SOW-3054 - Reference A.pdf

Fax completed copy to LOTP Committee at x2540.

Hazardous Energy Control Contractor Compliance Certification Document Rev C 2/10/2016

Purchase Order Number___________________________________ Job Location_____________, ___ New Equipment Y/N__N_____

Company name ___________________ Date __________

By the contractor’s representative’s signature below the contractor’s representative certifies that the Company whose name is listed above understands and agrees to the following requirements for any task or work the contractor performs aboard the Portsmouth Naval Shipyard (NAVSHIPYD PTSMH) that involves Hazardous Energy Control (HEC).

29 CFR Part 1915.89, which became effective and enforceable on 31 October 2011, provided a new standard addressing hazardous energy control in shipyard employment. Part 1915.89 applies to private-sector contractors performing servicing operations in shipyard employment, and states the Navy’s HEC Program is in effect in Naval Shipyards. Private-sector contractors performing work that involves HEC aboard NAVSHIPYD PTSMH are responsible for ensuring the safety of their employees who may perform tasks or work involving HEC.

The contractor’s representative’s signature below certifies that the contractor understands and shall comply with all requirements for work involving HEC as provided in 29 CFR Part 1915.89 and the Naval Sea Systems Command (NAVSEA) Occupational Safety, Health and Environmental Corporate Manual (OSHECM) Chapter 250 (latest revision), including Lockout/Tags-Plus (LOTP). The text of 29 CFR Part 1915.89 is available at the OSHA Fact Sheet web site, and the latest revision of OSHECM Chapter 250 is available at;

http://www.navsea.navy.mil/Portals/103/Documents/NNSY/OSHECM%20Chapter%20250-

Modified%20for%20Public%20Access.pdf

WARNING: CONTRACTOR’S FAILURE TO COMPLY WITH THE HEC REQUIREMENTS REFLECTED IN 29 CFR PART 1915.89 AND OSHECM CHAPTER 250 MAY CAUSE SERIOUS INJURY OR DEATH TO THE CONTRACTOR’S EMPLOYEES. UNDER NO CIRCUMSTANCES SHALL THE PORTSMOUTH NAVAL SHIPYARD ASSUME ANY LIABILITIES THAT RIGHTLY ARE THE

RESPONSIBILITIES OF THE CONTRACTOR.

Shop Card Holder/POC__________________________________________________________________________________

Lockout/Tags-Plus Coordinator _______________________________________________________________________________

Coordination Req’d (circle one) ( Y / N ) LOTP Serial Number ______________________

Contractor’s Representative’s Name (Print clearly) ____________________________________________________________ Contractor’s Representative’s Signature ____________________________________________Date_____________________ http://www.navsea.navy.mil/Portals/103/Documents/NNSY/OSHECM%20Chapter%20250-Modified%20for%20Public%20Access.pdf http://www.navsea.navy.mil/Portals/103/Documents/NNSY/OSHECM%20Chapter%20250-Modified%20for%20Public%20Access.pdf