N3319123R4017 Kombewa Water System Attach 5 - Safety Checklist.docx

Attachment 5

Safety Checklist Form

The contractor shall comply with local safety regulations, unless the U.S. Safety Regulations included in the U.S. Army Corps of Engineers Safety and Health Requirements Manual (EM 385-1-1) are more strict and not in conflict with the local regulations. In this case, U.S Safety Regulations shall apply. The EM 385-1-1 can be downloaded from the following website: http://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/EM_385-1-1_English_2003.pdf

Safety Checklist Requirements

Within 30 days of award of the contract, the contractor will provide a safety plan to monitor personnel performance during construction, and identify one competent employee in accordance with EM 385-1-1 to ensure execution of the safety plan.

The contractor will provide a full-time, on-site Site Safety and Health Officer (SSHO) that meets the requirements of the EM 385 Section 01.A.17, specifically:

- Five (5) years of continuous general industry or construction safety experience in supervising/managing general industry or construction (managing safety programs or processes or conducting hazard analyses and developing controls). Documentation for validation is required within 30 days of contract award.

- Completion of 30-hour OSHA Construction Industry safety class (may be web-based training if the student is able to directly ask questions of the instructor by internet or phone). Documentation for validation and proof of completed training is required within 30 days of contract award.

The contractor will provide a plan to monitor all subcontractor performance during construction if subcontractors will be used. The contractor and subcontractors must also comply with EM 385-1-1.

The contractor shall provide all necessary and required Personal Protective Equipment (PPE), which shall be used as required by the specific risk.

Steel toed shoes

Helmets

Vests and gloves

Eye and ear protection

Shoring for excavation, as needed

The use of helmets or "hard hats" is absolutely required for all personnel entering the job site. In addition the contractor shall have a minimum of 5 new hard hats to be used by any authorized visitor to the job site.

The contractor's price shall include the cost for any and all safety requirements for this project.

As a certified agent of this Company, I acknowledge and agree to the safety factor requirements.

Company Name:

Contractor's Printed Name:

Contractor's Signature:

Date: