification below which most closely describes your company’s primary type of business.

Classifications (Check one only)

Drilling Contractor Land Surveyor Waste Transporter Residential Building Contractor Non-residential Building Contractor Heavy Construction (except building) Highway/Street Contractor Heavy Construction (except highway) Plumbing, Heating, Air Conditioning Contractor Electrical Contractor Masonry/Stonework/Plastering Contractor Roofing/Siding/Sheet Metal Contractor Concrete Contractor Nondestructive Testing Miscellaneous Special Trades Other (please describe briefly)

9. Attach copies of any citations your company has received in the last 3 years from any government regulatory agency, such as Federal or state OSHA or EPA. Please include information as to the disposition of the citation and any corrective actions taken by your company.

If your company has not had any citations in the last 3 years, indicate so in the space provided.

No citations received in the last 3 years.

10. Has your company experienced any occupational fatalities in the past 5 years?

Yes No

If yes, provide an explanation below. List location, causes, and corrective actions (use additional sheets of paper as necessary)

11. Have your activities resulted in property damage claims in excess of $1,000 within the last 3 years?

Yes No

If yes, provide an explanation below (use additional sheets of paper as necessary)

12. Do you have a written occupational safety and health program? (If yes, we may request a copy) Yes No

13. If yes, who is responsible for administering the program?

14. Explain how health and safety requirements are implemented and enforced on your jobsites?

15. Indicate subject matter in which your employees have received training:

Yes No Yes No Company safety policy/rules Fire protection/hot work Confined space entry Decontamination Procedures Heavy equipment operation Hazard communication/Right-to-Know Health and safety plan requirements Electrical safety/lockout-tagout Chemical and physical hazard recognition

Fall Protection

Emergency response procedures First aid/CPR Injury reporting Drum handling Personal protective equipment Drilling hazards Non-injury accident reporting (near-miss)

Hearing conservation

Respiratory protection Trenching/excavation

16. Have the employees whom you intend to use on this project been trained in accordance with the OSHA Hazardous Waste and Emergency Response (HAZWOPER) standard [29 CFR 1910.120(e)]?

Yes No

17. What is the frequency of your HAZWOPER refresher training?

18. Can you provide documentation of such training?

Yes No

19. How many hours of initial HAZWOPER safety and health orientation training are conducted?

20. How many hours of annual HAZWOPER safety and health orientation training are conducted?

21. Do you conduct field safety inspections of work in progress? Yes No

a) If yes, who conducts inspection?

b) How often?

22. Do you conduct routine equipment inspection/maintenance on your vehicles including drill rigs, excavators etc.?

Yes No

23. Do you have a Medical Surveillance Program as required by 29 CFR 1910.120(f)?

Yes No

24. Do you intend to use ANY subcontractors in order to complete the proposed project?

Yes No

If yes, complete the following for EACH proposed lower-tier subcontractor. Include all subcontractors and be aware that they too will likely require Tetra Tech approval (attach additional sheets as necessary)

Name of lower-tier subcontractor #1:

Lower-tier subcontractor’s scope of work?

Name of lower-tier subcontractor #2:

Lower-tier subcontractor’s scope of work?

Name of lower-tier subcontractor #3:

Lower-tier subcontractor’s scope of work?

Name of lower-tier subcontractor #4:

Lower-tier subcontractor’s scope of work?

Name of lower-tier subcontractor #5:

Lower-tier subcontractor’s scope of work?

Please have an officer of the company sign below certifying that the information provided in this document is current and correct.

Officer Name (Printed)

Title

Signature

Date

MISREPRESENTATION OF DATA REQUESTED IS GROUNDS FOR IMMEDIATE TERMINATION OF

CURRENT SUBCONTRACTS AND DISQUALIFICATION FROM FUTURE CONSIDERATION.