Exhibit L Construction Environmental Safety Health Certification CESHC.pdf
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- Attached to
- C0 Service Building Renovation
- Solicitation number
- ISD_362164_DA
About this file
This document is a Construction Environmental, Safety & Health Certification (CESHC) template required for construction projects at the Fermi National Accelerator Laboratory site. The CESHC template assists subcontractors in describing project conditions, identifying hazards, and developing appropriate controls. Subcontractors must submit the completed CESHC for review and concurrence by the Fermi Research Alliance (FRA) Environmental, Safety & Health and Project Management teams prior to commencing work. The CESHC is intended to be a living document that can be updated as project information changes. Key requirements include acknowledgment of compliance with 10 CFR 851 Worker Safety and Health Program, provision of occupational medicine provider information, and identification of task-specific medical surveillance needs. Subcontractors must also highlight their designated medical facility from a list provided by FRA.
The related federal contract opportunity is for the C0 Service Building Renovation project at the Fermi National Accelerator Laboratory. The scope of work includes replacing doors, windows, flooring, and plumbing fixtures, as well as patching and painting walls. Interested parties should review the attached Statement of Work titled "Exhibit A SOW C0_Renovation" for more detailed information.
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Fermilab 013100 CESHC 1 of 3 Rev. 06/2021
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.
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
Fermilab 013100 CESHC 2 of 3 Rev. 06/2021
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.
Yes No
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)?
Yes No
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 Information Clinic Name & Address: Enter telephone number: Enter e-mail address:
(Optional)
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:
Signature (Subcontractor) Dated Signature (FRA) Dated https://www.gpo.gov/fdsys/granule/CFR-2012-title10-vol4/CFR-2012-title10-vol4-part851
Fermilab 013100 CESHC 3 of 3 Rev. 06/2021
FRA has identified five medical facilities. Please highlight the facility to be used or identify and provide a map of an alternate selected place. Annotate address for designated facility.
| undefined: |
| undefined_2: |
| undefined_5: |
| undefined_6: |
| Clinic Information: |
| Clinic Name Address: |
| Enter telephone number: |
| Enter email address Opt onal: |
| Others List others: |
| Signature SubcontractorRow1: |
| DatedRow1: |
| Signature FRARow1: |
| DatedRow1_2: |
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