Atch(1)-SPEC_2.pdf

APPENDIX A - Page 1 of 3

APPENDIX A

DEFINITIONS

Definition Description

Activity Hazard Analysis

(AHA)

A documented process by which the steps (procedures) required to accomplish a work activity are outlined, the actual or potential hazards of each step are identified, and measures for the elimination or control of those hazards are developed.

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

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.

Container for Infectious

MW

A receptacle designated for handling and transporting various types of infectious MW. It may also be referred to just as a container.

Container for Non-infectious MW

A receptacle used for the temporary storage of noninfectious MW while awaiting collection.

It may also be referred to just as a container.

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 PAP. The COR performs a variety of contract administration duties that includes oversight of PA, documenting and rating Contractor performance, reviewing invoices, and acceptance of work. Assignment as a COR is a collateral duty typically performed by the 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.

Debris Includes, but is not limited to, paper, cans, bottles, limbs and branches, pine straw and pinecones, leaves, rocks, and other similar items.

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.

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.

APPENDIX A - Page 2 of 3

Hazardous Waste A discarded material that may be solid, semi-solid, liquid, or contained gas, and either exhibits a characteristic of a hazardous waste defined in section AP1.1 or is listed as a hazardous waste in Tables AP1.T1 through AP1.T4 of the Japan Environmental Governing

Standards (JEGS). Excluded from this definition are domestic sewage sludge, household wastes and medical wastes.

Infectious Medical Waste

(MW)

Solid waste produced by medical and dental treatment facilities to include veterinary clinic that is specially managed because it has the potential for causing disease in humans and may pose a risk to both individuals or community health if not managed properly, and that includes the following classes:

(1) Microbiology waste, including cultures and stocks of etiologic agents which, due to their species, type, virulence, or concentration, are known to cause disease in humans.

(2) Pathology waste, including human tissues and organs, amputated limbs or other body parts, fetuses, placentas, and similar tissues from surgery, delivery, or autopsy procedures. Animal carcasses, body parts, blood, and bedding from contaminated animals are also included.

(3) Human blood and blood products (including serum, plasma, and other blood components), items contaminated with liquid or semi-liquid blood or blood products and items saturated or dripping with blood or blood products, and items caked with blood or blood products that are capable of releasing these materials during handling.

(4) Potentially infectious materials, including human blood fluids such as semen, vaginal secretions, cerebrospinal fluid, pericardial fluid, pleural fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

(5) Sharps, including hypodermic needles, syringes, biopsy needles, and other types of needles used to obtain tissue or fluid specimens, needles used to deliver intravenous solutions, scalpel blades, Pasteur pipettes, specimen slides, cover slips, glass Petri plates, test tubes, ampoules, vials, and broken glass potentially contaminated with infectious waste.

(6) Infectious waste from isolation rooms, but only including those items that were contaminated or likely to have been contaminated with infectious agents or pathogens, including excretion exudates and discarded materials contaminated with blood.

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.

Medical Waste (MW)

Deposit Area

Designated points where MW will be placed for collection by the Contractor. May also be referred to as storage area, collection point, or work site.

Monthly On-Site Labor

Report

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

Non-infectious Medical

Waste (MW)

Solid waste created that does not require special management because it has been determined to be incapable of causing disease in humans or it has been treated to render it non-infectious.

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.

On-site A particularly specified location on Installation (see APPENDIX D, Location Map) to provide the required services as described in the SOW.

Pathology Waste Waste such as human tissues and organs, amputated limbs or other body parts, fetuses, placentas, and similar tissues from surgery, delivery, or autopsy procedures.

Period of Performance

(POP)

Actual on-site work period from start to final completion.

APPENDIX A - Page 3 of 3

Performance Assessment 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 PAWs and the MPAS, and communicates findings as necessary with the Contractor, SPAR, and COR.

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 Hazardous Material (HM), which because of its physical characteristics, chemical make-up or biological nature requires 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 hazardous materials. Laboratory analysis may be required to verify the waste is not a RCRA-regulated hazardous waste.

Site Safety & Health

Officer (SSHO)

Superintendent or other qualified person responsible for on-site safety and health.

Specially Controlled

General Wastes (SCGW)

A classification term used in Japan that describes HW that exhibit the characteristics of explosivity, corrosivity, infection or harm to human health or environment originating from non-industrial sources.

Specially Controlled

Industrial Waste (SCIW)

A classification term used in Japan that describes HW that exhibit the characteristics of explosivity, corrosivity, infection or harm to human health or environment from industrial sources.

Spillage Any refuse dislodged from containers, waste bags, and/or waste collecting equipment in the course of collection and disposal.

Storage The interim containment of wastes after generation and prior to collection for ultimate recovery or disposal.

Supported Commands Key stakeholders, end users, and clients who will receive services.

APPENDIX B - Page 1 of 2

APPENDIX B

ACRONYMS

Acronym Title

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

Bldg. # Building Number

CFE Contractor-Furnished Equipment

CFM Contractor-Furnished Material

CFR Code of Federal Regulation

CHRIMP Consolidated Hazardous Material Reutilization and Inventory Management Program

CIRS Contractor Incident Report System

CLIN Contract Line Item Number

COR Contracting Officer’s Representative

CPARS Contractor Performance Assessment Reporting System

CS Contract Specialist

DENT 11th Dental Company Detachment

DFARS DoD Federal Acquisition Regulation Supplement

DoD Department of Defense

DTCN Designated Third Country Nationals

DUNS Data Universal Numbering System

ECC Environmental Compliance Course eCMRA Enterprise-wide Contractor Manpower Reporting Application

EDC Emergency Dispatch Center

ELIN(s) Exhibit Line Item Number(s)

EM Environmental Manager

EMS Environmental Management System

FAR Federal Acquisition Regulation

FSC Facilities Support Contract

FSCM Facilities Support Contract Manager

FY Fiscal Year

GDA Government Designated Authority

GFE Government-Furnished Equipment

GFF Government-Furnished Facilities

GFM Government-Furnished Material

HS Hazardous Substance

IAW In Accordance With

IH Industrial Hygienist

JCOSHA Japan Construction Occupational Safety and Health Association

JEGS Japan Environmental Governing Standards

JV Joint Venture

JVA Joint Venture Agreement kg kilograms

KO Contracting Officer

LHE Load Handling Equipment

MCAS Marine Corps Air Station

MCASO Marine Corps Air Station Order

MCIPACBul Marine Corps Installation Pacific Bulletin

MW Medical Waste

N/A Not Applicable

NAVFAC Naval Facilities Engineering Command

APPENDIX B - Page 2 of 2

Acronym Title

NAVFACINST Naval Facilities Engineering Command Instruction

NAVSAUP Naval Supply Systems Command Publication

NFBC Naval Family Branch Clinic

NMCARS Navy Marine Corps Acquisition Regulation Supplement

OIW Ordinary Industrial Waste

OPS Airfield Operations Department

OSHA Occupational Safety and Health Administration

PAR Performance Assessment Representative

PBSA Performance-Based Service Acquisition

PCBs polychlorinated biphenyls

P.L. Public Law

PM Project Manager

PMO Provost Marshall’s Office

POC Point of Contact

POL Petroleum, Oils, and Lubricants

POP Period of Performance

PPE Personal Protective Equipment

PPIRS Past Performance Information Retrieval System

QA Quality Assurance

QC Quality Control

QM Quality Manager

QMS Quality Management System

RSO Radiation Safety Officer

SCGW Specially Controlled General Waste

SCIW Specially Controlled Industrial Waste

SDS Safety Data Sheets

SECNAVINST Secretary of the Navy Instruction

SF Standard Form

SJA Station Judge Advocate

SOH Safety and Occupational Health

SOW Scope of Work

SPAR Senior PAR

Spec Item(s) Specification Item(s)

SSHO Site Safety and Health Officer

TBA To be announced

UFGS Unified Facilities Guide Specifications

USFJ United States Forces Japan

WAWF Wide Area Workflow

WHE Weight Handling Equipment

APPENDIX C - Page 1 of 1

APPENDIX C

REFERENCES, INSTRUCTIONS, AND DIRECTIVES

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

Reference Reference

29 CFR 1910 OSHA Standards

29 CFR 1910.120 Hazardous Waste Operations and Emergency Response

29 CFR 1926.59 Hazard Communication

DFARS 252.223-7004 Drug-Free Work Force

DFARS 252.232-7003 Electronic Submission of Payment Requests and Receiving Reports

DFARS 252.232-7006 Wide Area Workflow Payment Instructions

EM 385-1-1 U. S. Army Corps of Engineers 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.as px

Note: Japanese version is provided for information only. The Contractor shall comply with the most current English version.

Executive Order 13693 Planning for Federal Sustainability in the Next Decade

FAR Subpart 23.3 HAZARDOUS MATERIAL IDENTIFICATION AND MATERIAL SAFETY

DATA

FAR 52.228-05 INSURANCE – WORK ON A GOVERNMENT INSTALLATION

FAR 52.245-1 GOVERNMENT PROPERTY

FAR 52.246-4 INSPECTION OF SERVICES – FIXED PRICE

Japanese Law No. 57 Industrial Safety and Health Law (Roudo Anzen Eisei Ho)

JCOSHA Japan Construction Occupational Safety and Health Association (JCOSHA) website: http://www.kensaibou.or.jp

JEGS Japan Environmental Governing Standards (JEGS)

MCASO 3140.4 Destructive Weather Bill

MCASO 4440.6 Consolidated Hazardous Material Control and Management

MCASO 5100.20 Procedure for Ground Occupational Safety and Health Program

MCASO 5100.25 Smoke-free Workplace

MCASO 5500.2 Installation Access Control

MCASO 5560.8 Motor Vehicle Traffic Supervision

MCO 5090.2 Environmental Compliance and Protection Program

NFAS 5252.245-9300 GOVERNMENT-FURNISHED PROPERTY, MATERIALS NAD SERVICES

NAVFACINST 11013.40 NAVFAC Partnering Policy

NAVFAC P-307 Management of Weight Handling Equipment

NAVSUP 722 Consolidated Hazardous Material Reutilization and Inventory Management

Program (CHRIMP) Manual

NFPA 10 Standard for Portable Fire Extinguishers

NFPA 70 National Electrical Code

NFPA 70E Standard for Electrical Safety in the Workplace

Public Law (P.L.) 91-596 Occupational Safety and Health Act

UFGS 01 35 26 Unified Facilities Guide Specifications (UFGS) 01 35 26

Government Safety Requirements

USFJ Instruction 31-204 Restrictions on Designated Third Country Nationals to USFJ Installations and

Areas

N/A Website for the Contractor performance evaluation report entry system:

http://www.cpars.gov

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.publications.usace.army.mil/USACEPublications/EngineerManuals.aspx http://www.publications.usace.army.mil/USACEPublications/EngineerManuals.aspx http://www.kensaibou.or.jp/ http://www.cpars.gov/ http://www.ccb.org/ https://wawf.eb.mil/

APPENDIX D - Page 1 of 1

APPENDIX D

SAMPLE INVOICE COVER FORM (NAVFAC 7300/30)

APPENDIX E - Page 1 of 1

APPENDIX E

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

APPENDIX F - Page 1 of 6

APPENDIX F - SAMPLE AHA

Activity Hazard Analysis (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

APPENDIX F - Page 2 of 6

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

APPENDIX F - Page 3 of 6

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 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.

APPENDIX F - Page 4 of 6

2. Assembly of Scaffolding (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.

APPENDIX F - Page 5 of 6

3. Use of Scaffolding

4. Disassembling of Scaffolding

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.

APPENDIX F - Page 6 of 6

4. Disassembling of Scaffolding

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.

APPENDIX G - Page 1 of 1

APPENDIX G

SAMPLE INITIAL NEAR MISS NOTIFICATION REPORT FORM

APPENDIX H - Page 1 of 2

APPENDIX H

INSTALLATION SPILL PREVENTION RESPONSE PLAN

POL/HAZARDOUS SUBSTANCE (HS) SPILL RESPONSE FLOWCHART

APPENDIX H - Page 2 of 2

APPENDIX I

INSTALLATION SPILL PREVENTION RESPONSE PLAN

POL/HAZARDOUS SUBSTANCE (HS) SPILL RESPONSE FLOWCHART

ELIN Description Quantity Unit of

Issue

Unit Price Total

A001 - Naval Family Branch Clinic (NFBC) Iwakuni-Funded Services for NFBC Iwakuni-funded locations listed in the Maps provided in

APPENDIX M and Medical Waste deposit areas listed in Spec Item 8.4.1 performed as specified per the SOW.

Note: Refer to the Spec Item 8.4.1. MW Collection and Transportation for

Supported Commands included under NFBC Iwakuni. 1 YR -¥

A002 - 11th Dental Company Detachment-Funded

Services for 11th Dental Company Detachment-funded locations listed in the

Maps provided in APPENDIX M and Medical Waste deposit areas listed in Spec

Item 8.4.1 performed as specified per the SOW. 1 YR -¥

TOTAL RECURRING WORK PRICE - BASE PERIOD (ELINs A001 and A002) -¥

PROVIDE PRICES TO PERFORM SERVICES FOR MCAS IWAKUNI - RECURRING WORK - IN ACCORDANCE WITH SCOPE OF WORK (SOW)

ELINs A001 through A002

Line Item 0001 Recurring Work - Base Period

APPENDIX J

EXHIBIT LINE ITEM NUMBERS (ELINs)

SOLICITATION/CONTRACT #N40084-19-P/T-5404

EXHIBIT A - Contract Line Item Number (CLIN) 0001

1 October 2019 through 30 September 2020

APPENDIX J - 1 of 3 UNCLASSIFIED/FOR OFFICIAL USE ONLY

ELIN Description Quantity Unit of

Issue

Unit Price Total

B001 - Naval Family Branch Clinic (NFBC) Iwakuni-Funded Services for NFBC Iwakuni-funded locations listed in the Maps provided in

APPENDIX M and Medical Waste deposit areas listed in Spec Item 8.4.1 performed as specified per the SOW.

Note: Refer to the Spec Item 8.4.1. MW Collection and Transportation for

Supported Commands included under NFBC Iwakuni. 1 YR -¥

B002 - 11th Dental Company Detachment-Funded

Services for 11th Dental Company Detachment-funded locations listed in the

Maps provided in APPENDIX M and Medical Waste deposit areas listed in Spec

Item 8.4.1 performed as specified per the SOW. 1 YR -¥

TOTAL RECURRING WORK PRICE - 1st OPTION PERIOD (ELINs B001 and B002) -¥

MO = Month

Line Item 0002 Recurring Work - 1st Option Period

PROVIDE PRICES TO PERFORM SERVICES FOR MCAS IWAKUNI - RECURRING WORK - IN ACCORDANCE WITH SCOPE OF WORK (SOW)

ELINs B001 through B002

APPENDIX J

EXHIBIT LINE ITEM NUMBERS (ELINs)

SOLICITATION/CONTRACT #N40084-19-P/T-5404

EXHIBIT A - Contract Line Item Number (CLIN) 0002

1 October 2020 through 30 September 2021

APPENDIX J - 2 of 3 UNCLASSIFIED/FOR OFFICIAL USE ONLY

ELIN Description Quantity Unit of Issue Unit Price Total

C001 - Naval Family Branch Clinic (NFBC) Iwakuni-Funded Services for NFBC Iwakuni-funded locations listed in the Maps provided in

APPENDIX M and Medical Waste deposit areas listed in Spec Item 8.4.1 performed as specified per the SOW.

Note: Refer to the Spec Item 8.4.1. MW Collection and Transportation for

Supported Commands included under NFBC Iwakuni. 1 YR -¥

C002 - 11th Dental Company Detachment-Funded

Services for 11th Dental Company Detachment-funded locations listed in the

Maps provided in APPENDIX M and Medical Waste deposit areas listed in Spec

Item 8.4.1 performed as specified per the SOW. 1 YR -¥

TOTAL RECURRING WORK PRICE - 2nd OPTION PERIOD (ELINs C001 and C002) -¥

MO = Month

Line Item 0001 Recurring Work - 2nd Option Period

PROVIDE PRICES TO PERFORM SERVICES FOR MCAS IWAKUNI - RECURRING WORK - IN ACCORDANCE WITH SCOPE OF WORK (SOW)

ELINs C001 through C002

APPENDIX J

EXHIBIT LINE ITEM NUMBERS (ELINs)

SOLICITATION/CONTRACT #N40084-19-P/T-5404

EXHIBIT A - Contract Line Item Number (CLIN) 0003

1 October 2021 through 30 September 2022

APPENDIX J - 3 of 3 UNCLASSIFIED/FOR OFFICIAL USE ONLY

To: NFBC Iwakuni and 11th Dental Company Detachment Date: DD/MMM/YYYY

USMC Iwakuni Contractor:(Contractor's name)

(Contractor's address)

The following indicated amount of Hazardous Materials were collected by:

下記に示す数量の医療廃棄物を回収しました。

Truck Driver's Signature 運転者署名 type

(種類)

QTY

(数)

Regular XX.X (kg) XX ℓ X X.X (kg)

Pathology (Frozen) XX.X (kg) XX ℓ X X.X (kg)

TOTAL XX.X (kg) X.X (kg)

The above weight is confirmed by Clinic Personnel:

(Signature of designated Government Representative (Supported Command))

APPENDIX K

SAMPLE COLLECTED MEDICAL WASTE QUANTITY CHIT

BIOHAZARDOUS MEDICAL WASTE CONTAINER

DELIVERING AND RECEIVING CHIT

Infectious Waste (感染性廃棄物) Containers (容器) Non-Infectious Waste (非感染性廃棄物)

Weight (重量) weight (kg)

(重さ) # of Bags (数量)

(kg)

Weight (重量)

NFBC

NFBC XX 袋 XX (kg)

TOTAL

Dental XX 袋 XX (kg)

Dental XX.X (kg) XX ℓ X XX

APPENDIX K - 1 of 2

UNCLASSIFIED/FOR OFFICIAL USE ONLY

To: Veterinary Clinic Date: DD/MMM/YYYY

USMC Iwakuni Contractor: (Contractor's name)

(Contractor's address)

The following indicated amount of Hazardous Materials were collected by:

下記に示す数量の医療廃棄物を回収しました。

Truck Driver's Signature 運転者署名 type

(種類)

QTY

(数)

XX.X (kg) XX ℓ X X.X (kg)

XX.X (kg) XX ℓ X X.X (kg)

XX.X (kg) X.X (kg)

The above weight is confirmed by VET Clinic Personnel:

(Signature of designated Government Representative (Supported Command))

APPENDIX K

SAMPLE COLLECTED MEDICAL WASTE QUANTITY CHIT

BIOHAZARDOUS MEDICAL WASTE CONTAINER

DELIVERING AND RECEIVING CHIT

Infectious Waste (感染性廃棄物) Containers (容器) Non-Infectious Waste (非感染性廃棄物)

Weight (重量) weight (kg)

(重さ) # of Bags (数量) Weight (重量)

VET

(NFBC)

Regular VET

(NFBC)

XX 袋 XX (kg)

Animal Carcass(es)

TOTAL TOTAL

APPENDIX K - 2 of 2

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TOTAL (1 year)

(kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg)

24.00 67.50 31.50 55.00 111.00 27.00 90.50 81.00 35.00 45.00 46.00 38.50

40.00 48.00 52.50 63.00 62.50 48.00 23.00 33.50 32.50 6.00 40.50 121.50

107.50 50.50 49.50 106.00 124.00 18.00 66.50 47.50 54.50 78.00 13.00 12.00

87.50 19.00 51.00 51.50 20.50 21.50 22.50 58.00 42.50 102.00 59.50 45.50

- 25.00 - 87.00 - - 20.50 48.50

0.00 0.00 12.50 21.50 0.00 0.00 32.50 0.00 12.50 23.50 14.50 17.50

0.00 0.00 20.50 15.50 0.00 24.50 21.50 0.00 23.50 0.00 50.00 20.50

22.50 6.50 24.50 23.50 31.00 8.50 12.50 0.00 13.50 33.50 5.50 17.00

0.00 14.50 40.00 29.50 20.50 15.50 12.50 30.00 13.50 0.00 21.50 15.50

- 6.50 - 25.00 - - 26.50 37.50

8.00 2.00 6.50 4.50 2.50 1.50 2.50 0.00 20.00 1.50 4.00 5.00

0.00 9.50 7.50 0.00 0.00 1.50 - 2.50 17.00 3.50 2.50 3.00

4.50 1.50 4.00 7.00 4.00 5.00 4.50 1.50 3.50 16.50 0.00 2.00

1.50 0.00 1.50 2.50 0.50 4.50 2.50 9.50 3.50 5.00 11.00 10.50

- - 2.50 2.50 - - 8.00 25.50

0.00 21.50 0.00 0.00 0.00 0.00 0.00 10.50 0.00 0.00 0.00 0.00

0.00 0.00 0.00 14.00 8.50 0.00 - 0.00 0.00 0.00 0.00 0.00

1.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 1.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.50

- - 0.00 0.00 - - 10.50 0.00

297.00 273.50 304.00 508.00 385.00 175.50 356.50 274.00 271.50 426.00 268.00 313.00 3,852.00

66.00 85.00 78.00 108.00 140.00 86.00 111.00 85.00 86.00 72.00 81.00 97.00

80.00 121.00 75.00 84.00 142.00 89.00 94.00 67.00 106.00 87.00 85.00 126.00

61.00 84.00 110.00 116.00 127.00 68.00 121.00 91.00 93.00 405.00 42.00 85.00

52.00 76.00 115.00 97.00 80.00 75.00 71.00 68.00 73.00 95.00 96.00 96.00

- 45.00 - 113.00 - - 69.00 118.00

4.00 4.00 8.00 2.00 1.00 4.00 13.00 3.00 3.00 4.00 3.00 4.00

0.00 2.00 2.00 1.00 2.00 2.00 - 3.00 4.00 2.00 3.00 5.00

5.00 6.00 3.00 2.00 1.00 1.00 12.00 2.00 3.00 5.00 2.00 2.00

8.00 3.00 0.00 2.00 3.00 3.00 5.00 1.00 0.00 5.00 5.00 3.00

- - 2.00 5.00 - - 5.00 1.00

276.00 426.00 393.00 530.00 496.00 328.00 501.00 320.00 368.00 794.00 317.00 418.00 5,167.00

NFBC = Naval Family Branch Clinic

Note: The weights listed above do NOT include the weight of the containers.

For infectious waste, the tare (empty) weight of the container (2.5 kg per container) was deducted from the gross weight to calculate the net weight of the MW.

APPENDIX L

HISTORICAL QUANTITY DATA

817.50

250.00

72.50

4,993.00

174.00

Supported

Command Bldg. # Facility Waste Type

2,712.00110

Infectious

(Liquid -frozen)

Infectious

(Regular)

Infectious

(Animal

Carcasses )

Non-infectious

NFBC Infectious Total

Period: 01 April 2018 - 31 March 2019

NFBC

Medical Infectious

(Regular)

Non-infectious

Medical

VET

VET

Medical

VET

NFBC Non-Infectious Total

APPENDIX L - Page 1 of 3

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TOTAL (1 year)

(kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg) (kg)

0.00 31.50 0.00 9.50 0.00 0.00 0.00 0.00 55.50 0.00 38.50 40.00

10.00 0.00 0.00 0.00 0.00 24.50 0.00 0.00 0.00 0.00 0.00 32.00

7.00 6.50 29.00 0.00 0.00 0.00 0.00 0.00 0.00 38.50 11.50 0.00

0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 30.50

- 8.00 - 17.00 - 28.00 0.00

17.00 46.50 29.00 26.50 0.00 24.50 28.00 0.00 55.50 38.50 69.00 102.50 437.00

56.00 117.00 56.00 81.00 83.00 23.00 55.00 93.00 117.00 92.00 101.00 107.00

65.00 110.00 98.00 33.00 74.00 60.00 62.00 62.00 89.00 29.00 115.00 184.00

86.00 102.00 67.00 74.00 65.00 61.00 65.00 110.00 106.00 113.00 67.00 92.00

91.00 91.00 81.00 86.00 31.00 70.00 31.00 94.00 85.00 95.00 109.00 109.00

- 44.00 - 96.00 - - 62.00 90.00

298.00 464.00 302.00 370.00 253.00 214.00 275.00 359.00 397.00 419.00 392.00 492.00 4,235.00

DENT = 11th Dental Company Detachment

Note: The weights listed above do NOT include the weight of the containers.

For infectious waste, the tare (empty) weight of the container (2.5 kg per container) was deducted from the gross weight to calculate the net weight of the MW.

APPENDIX L

HISTORICAL QUANTITY DATA

437.00

4,235.00

DENT

DENT

DENT

Infectious

Non-infectious

DENT Non-infectious Total

DENT Infectious Total

Supported

Command Bldg. # Facility Waste Type

Period: 01 April 2018 - 31 March 2019

APPENDIX L - Page 2 of 3

Contractor-Furnished Materials (CFM)

Period: 01 April 2018 - 31 March 2019

01APR2018

through

30SEP2018

01OCT2018

through

31MAR2019

TOTAL

(1 year)

NFBC

DENT

1052 Vet Clinic NFBC 28 39 67

APPENDIX L

HISTORICAL QUANTITY DATA

110 70 ℓ container 421

Bldg. # Facility supported command item

Quantity

NFBC

(Medical &

Dental)

70 ℓ container

APPENDIX L - Page 3 of 3