PWS - FY26 B1 Ft Hood Doors MnS Appendix B.1 SSHO_Designation_Eng_Form_6282_2023Aug28.pdf
PDF 45 KB Posted
- Solicitation number
- DRAFTW912DY26RA076
About this file
ENG Form 6282 is a U.S. Army Corps of Engineers (USACE) Site Safety & Health Officer (SSHO) Designation Letter template used to designate personnel responsible for overseeing and ensuring the implementation of a prime contractor's Safety & Occupational Health (SOH) program. The form must be signed by the company's official responsible for the SOH program, such as a Corporate Safety Manager, and submitted to the Government Designated Authority (GDA) as part of the Accident Prevention Plan, along with an instructor-signed OSHA 30-hour card and proof of 24 hours of competency training within the last three years.
The form establishes three SSHO designation levels with corresponding minimum requirements. Level 1 requires Construction or General Industry OSHA 30-hour certification and 5 years of cumulative safety experience within the last 10 years managing or implementing SOH programs on similar projects, plus 24 hours of documented SOH-related training within the past five years with ongoing 24-hour competency training every three years. Level 2 requires the same OSHA certification and training but only 3 years of cumulative safety experience within the last 10 years. Level 3 designates a Qualified or Competent Person without specified experiential or training details in the template. The form includes sections for the company SOH official to certify the designee's qualifications and for the designated SSHO to acknowledge the appointment through signature.
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ENG FORM 6282, AUG 2023
U.S. Army Corps of Engineers (USACE)
SITE SAFETY & HEALTH OFFICER (SSHO) DESIGNATION LETTER
For use of this form, see EM 385-1-1; the proponent agency is CESO.
Purpose: This document designates personnel responsible for overseeing and ensuring the implementation of the prime contractor's Safety & Occupational Health (SOH) program. This designation letter will be signed by the company's official responsible for the SOH program (e.g., Corporate Safety Manager).
Submit the following documentation to the Government Designated Authority (GDA) as part of the Accident Prevention Plan: 1) This signed SSHO Designation Letter (Eng Form 6282); 2) An instructor-signed OSHA 30-hour card (or course completion certificate if within 90 days of completing the OSHA 30-hour training); and 3) proof of 24 hours of competency of SOH training within the last 3 years.
PART I: COMPLETED BY COMPANY'S SOH PROGRAM OFFICIAL
1. Project Name 2. Contract Number
3. Location
4. The designated SSHO on this form meets the minimum EM 385-1-1 training and experience requirements for the selected level below and is knowledgeable of the SOH requirements for this project and has the authority to stop work when required.
SSHO Level Experience Competency Training OSHA 30-Hour
Qualified or Competent Person
3 years of cumulative safety experience, within the last 10 years, managing or implementing a SOH program on projects similar in industry type, size, and complexity as the project described in the contract scope of work.
24 hours of documented formal classroom or online SOH-related training within the past five years and must maintain competency by taking 24 hours every three-year period for the duration of the contract.
Construction or General Industry
5 years of cumulative safety experience, within the last ten years, managing or implementing a SOH program on projects similar in industry type, size, and complexity as the project described in the contract scope of work.
24 hours of documented formal classroom or online SOH-related training within the past five years and must maintain competency by taking 24 hours every three-year period for the duration of the contract.
Construction or General Industry Level 1
Level 2
Level 3
5. Summary of required safety experience:
By my signature below, I certify that the information I provided on this form is true and correct to the best of my knowledge.
Company SOH Official Name Company SOH Official Title
Company SOH Official Signature Date
PART II: COMPLETED BY DESIGNATED SSHO
SSHO Name Date SSHO Signature
ENG FORM 6282, AUG 2023
U.S. Army Corps of Engineers (USACE)
SITE SAFETY & HEALTH OFFICER (SSHO) DESIGNATION LETTER
For use of this form, see EM 385-1-1; the proponent agency is CESO.
Purpose: This document designates personnel responsible for overseeing and ensuring the implementation of the prime contractor's Safety & Occupational Health (SOH) program. This designation letter will be signed by the company's official responsible for the SOH program (e.g., Corporate Safety Manager).
Submit the following documentation to the Government Designated Authority (GDA) as part of the Accident Prevention Plan: 1) This signed SSHO Designation Letter (Eng Form 6282); 2) An instructor-signed OSHA 30-hour card (or course completion certificate if within 90 days of completing the OSHA 30-hour training); and 3) proof of 24 hours of competency of SOH training within the last 3 years.
PART I: COMPLETED BY COMPANY'S SOH PROGRAM OFFICIAL
4. The designated SSHO on this form meets the minimum EM 385-1-1 training and experience requirements for the selected level below and is knowledgeable of the SOH requirements for this project and has the authority to stop work when required.
SSHO Level Experience Competency Training OSHA 30-Hour Qualified or Competent Person 3 years of cumulative safety experience, within the last 10 years, managing or implementing a SOH program on projects similar in industry type, size, and complexity as the project described in the contract scope of work.
24 hours of documented formal classroom or online SOH-related training within the past five years and must maintain competency by taking 24 hours every three-year period for the duration of the contract.
Construction or General Industry 5 years of cumulative safety experience, within the last ten years, managing or implementing a SOH program on projects similar in industry type, size, and complexity as the project described in the contract scope of work.
24 hours of documented formal classroom or online SOH-related training within the past five years and must maintain competency by taking 24 hours every three-year period for the duration of the contract.
Construction or General Industry By my signature below, I certify that the information I provided on this form is true and correct to the best of my knowledge.
PART II: COMPLETED BY DESIGNATED SSHO
1.0 darwin.chen@usace.army.mil 2023-05-05 Forms Design Team Darwin Chen 2023-08-30
SITE SAFETY & HEALTH OFFICER (SSHO) DESIGNATION LETTER
SITE SAFETY & HEALTH OFFICER (SSHO) DESIGNATION LETTER
| PrintButton1: |
| saveas: |
| TextField1: |
| lev1: 0 |
| lev2: 0 |
| lev3: 0 |
| SignatureField1: |
| DateField1: |
File details come from the government source that posted it. Updated .