Atch(1c)_PWS_Section_J_Attachment_0200000_Kitchen_Exhaust_System_Part3.pdf

Section J – 0200000 Management and Administration

Attachment Number Attachment Title

J-0200000-01 Definitions and Acronyms J-0200000-02 Directives, Instructions, and References J-0200000-03 Sample Invoice Cover Form (NAVFAC 7300/30) J-0200000-04 Daily Report Form J-0200000-05 Contractor QMS Pre-Performance Review Checklist J-0200000-06 Sample Secondary Job Notification Form J-0200000-07 Sample AHA Form J-0200000-08 Contractor Crane Operating Checklist For Critical Lifts J-0200000-09 Sample NAVFAC CIRS Report Form J-0200000-10 Sample NAVFAC Initial Mishap Notification Report Form J-0200000-11 Sample Crane and Rigging Gear Accident Report Form J-0200000-12 Sample Initial Near Miss Notification Report Form J-0200000-13 Sample of the Crane and Rigging Gear Near Miss Report Form J-0200000-14 Installation Spill Preventive Response Plan POL/Hazardous Substance (HS) Spill

Response Flowchart J-0200000-15 Exhibit Line Item Numbers (ELINs)

Attachment J-0200000-01 Definitions and Acronyms

Definition Description Assessment A general term referring to either a survey or inspection of a facility to determine condition.

Asset A general term used to refer to an item, such as a component, system, building or facility, which is managed by an automated data management program.

Competent Person A person who has the professional experience and training necessary to identify existing and predictable hazards at a work or service environment, and who has the authority to take prompt and corrective action to eliminate or remove dangers from the environment.

One who can identify existing and predictable hazards in the working environment or working conditions that are dangerous to personnel and who has authorization to take prompt corrective measures to eliminate them.

Confined Work Space A space that is large enough and so configured that a person may bodily enter a space (such as in tanks, vessels, silos, storage bins, hoppers, vaults, pits, and like spaces where there is limited means of entry) and is hindered or restricted from escaping during an emergency.

Contracting Officer (KO) That individual with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings. The term includes certain authorized representatives of the Contracting Officer acting within the limits of their authority as delegated by the Contracting Officer.

Contracting Officer’s Representative (COR)

The individual appointed by the KO responsible for monitoring the Contractor’s technical compliance and progress, relative to assigned contract(s)/orders(s), based on the contract requirements specified in the PWS and in accordance with the Performance Assessment Plan (PAP). The COR performs a variety of contract administration duties that includes oversight of Performance Assessment (PA), documenting and rating Contractor performance, reviewing invoices, and acceptance of work. Assignment as a COR is a collateral duty typically performed by the FSC manager (FSCM) or senior

PAR (SPAR).

Contractor That entity or its representative responsible for the delivery of the services or materials specified in this contract, as designated by contract award. The term Contractor as used herein refers to both the prime Contractor and any subcontractors. The prime Contractor shall insure that subcontractors comply with the provision of this contract.

Contractor Representative That individual appointed by the Contractor, either orally or in writing, who has been assigned responsibility for executing the requirements of this contract.

Direct Material Costs The actual vendor invoice charges for materials used for performance of work under this contract. Direct material costs shall include transportation charges when such charges are included on the invoice by the vendor, as well as any discounts allowed for prompt payment and discounts or rebates for core value or salvage value that accrue to the Contractor. When questions arise concerning the cost of materials, material costs will be based on the lowest of quotes provided by the Contractor from at least three different commercial vendors for the direct material cost. The Government retains the right to obtain additional quotes in questionable situations. The lowest price will be used.

DoD FEDMALL The electronic medium for authorized Government personnel to place orders for Services to the Contractor.

Equipment Tangible asset that is functionally complete for its intended purpose, durable, and non-expendable.

Facility A building or structure designed and created to serve a particular function.

Government Furnished Property

Property in the possession of, or directly acquired by, the Government and subsequently furnished to the contractor for performance of a contract. Government furnished property includes, but is not limited to, spares and property furnished for repairs, maintenance, overhaul, or modification. Government furnished property also includes contractor acquired property if the contractor acquired property is a deliverable under a cost contract when accepted by the Government for continued use under the contract.

Hazardous Material (HM) A material that because of its quality, concentration, physical, chemical or infectious nature may pose a threat to human health or the environment if released or spilled into the environment or any material designated by the Department of Transportation (DOT) or any materials that require a SDS form as posing a potential threat while being transported. HMs are listed in 49 CFR Part 172.

Hazardous Waste (HW) Any discarded solid waste (liquid, semi-solid, solid, or gaseous) that meets the definition of a HW by United States Environmental Protection Agency (USEPA), state authorities, or the Navy. In accordance with Resource Conservation and Recovery Act (RCRA), a solid waste is a listed HW if it is specifically listed, or it is a characteristic HW if it exhibits the characteristics of ignitability, corrosivity, reactivity, or toxicity.

Hazardous Waste (HW) Management Plan

In accordance with OPNAVINST 5090.1C, every Navy shore activity that generates HW shall develop and use a HW Management Plan or a HW management component in its P2 Plan and EMS. A HW Management Plan shall:

• Identify applicable federal, state, and local regulations pertaining to the generation and management of HW.

• Identify training requirements and describe procedures for obtaining training and maintaining training records.

• Assign responsibilities for the generation, designation, handling, storage, treatment, disposal, and all documentation.

• Describe all HW generation and management procedures.

• Include or reference the HW minimization plan and goals.

• Include or reference contingency plans and emergency response procedures.

The plan shall be kept up to date to include changes in hazardous waste generation and management procedures, as well as changes in applicable federal, state, and local hazardous waste regulations. The plan shall include or reference minimization procedures sufficient to achieve DOD minimization goals. Tenant activities are covered by the host CO's HW Management Plan.

Inspection A rigorous, detailed assessment of the condition of a facility performed to generate a fundable scope and cost estimate for prioritization and funding of maintenance and repair.

Integrated Maintenance Program (IMP)

IMP is a recurring state-of-the-art, reliability-centered inspection, testing, maintenance and repair program that determines best practices for managing the functions and consequences of failures of facilities equipment and system components. IMP encompasses accepted commercial practices, including reactive, preventive, predictive and proactive maintenance, into one optimal program. The IMP approach gives the Contractor full responsibility to maintain systems and equipment and perform repairs whenever necessary to ensure equipment and systems are operational and remain in a constant state of readiness. Service orders will not be issued for accomplishment of repairs on systems and equipment maintained under IMP.

Job or Work Order An authorization for work that requires planning and estimating and has an individual line of accounting for financial and performance evaluation.

Less-than-90-day Accumulation Areas or Storage Facilities

Temporary HW storage areas where HW may be stored for up to 90 days without a RCRA permit.

Maintenance And Repair The preservation or restoration of a piece of equipment, system, or facility to such condition that it may be effectively used for its designated purposes. Maintenance/repair may be adjustment, overhaul, reprocessing, or replacement of constituent parts or materials that are missing or have deteriorated by action of the elements or usage, or replacement of the entire unit or system if beyond economical repair.

Monthly On-Site Labor Report

A compilation of all Contractor and subcontractor employee-hours involved in delivering contract services on a Government property.

NAVFAC MAXIMO A specially configured software version of MAXIMO®, a commercially available computerized maintenance management system (CMMS), adopted by NAVFAC for enterprise facility asset data management. The terms “MAXIMO”, “NAVFAC MAXIMO” or “Government’s MAXIMO” shall be used interchangeably in the document.

Non-RCRA Regulated Waste

Waste that is not regulated as a HW under RCRA; however, is waste may be regulated by other federal, state or local regulations including but not limited to Toxic Substances Control Act, Clean Air Act, Clean Water Act or other regulations and statues. Examples include Used Oil, Universal Waste, Oily Water, antifreeze, etc.

Non-RCRA regulated waste (while not meeting the definition of a HW) must be managed according to its applicable regulations and may not be discarded into the general trash.

Non-Regulated Solid Waste (Debris and Rubbish)

Waste not associated with an industrial process such as refuse and scraps resulting from preparation, cooking, dispensing, and consumption of food. Non-hazardous construction and demolition wastes such as dimension and non-dimension lumber, plywood, chipboard, and hardboard are included.

Partnering The terms “partnering” and “partnership” used herein shall mean a relationship of open communication and close cooperation that involves both Government and Contractor personnel working together for the purpose of establishing a mutually beneficial, proactive, cooperative environment within which to achieve contract objectives and resolve issues and implementing actions as required.

Performance Assessment

(PA)

A method used by the Government to provide some measure of control over the quality of purchased goods and services received.

Performance Assessment Representative (PAR)

The individual(s) assigned as a Technical Point of Contact (TPOC) / Subject Matter Expert (SME) to the COR to perform duties as the on-site representative who assesses Contractor performance. The PAR periodically observes Contractor performance, reviews delivered services, reviews quality management corrective actions, periodically assesses and documents Contractor performance on Performance Assessment Worksheet (PAWs) and the Monthly Performance Assessment Summary (MPAS), and communicates findings as necessary with the Contractor, SPAR, and COR.

Property Administrator An authorized representative of the KO who is responsible for administering contract property requirements, terms and conditions of the contract

Property Management Program

A Government program established for the purpose of reviewing and approving the Contractor’s Property Management Plan and System through performance of a system analysis whenever government property is in the possession of the Contractor.

Quality Assurance (QA) The planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled.

Quality Control (QC) The observation techniques and activities used to fulfill requirements for quality.

Regulated Waste (RW) Any hazardous, non-hazardous, industrial process waste (aka special waste), e-waste, and/or off-specification HM, which because of its physical characteristics, chemical make-up or biological nature re quires either special handling procedures and permitting, or poses an unusual threat to human health, equipment, property, or the environment.

Examples include (but are not limited to) liquid sludge, pastes, and/or filter cakes, chemical compounds and/or petroleum products, fine powders or highly dusty materials, spent blast media and/or grit, demolition wastes from industrial facilities, debris and/or residues from spill cleanup work, underground storage tank remediation materials, pollution control wastes, ash from fires, furnaces, boilers or incinerators, off-specification products, other materials that have the potential to be a hazardous waste.

All RW may be used or unused excess HMs. Laboratory analysis may be required to verify the waste is not a RCRA-regulated hazardous waste.

Satellite Accumulation Areas

Designated approved areas, at or near the point of generation and under the control of the operator generating the waste, where no more than 55 gallons (cumulative total) of all types of HW or 1 quart of acutely HW may be accumulated. The 55-gallon limit does not include non RCRA regulated waste, universal waste and used oil etc.

System An assemblage of mechanically and/or electrically interlocked parts, equipment and/or components forming a unitary whole.

Universal Equipment Universal equipment refers to equipment that can cover two or more industries and is commercially employed in execution of operation, maintenance, and repair work, such as: Aerial Work Platforms, Backhoes, Cranes, Dump Trucks, Excavators, Generators, Graders, Lifts, Loaders, Man Lifts, Monitoring and Test Equipment, Pumps, Tractors, Trailers, etc.

Universal Waste (UW) Universal Waste (UW) (defined in 40 CFR Part 273) means batteries, fluorescent lamps, some pesticides, and mercury-containing equipment formally classified as a HW, but that are now subject to less stringent regulations, when recycled if recycling is available.

Acronym Title ACM Asbestos Containing Material ACO Administrative Contracting Officer AHA, AHAs Activity Hazard Analysis, Activity Hazard Analyses ANSI American National Standards Institute APP Accident Prevention Plan ASME American Society of Mechanical Engineers ASSE American Society of Safety Engineers ATCMD Air Traffic Control Maintenance Division BK Burger King Bldg #, Bldg. Building Number CCC, CDC Child Care Center, Child Development Center CDR Contract Discrepancy Report CEU Continuing Education Unit CFR Code of Federal Regulations CHRIMP Consolidated Hazardous Material Reutilization and Inventory Management Program CIRS Contractor Incident Reporting System CLIN Contract Line Item Number CMMS Computerized Maintenance Management System COR Contracting Officer’s Representative CP Competent Person CPARS Contractor Performance Assessment Reporting System CPG Comprehensive Procurement Guideline CS Contracting Specialist CSP Certified Safety Professional DBIDS Defense Biometric Identification System DeCA Defense Commissary Agency DFARS DoD Federal Acquisition Regulation Supplement DoD Department of Defense DoDI Department of Defense Instruction DoN Department of Navy DOT Department of Transportation DR Designated Representative DTCN Designated Third Country Nations eCMRA Enterprise-wide Contractor Manpower Reporting Application ECC Environmental Compliance Course EDC Emergency Dispatch Center ELIN Exhibit Line Item Number EMS Environmental Management System E.O. Executive Order EPA Environmental Protection Agency EPEAT Electronic Product Environmental Assessment Tool FAR Federal Acquisition Regulation FEMP Federal Energy Management Program FLS Flight Line Security FSC Facility Support Contract FSCM Facility Support Contract Manager FY Fiscal Year GDA Government Designated Authority GFE Government-furnished Equipment GFF Government-furnished Facilities

GFM Government-furnished Materials GFS Government-Furnished Services HCA Head Contracting Agency HM Hazardous Material HS Hazardous Substance HW Hazardous Waste IMP Integrated Maintenance Program ISEA International Safety Equipment Association IT Information Technology JCOSHA Japan Construction Occupational Safety and Health Association JEGS Japan Environmental Governing Standards KFC Kentucky Fried Chicken KO Contracting Officer LHE Load Handling Equipment LO lot LSIO Labor Standards Inspection Office MCAS Marine Corps Air Station MCASO Marine Corps Air Station Order MCEN Marine Corps Enterprise Network MLR Multiple Lift Rigging MPAS Monthly Performance Assessment Summary N/A Not Applicable NAVFAC Naval Facilities Engineering Command NAVSUP Naval Supply Systems Command NFBC Naval Family Branch Clinic NMCI Navy Marine Corps Intranet OBOS Other Base Operations Support OEM Original Equipment Manufacturer OPNAV Chief of Naval Operations OPS Airfield Operations Department OSHA Occupational Safety and Health Administration PA Performance Assessment PAP Performance Assessment Plan PAR Performance Assessment Representative PAW Performance Assessment Worksheet PBSA Performance-Based Service Acquisition PCB Polychlorinated Biphenyls P.L. Public Low PM Project Manager PM Planned Maintenance or Preventative Maintenance PMO Provost Marshal’s Office POC Point of Contact POL Petroleum, Oil, and Lubricants PPE Personal Protective Equipment PPIRS Past Performance Information Retrieval System PWS Performance Work Statement QA Quality Assurance QC Quality Control QM Quality Manager or Quality Management QMS Quality Management System

QRP Qualified Recycling Program RCRA Resource Conservation and Recovery Act RFP Request For Proposal RSO Radiation Safety Officer RW Regulated Waste SAE Society of Automotive Engineers SDS Safety Data Sheets SECNAV Secretary of the Navy SME Subject Matter Expert SOH Safety and Occupational Health SPAR Senior Performance Assessment Representative SSHO Site Safety and Health Officer TPOC Technical Point of Contact USACE U.S. Army Corps of Engineers USEPA United States Environmental Protection Agency USFJ United States Forces Japan UW Universal Waste WAWF Wide Area Workflow WHE Weight Handling Equipment YR year

Attachment J-0200000-02 Directives, Instructions, and References

*Note: The Contractor shall refer to the most recent edition.

Reference Title 29 CFR 1910 OSHA Standards 29 CFR 1910.120 Hazardous Waste Operations and Emergency Response 29 CFR 1915 Confined and Enclosed Spaces and Other Dangers Atmospheres in Shipyard

Employment 29 CFR 1926 Safety and Health Regulations for Construction 29 CFR 1926.16 Comprehensive Procurement Guideline for Products Containing Recovered Materials 29 CFR 1926.59 Safety and Health Regulations for Construction, Hazard Communication 40 CFR 247 Comprehensive Procurement Guideline for Products Containing Recovered Materials ANSI A10.32 Fall Protection Systems ANSI Z 359.1 Safety Requirements for Personal Fall Arrest Systems, Subsystems and Components ANSI/ASSE A10.34 Protection of the Public on or Adjacent to Construction Sites American National

Standards for Construction and Demolition Operations ANSI/ISEA 107-2015 American National Standard for High-Visibility Safety Apparel and Accessories ASME B30 Safety Standard DFARS Clause 252.223-

DRUG-FREE WORK FORCE

DFARS Clause 252.232-

Electronic Submission of Payment Requests and Receiving Reports

DFARS Clause 252.232-

Wide Area Workflow Payment Instructions

EM 385-1-1 U.S. Army Corps of Engineers (USACE) Safety and Health Requirements Website (both English and Japanese versions can be found at the following link):

http://www.publications.usace.army.mil/USACEPublications/EngineerManuals.aspx Note: Japanese version is provided for information only. The Contractor shall comply with the most current English version.

E.O. 13834 Planning for Federal Sustainability in the Next Decade

FAR 52.245 GOVERNMENT PROPERTY

FAR Clause 52.223-2 AFFIRMATIVE PROCUREMENT OF BIOBASED PRODUCTS UNDER SERVICE

AND CONSTRUCTION CONTRACTS

FAR Clause 52.223-3 HAZARDOUS MATERIAL IDENTIFICATION AND MATERIAL SAFETY DATA FAR Clause 52.228-5 INSURANCE – WORK ON A GOVERNMENT INSTALLATION FAR Clause 52.237-1 SITE VISIT FAR Clause 52.246-4 INSPECTION OF SERVICE – FIXED PRICE Iwakuni City Ordnance No. 140 of March 2006 (Latest revised edition is No. 35 of December 2016)

Iwakuni City Ordinance for Waste Management and Public Cleansing（岩国市廃棄物

の処理及び清掃に関する条例） Website (Japanese):

http://www3.e-reikinet.jp/iwakuni/d1w_reiki/418901010140000000MH/418901010140000000MH/418 901010140000000MH.html

Japanese Law No. 48 of

Act on the Promotion of Effective Utilization of Resources (資源の有効な利用の促進

に関する法律） Japanese Law No. 57 Industrial Safety and Health Low (Roudo Anzen Eisei Ho) Japanese Law No. 137 of

Waste Management and Public Cleansing Act (廃棄物の処理及び清掃に関する法律)

JCOSHA JCOSHA

Website: https://www.kensaibou.or.jp/ or https://www.kensaibou.or.jp/eng/index.html

JEGS Japan Environmental Governing Standards (JEGS) Website: http://www.usfj.mil/Portals/80/Documents/Other/2016%20JEGS.pdf Japanese version can be found at the following website:

http://www.mod.go.jp/j/approach/chouwa/2016_jegs/index.html (Japanese version is http://www.publications.usace.army.mil/USACEPublications/EngineerManuals.aspx http://www3.e-reikinet.jp/iwakuni/d1w_reiki/418901010140000000MH/418901010140000000MH/418901010140000000MH.html http://www3.e-reikinet.jp/iwakuni/d1w_reiki/418901010140000000MH/418901010140000000MH/418901010140000000MH.html http://www3.e-reikinet.jp/iwakuni/d1w_reiki/418901010140000000MH/418901010140000000MH/418901010140000000MH.html https://www.kensaibou.or.jp/eng/index.html http://www.usfj.mil/Portals/80/Documents/Other/2016%20JEGS.pdf http://www.mod.go.jp/j/approach/chouwa/2016_jegs/index.html

Attachment J-0200000-02 Directives, Instructions, and References

*Note: The Contractor shall refer to the most recent edition.

Reference Title provided for information only. The Contractor shall comply with the most current English version.)

MCASO 3710.3 Air Operations Manual, MCAS Iwakuni, Japan MCASO 5100.20 Procedures for Ground Occupational Safety and Health Program MCASO 5100.23 Fall Protection Program MCASO 5100.24 Procedure for Confined Space Entry MCASO 5100.25 Smoke-free Workplace MCASO 5500.1 Procedures for the Flight Line Security (FLS) Program MCASO 5500.2 Installation Access Control MCASO 5560.8 Motor Vehicle Traffic Supervision NAVFAC Clause 5252.245-9300

GOVERNMENT-FURNISHED PROPERTY, MATERIALS NAD SERVICES

NAVFAC P-307 Management of Weight Handling Equipment NAVFACINST 11260.1 Weight Handling Equipment Program Manual NAVSUP Publication

Consolidated Hazardous Material Reutilization and Inventory Management Program (CHRIMP) Manual

OSHA Directive CPL 2.100

Application of the Permit-Required Confined Spaces (PRCS) Standards, 29 CFR 1910.146

Public Law (P.L.) 91-596 Occupational Safety and Health Act UFC 3-560-01 Operation and Maintenance Electrical Safety USFJ Instruction 31-204 Designated Third Country Nationals (DTCN) Yamaguchi Prefecture Ordinance No. 9 of March 2011 (Revised Version)

Ordinance for Establishing the Recycling-Based Society (山口県循環型社会形成推進

条例) Website (Japanese):

http://www.pref.yamaguchi.lg.jp/cms/a15700/14jourei/jourei/apd1_1_201202061410064 0.pdf

N/A Construction Criteria Base Website: http://www.ccb.org/.

N/A DoD WAWF Receipt and Acceptance system Website: https://wawf.eb.mil http://www.pref.yamaguchi.lg.jp/cms/a15700/14jourei/jourei/apd1_1_2012020614100640.pdf http://www.pref.yamaguchi.lg.jp/cms/a15700/14jourei/jourei/apd1_1_2012020614100640.pdf http://www.ccb.org/ https://wawf.eb.mil/

ATTACHMENTS J-0200000-02

DIRECTIVES, INSTRUCTIONS, AND REFERENCES

Q and A

SSHO 24 Hours of Formal Safety Training

Question: Is only JOSHA the only required source for 24 hours formal safety training?

Answer: No, Contractors are encouraged to seek other recognized sources of formal safety training through the internet, conferences, seminars, etc. that issue a certificate of completion and/or Continuing Education Unit (CEU) credits. CEU is awarded for each 10 contact hours of instruction.

For example: Attendance to a 3-day Safety Convention with seminars may be awarded 1-2 CEUs.

The Contracting Officer or Government Designated Authority (GDA) has final review and acceptance authority.

Question: It seems there are many different courses provided by JCOSHA. What should the Contractor complete first?

Answer: The most important element in safety is being able to recognize hazards on the worksite. To be able to recognize hazards the SSHO needs to have basic knowledge in construction processes or activities in areas of scaffolding, excavation, elevated work, electrical, asbestos, cranes, personal protective equipment (PPE), etc.

One leading causes of fatal accidents on construction sites in Japan is “FALLS FROM HEIGHTS”

Recommend SSHOs start with fall protection training.

Way Forward: NAVFACFE Safety Office is in the process of translating JCOSHA course schedule and listing for review.

Question: Is there any certificate for the required 24-hrs of formal safety training?

Answer: No, the 24-hrs is referring SSHOs need at least a total of 24-hrs of training from a recognized sources such as on-line, JCOSHA courses, seminars, conferences, etc.

For example: Completion of a 10-hr online OSHA class counts to the total of 24-hrs of formal safety training.

SSHO needs to complete at least another 14-hrs or more of formal safety training for the year.

UNCLASSIFIED/FOR OFFICIAL USED ONLY

Attachment J-0200000-03

Sample Invoice Cover Form (NAVFAC 7300/30)

Attachment J-0200000-04 Daily Report Form

CONTRACTOR PRODUCTION REPORT

(ATTACH ADDITIONAL SHEETS IF NECESSARY) DATE

CONTRACT NO TITLE AND LOCATION

REPORT NO

CONTRACTOR SUPERINTENDENT

AM WEATHER PM WEATHER MAX TEMP (F) MIN TEMP (F)

WORK PERFORMED TODAY

WORK LOCATION AND DESCRIPTION EMPLOYER NUMBER TRADE HRS

JOB

SAFETY

WAS A JOB SAFETY MEETING HELD THIS DATE?

(If YES attach copy of the meeting minutes) YES NO

TOTAL WORK HOURS ON JOB SITE,

THIS DATE, INCL CON'T SHEETS

WERE THERE ANY LOST TIME ACCIDENTS THIS DATE?

(If YES attach copy of completed OSHA report) YES NO CUMULATIVE TOTAL OF WORK

HOURS FROM PREVIOUS REPORT

WAS CRANE/MANLIFT/TRENCHING/SCAFFOLD/HV ELEC/HIGH WORK/ HAZMAT WORK DONE?

(If YES attach statement or checklist showing inspection performed.) YES NO

TOTAL WORK HOURS FROM

START OF CONSTRUCTION

WAS HAZARDOUS MATERIAL/WASTE RELEASED INTO THE ENVIRONMENT?

(If YES attach description of incident and proposed action.) YES NO

TOTAL MONTHLY WORK HOURS USED FOR THIS CONTRACT (TO BE SUBMITTED WITH MONTHLY INVOICE) TOTAL WORK HOURS ______________ FOR THE MONTH OF _____________________

LIST SAFETY ACTIONS TAKEN TODAY/SAFETY INSPECTIONS CONDUCTED SAFETY REQUIREMENTS HAVE BEEN MET.

REMARKS

CONTRACTOR/PROJECT MANAGER SIGNATURE &

DATE

REMARKS

On behalf of the contractor, I certify that this report is complete and correct and equipment and material used and work performed during this reporting period is in compliance with the contract drawings and specifications to the best of my knowledge except as noted in this report. AUTHORIZED QC MANAGER AT SITE DATE

GOVERNMENT PERFORMANCE ASSESSMENT REPORT

PEFORMANCE ASSESSMENT REPRESENTATIVE(PAR)'S REMARKS AND/OR EXCEPTIONS TO THE REPORT

GOVERNMENT PERFORMANCE ASSESSMENT REPRESENTATIVE (PAR) DATE

ATTACHMENTS J-0200000-05

Contractor QMS Pre-Performance Review Checklist

GENERAL INFORMATION

NAME PHONE EMAIL

CONTRACTOR Project Manager CONTRACTOR Quality Manager

SUB-CONTRACTOR QC

SUB-CONTRACTOR QC

SUB-CONTRACTOR QC

PERFORMANCE ASSESSMENT

REPRESENTATIVE (PAR)

SUPERVISORY PAR

CONTRACT INFORMATION

TITLE:

Contract #: TO# LOCATION:

START: END: CONTRACT PRICE:

UALITY MANAGEMENT BRIEFING CHECKLIST

CHECKPOINT (Y/N) COMMENTS

QUALITY ORGANIZATION:

Is the QM plan submitted in accordance with Annex 0200000 and Section F requirements?

品質管理プランは Annex 0200000 並びに Section F の要件に

従って提出されているか。

ACCEPTANCE OF CONTRACTOR’S QUALITY

APPROACH DOES NOT LIMIT CONTRACTING

OFFICER FROM REQUIRING ADDITIONAL

MEASURES IF PERFORMANCE IS

UNACCEPTABLE.

Is the Quality organization clearly identified (e.g., org chart) and a list of all Quality personnel provided?

契約履行上の組織内容、編成について明記されており、全て

の品質管理関係人員の名簿も提出されているか。

Are the responsibilities of Quality personnel detailed and lines of authority explained (e.g., Quality staff and Quality Manager reports directly to Prime Contractor management)?

契約履行上の要件となっている品質管理人員の責任並びに組

織内での権限系統について明記されているか。 （例として、品質管理人員並びに品質管理責任者が直接主契

約責任者に対して報告を行う、等。）

Are the training and qualification requirements for Quality staff specified and does the Contractor’s staff meet these requirements?

契約履行上要件となっている品質管理人員に必要とされてい

る資格、訓練等が明記されているか、更にそれらの要件を満

たしているか。

Does the Quality organization show relationship between the Prime Contractor’s Quality staff and Subcontractor’s management or Quality?

組織内容、編成が主契約品質管理人員と下請け業者の品質管

理人員並びにその管理、品質にまで及ぶ内容での関係を示し

ているか。

QUALITY APPROACH:

Is the QM plan current and specifically tailored for this contract?

Contractor QMS Pre-Performance Review Checklist

品質管理プランは最新のものであり、本契約の内容に特に沿

ったものとして作成されているか。 Does the Contractor’s Quality Management System and management approach indicate a clear understanding of the contract requirements?

品質管理体制とその品質管理遂行方法は契約要件をその内容

通り適切に理解したものであるか。

METHODS AND PROCEDURES FOR PERFORMANCE OF WORK:

Does the Contractor provide detail of their work planning and control to ensure first time quality?

This could include:

詳細な作業計画と最高の品質提供を確実にする管理方法につ

いて明記されているか。

a. Proper selection and training of personnel 適切な人員選抜と訓練について明記されているか。

b. Tracking and verification of training and certification requirements 訓練、資格等の有効期限の管理と取得について明記

されているか。

c. Work center supervisor/lead personnel oversight of work performance 作業監督者、作業責任者は作業内容を監督、管理し

ているか。

d. Detailed Standard Operation Procedures and procedures for work requirements 詳細な作業手順書と作業方法について明記されてい

るか。

e. Routine training and meetings 日常、定期的な訓練、会議について明記されている

か。

f. Selection procedures for subcontractors 下請け業者の選別手続きについて明記されている

g. Management control of subcontracted work 下請け業者の作業内容についての管理方法が明記さ

れているか。

SURVEILLANCE AND INSPECTION PROCEDURES:

Does the Contractor provide detailed procedure for the selection of samples (e.g., percentage of work inspected, process for selection of samples, in-process vs. completed work.)?

調査、検査標本として選別する為の詳細な方法が明記されて

いるか。（例として、作業の何割を検査するか、どのように

その調査、検査対象を選別するか、あるいは作業中に対して

作業終了後での検査、等。）

Does the QM plan detail procedures for the collection, recording, and analysis of inspection and surveillance results?

Contractor QMS Pre-Performance Review Checklist

調査、検査結果の収集、記録と分析についての詳細な方法が

明記されているか。 Does the QM plan include processes for utilization analysis of inspection and surveillance results to determine cause and implement corrective actions?

調査、検査結果をどのようにその原因と是正方法を決定して

いく上で利用していくのか明記されているか。

Does the QM plan provide a process for preventing recurrence of quality issues and continuous improvement of work performance?

品質管理上繰り返し発生する問題を防止し、継続した作業改

善を実施する為の方法が明記されているか。

Does the QM plan detail specific procedures for the oversight of subcontracted work or the review and analysis of subcontractor quality?

下請け業務に対する監督あるいは下請け業者の品質に対する

精査、分析について詳細な方法が明記されているか。

DOCUMENTATION AND RECORDS MANAGEMENT:

Does the Contractor have a process for the control and retention of Quality documentation and records?

品質管理書類、記録の管理と保管について明記されている

Does the Contractor provide the controls in place to ensure all Quality records are documented, maintained reviewed and properly filed?

品質管理記録は書面で残してあり、精査、保管され適切にフ

ァイルされているか。

Does the QM plan have a process for the review of documentation for completeness, accuracy, and consistency?

(This may include management reviews or internal audit plan.)

書面の完成度、正確性、一貫性について精査する方法につい

て明記されているか。（管理者による精査あるいは組織内で

の監査による場合を含んでもよい。）

Does the QM Plan provide a process for tracking and ensuring all submittal requirements are met?

全ての提出物の要件が満たされていることを確実にする為の

管理方法が明記されているか。

COMMUNICATION WITH GOVERNMENT:

Does the QM plan address the level, format, and frequency of communications with the government? This could include:

政府側との連絡に際してそのレベル、方法、頻度について明

記されいるか。

a. Routine, yet informal communications between contractor, quality staff, and Government PARs 日常の非公式な品質管理人員と政府品質管理担当者

間の連絡。

Contractor QMS Pre-Performance Review Checklist

b. Established meeting requirements between Contractor Quality and/or management staff with Government PA and/or contracting personnel.

品質管理人員、品質管理責任者と政府品質管理担当

者と、あるいは契約担当者との会議設定について明

記されいるか。

c. Progressive reporting and communication based on the frequency or severity of the issue being addressed (e.g., Quality staff to PAR, Quality Manager to SPAR/FSCM, Project Manager to Public Works Officer) 懸案問題の程度、頻度に応じた発展的な報告、連絡

方法について明記されているか。

d. Details of protocol for attendance at meetings required by contract, including partnering sessions.

契約当事者間の良好な関係確立の為の場も含む契約

要件となっている会議出席への詳細な内部規定が明

記されているか。

REVIEW SIGNATURES

PAR:

DATE:

SPAR:

CONTRACTOR QUALITY MANAGER: DATE:

CONTRACTOR PROJECT MANAGER:

SUBCONTRACTOR:

Attachment J-0200000-06 Sample Secondary Job Notification Form

ATTACHMENT J-0200000-07, SAMPLE AHA

Activity/Work Task: Scaffolding Erection Overall Risk Assessment Code (RAC) (Use highest code) M Project Location: Camp Zama, Japan Risk Assessment Code (RAC) Matrix Contract Number: CEPOJ-SO-263-4873 Severity Probability Date Prepared: Frequent Likely Occasional Seldom Unlikely

Prepared by (Name/Title): Tsuno Toru, SO Specialist Catastrophic E E H H M Critical E H H M L

Reviewed by (Name/Title): Daniel Fujimoto/SOH Manager Marginal H M M L L Negligible M L L L L

Notes: (Field Notes, Review Comments, etc.)

Crane set-up and use are on a separate AHA.

Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above)

“Probability” is the likelihood to cause an incident, near miss, or accident and identified as: Frequent, Likely, Occasional, Seldom or Unlikely. RAC Chart “Severity” is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible

E = Extremely High Risk H = High Risk

Step 2: Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA.

M = Moderate Risk L = Low Risk

Job Steps Hazards Controls RAC General Safety Requirements all Steps

Exposure to Cold or Hot Weather

Dehydration

**Add additional potential hazards for general on site safety requirements. **

The above hazards are not all inclusive and the Site Safety and Health Officer including the Quality Assurance Representative (QAR) shall review the AHAs

Minimum Personal Protective Equipment Dress:

• Long Pants

• Shirts with Sleeves

• Hardhat

• Covered Shoes (Steel Toe Preferred)

• Safety Glasses (Potential Eye Hazard Areas)

Weather:

• Wear appropriate clothing for hot or cold weather.

(List specific clothing or refer to Company quick sheet, SOPs, plan, etc. for specific details)

• Sun block

• Lip balm

Dehydration:

• Drink at least ½ liter of water an hour.

• Refer to Company quick sheet, SOPs, plan, etc. for specific details on heat stress signs and symptoms.

L

Job Steps Hazards Controls RAC

1. Set-Up

1. Back Strain from uploading or moving scaffold components.

2. Lacerations on hands

3. Scaffold failure due to damaged scaffolding components.

4. Struck by mechanized equipment.

**See above “Notes box”**

5. Loss of load.

6. Stuck by suspended loads or material.

7. Electrical Shock

8. Scaffold failure due to improper set-up

1a. Utilize proper lifting techniques.

1b. Size up load before lifting.

1c. Ask for help when lifting heavy items more than 50 lbs.

2. Wear leather gloves.

3a. INSPECT all scaffolding components defects or damage such as cracks, excessive rust, metal fatigue, unauthorized repairs, bent tubing or frame, etc.

• Frames

• Tubing

• Base Plates

• Locking Pins

• Access Ladder

• Planking (Wood or Metal)

• Cross Braces

3b. REMOVE damaged or defective scaffold components immediately.

3c. Attach tag or label “DO NOT USE” on scaffold component.

4a. ALWAYS maintain eye contact with operator of equipment.

4b. NEVER stand behind (Blind Spots) equipment.

4c. NEVER stand near unloading or moving of scaffold components.

4d. ONLY qualified operators shall operate equipment.

5a. Secure loads from displacement with ropes, cables, chains, etc. before movement.

5b. Ensure load to be lifted is secured, balanced, etc.

5c. Keep hands, fingers, or other body parts away from pinch points.

6a. NEVER stand underneath suspended loads.

6b. Use taglines to control loads when elevated.

7a. Check above for overhead power lines.

7b. NEVER erect scaffolding within 10 ft (3 m) of overhead power lines. Refer to EM 385-1-1, Table 11-1 for Minimum Clearance from Energized Overhead Electrical Lines 7c. NEVER string or hang temporary power cords, wires, etc. on metal scaffolding.

Consult with Safety Officer.

8a. Inspect ground conditions (level and firm).

8b. Stable base is necessary for proper scaffold assembly.

8c. Scaffold shall be tied into structure when the scaffold height exceeds four times the minimum scaffold base dimension per EM 385-1-1, para 22.B.09

M

Job Steps Hazards Controls RAC

2. Assembly of Scaffolding

1 Fall from Elevated Heights

2. Scaffold Failure

3. Back Strain

4. Lacerations on hands

1a. 100 percent fall protection required during assembly.

1b. Personnel shall not be exposed to unprotected sides or falls greater than 6 ft. (1.8 m).

1c. Scaffolding shall not exceed 14 inches (35.5 cm) from the planking to the face of the building or structure.

1d. Scaffolding more than 14 inches (35.5 cm) from the planking to the face of the building or structure shall be guardrails and/or the use of personal fall protection.

1e. Personnel shall be tied off to a vertical lifeline with a rope grab during assembly of scaffolding.

1f. Vertical lifeline shall be secured to an anchor point of at least 5,000 lbs.

(2,267.9 kg) per individual.

Develop a site specific Fall Protection Plan IAW EM 385-1-1, para 21.C.01 and refer to EM 385-1-1, Section 21.

1g. Contact Safety Officer for additional guidance on fall protection requirements.

2a. See diagram below and refer EM 385-1-1, Section 22 for specific requirements (i.e., toe boards, guard rails, safe access, etc.)

2b. Scaffolding shall be assembled on mud sills and base plates.

2c. Mud sills shall be at least 2 times the size of the base plates to disperse total weight of scaffolding.

2d. Scaffolding shall be plumb and level.

2e. Working levels shall be fully decked and/or planked.

2f. Planking shall extend over the end supports not less than 6 in (30.4 cm), 2g. Planking shall be secured, supported, or braced to prevent excessive spring or deflection and secured to prevent loosening, tipping, or displacement. Use of tie wire, cleats, etc. are options.

2h. Planking shall be overlapped at least 12 inches (30.4 cm) or secured from movement.

2i. Scaffold shall be capable of supporting without failure at least 4 times the maximum anticipated loads.

2j. Scaffolding shall be all required cross, horizontal, or diagonal braces to secure vertical members laterally.

2k. Scaffolding shall be rigid.

3a. Utilize proper lifting techniques.

3b. Size up load before lifting.

3c. Ask for help when lifting heavy items more than 50 lbs.

4. Wear leather gloves.

Job Steps Hazards Controls RAC

2. Assembly of

(Diagram)

3. Use of Scaffolding

1. Scaffold Failure

2. Falls from Heights

3. Slips, Trips, or Fall

1a. DO NOT overload more than 4 times the maximum load rating.

1b. DO NOT attached hoists or other material lifting devices without Safety Officer approval.

1c. Scaffolding shall be tied into building whenever height of the scaffold exceeds 4 times the minimal base. Refer to EM 385-1-1, para 22.B.09 for additional guidance.

1d. Scaffold usage shall cease during high winds or severe inclement weather conditions.

2a. Guardrails shall be used as primary fall protection. Guard rails shall installed IAW EM 385-1-1, para 21.B.02.

2b. Securing of personal fall protection devices to scaffolding is prohibited.

2c. Personnel shall have fall protection whenever above 6 ft. (1.8 m).

2d. Climbing of braces or cross bracing is prohibited.

2e. Safe access (ladder) shall be provided.

2f. Personnel shall not stand on mid rails.

2g. Ladders shall extend at least 3 ft. (0.9 m) past the work area.

3. Walking surfaces on and around scaffolding shall be clear of debris.

Job Steps Hazards Controls RAC

3. Use of Scaffolding

4. Disassembling of

1 Fall from Elevated Heights

The scaffold checklist is not all inclusive of the safety requirements for the assembly, use, and disassembly of scaffolding. Competent Person onsite for work platform safety shall review EM 385-1-1 Safety and Health Requirements Manual, Host Nation safety laws, contract specifications, manufacture specifications, etc. as additional guidance or information for work platform safety.

1a. 100 percent fall protection required during disassembly.

1b. Personnel shall not be exposed to unprotected sides or falls greater than 6 ft. (1.8 m).

1c. Personnel shall be tied off to a vertical lifeline with a rope grab during assembly of scaffolding.

1d. Vertical lifeline shall be secured to an anchor point of at least 5,000 lbs.

(2,267.9 kg) per individual.

Develop a site specific Fall Protection Plan IAW EM 385-1-1, para 21.C.01 and refer to EM 385-1-1, Section 21.

1e. Contact Safety Officer for additional guidance on fall protection requirements.

Job Steps Hazards Controls RAC

4. Disassembling of

2. Back Strain

3. Lacerations on hands

2a. Utilize proper lifting techniques.

2b. Size up load before lifting.

2c. Ask for help when lifting heavy items more than 50 lbs.

3. Wear leather gloves.

Equipment to be Used Training Requirements/Competent or Qualified Personnel name(s)

Inspection Requirements

Scaffold components Hammers Mud sills Full body harness Lanyard Lifeline Fall protection anchor points Float Crane Electric Hand Tools (Battery type) Portable Generator 5 Ma GFCIs Power Cords Ladders First Aid Kit

Competent/Qualified Personnel:

Mr. Tsuno Toru – CP/Scaffolding Mr. Safety Man – QP/First Aid and

CPR

Mr. Work Man – QP/First Aid and

CPR

Mr. Fall Safety – CP/Fall Protection Mr. Shocker Cord – QP/Electrical Mr. Lift Boom – QP/Crane Operator

Training Requirements:

Scaffold Assembly Fall Protection Inspection of Work Platforms Heat or Cold Hazards Daily/Monthly safety toolbox meetings

Inspect scaffold components prior to use

Inspect scaffold daily (Use Checklist)

Inspect level and plumb of scaffoldings during erection and daily when in use.

Daily Housekeeping of work areas and scaffolding

Inspect PPE to include fall protection harnesses and lanyards prior to use.

Inspect fall protection anchor points.

Inspect crane IAW manufacture instructions.

Inspect power cord sets prior to use.

Inspect temporary power panel box, circuit breakers, grounding, etc. at least monthly.

Inspect first aid kit at least monthly.

Daily site safety inspections by SSHO and CQC.

Attachment J-0200000-08

Contractor Crane Operating Checklist or Critical Lifts

ATTACHMENT "A"

CONTRACTOR CRANE OPERATING CHECKLIST FOR CRITICAL LIFTS YES NO

1 Does the operator know the weight of the load to be lifted?

2 Is the load to be lifted within the crane manufacturer's rated capacity in its present configuration?

3 Is the crane level and on firm ground?

4 Are outriggers required?

5 If so, are outriggers fully extended and down, and the load off the wheels?

If blocking is required, is the entire surface of the outrigger pad supported, and is the blocking material of sufficient strength to safely support the loaded outrigger pad?

7 If outriggers are not used, is the crane rated for on-rubber lifts by the manufacturer's load chart?

Is the swing radius of the crane counterweight clear of people and obstructions and accessible areas within the swing area barricaded to prevent injury, damage and unplanned encroachment?

9 Has the hook been centered over the load in such a manner to prevent swing (deflection, side loading, load-moment)?

10 Is the load well secured and balanced in the sling or lifting device before it is lifted (free and clear) more than a few inches?

11 Is the lift swing path clear of obstructions?

12 If rotation of the load being lifted is hazardous, is tag line or restraint line being used?

13 Are personnel prevented from standing or passing under a suspended load?

14 Are personnel prevented from entering the load fall zone?

15 Is the crane operator's attention diverted?

16 Are proper signals being used at all times?

17 If radio communications are used is the frequency isolated to the crane team?

18 Do the operations ensure that side and tip loading is prohibited?

19 Are start and stop motions in a smooth fluid motion (no sudden acceleration or deceleration)?

20 If operating near electric power lines, are the rules and guidelines understood and adhered to as specified in NAVFAC P-307?

21 Is the lift a critical lift?

If so, are critical lift regulations understood, check-off sheets initialed and signed off, and was there an interactive brief conducted with associated personnel?

23 Is Attachment "A" current, filled out completely, and posted in the crane?

Contractor Name (Print Legibly):

Contractor Name (Signature):

Location: Date:

Attachment J-0200000-09 Sample NAVFAC CIRS Report Form

Attachment J-0200000-10 Sample NAVFAC Initial Mishap Notification Report Form

Attachment J-0200000-10 Sample NAVFAC Initial Mishap Notification Report Form

Attachment J-0200000-11 Sample Crane and Rigging Gear Accident Report Form

UNCLASSIFIED/FOR OFFICIAL USED ONLY

CRANE AND RIGGING GEAR ACCIDENT REPORT

Accident Category: Crane Accident Rigging Gear Accident From:

UIC:

To: Navy Crane Center Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Activity:

Report No:

Crane No:

Category:

Accident Date:

Time: hrs:

Category of Service: SPS GPS Crane Type:

Crane Manufacturer:

Was Crane/Rigging Gear Being Used in SPS: Yes No Was Crane/Rigging Gear Being Used in a Complex Lift/Critical Non-Crane Rigging Operation: Yes No

Location:

Weather:

Crane Capacity:

Hook Capacity:

Weight of Load on hook:

Fatality or Permanent Disability? Yes No

Material/Property Cost Estimate:

Reported to NAVSAFECEN? Yes No Accident Type:

Personal Injury Overload Derail Damaged Rigging Gear

Load Collision Two Blocked Dropped Load Damaged Crane

Crane Collision Damaged Load Other: Specify

Cause of Accident:

Improper Operation Equipment Failure Inadequate Visibility

Improper Rigging Switch Alignment inadequate Communication

Track Condition Procedural Failure Other: Specify

Chargeable to:

Crane Walker Rigger Operator

Maintenance Management/Supervision Other: Specify

Crane Function:

Travel Hoist Rotate Luffing Telescoping Other N/A Is this accident indicative of a recurring problem? Yes No

If yes, list Accident Report Nos.:

ATTACH COMPLETE AND CONCISE SITUATION DESCRIPTION AND CORRECTIVE/PREVENTIVE ACTIONS TAKEN AS ENCLOSURE (1). Include probable cause and contributing factors. Assess damages and define responsibility. For equipment malfunction or failure, include specific description of the component and the resulting effect or problem caused by the malfunction or failure. List immediate and long term corrective/preventive actions assigned and respective codes.

Preparer:

Phone:

E-mail:

Code:

Date:

Concurrences: (Include Code, Signature and Date)

Certifying Official (Crane Accident Only):

Attachment J-0200000-11 Sample Crane and Rigging Gear Accident Report Form

CRANE AND RIGGING GEAR ACCIDENT REPORT INSTRUCTIONS

This form is designed for fax transmission without a cover page or by e-mail and, with enclosures and signatures, shall be the official document. Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is m_nfsh_ncc_accident@navy.mil. The fax number is (757) 967-3808.

1. Accident Category: Indicate either crane accident or rigging gear accident.

2. From: The naval activity that is responsible for reporting the accident and UIC number.

3. Activity: The naval activity where the accident took place.

4. Report No.: The activity assigned accident number (e.g., 95-001).

5. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

6. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

7. Accident Date: The date the accident occurred.

8. Time: The time (24 hour clock) the accident occurred (e.g., 1300).

9. Category of Service: Check the applicable service (SPS as defined by NAVSEA 0989-030-7000).

10. Crane Type: The type of crane involved in the accident (e.g., mobile, bridge), if applicable.

11. Crane Manufacturer: The manufacturer of the crane (e.g., Dravo, Grove, P&H), if applicable.

12. SPS: Was the crane or rigging gear being used in an SPS lift?

13. Complex lift: Was the crane or rigging gear being used in a complex lift?

14. Location: The detailed location where the accident took place (e.g., building 213, dry dock 5).

15. Weather: The weather conditions at time of accident (e.g., wind, rain, cold).

16. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

17. Hook Capacity: The capacity of the hook involved in the accident at the max radius of the operation, if applicable.

18. Weight of Load on Hook: If applicable, the weight of the load on the hook.

19. Fatality or Permanent Disability?: Check yes or no.

20. Material/Property Cost Estimate: Estimate total cost of damage resulting from the accident.

21. Reported to NAVSAFECEN?: Self-explanatory.

22. Accident Type: Check all that apply.

23. Cause of Accident: Check all that apply.

24. Chargeable to: Check all that apply.

25. Crane Function: Check all functions in operation at time of accident. Check N/A if a rigging gear accident.

26. Is this a recurring problem?: Check yes or no. Identify any other similar accidents.

27. Situation Description/Corrective Actions: Self-explanatory.

28. Preparer: Self-explanatory.

29. Concurrences: Self-explanatory.

30. Certifying Official (Crane Accidents Only): Self-explanatory.

31. Brief Description: No more than one paragraph summarizing the resultant incident.

32. Background and Detailed Description: Provide the relevant background in a descriptive timeline of preconditions leading up to the event, as well as a detailed description of the…