CELRH_FORM_2800_Contractor_Equipment_and_Supply_Inspection_MAY_2010.pdf

CELRH FORM 2800, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 4

VERSION 1.1

1. DATE OF INSPECTION (YYYYMMDD)

2. CORPS PROJECT

SECTION III - EQUIPMENT

CONTRACTOR EQUIPMENT AND SUPPLY INSPECTION

The proponent agency is CELRH-CT.

4. CONTRACTOR 5. CONTRACTOR PHONE3. CORPS INSPECTOR

6. FIRM OR CORPS REPRESENTATIVE 7. SOLICITATION NUMBER

CONTRACT SESSIONS: THE FOLLOWING CODES ARE TO BE USED IN SUBJECTIVELY EVALUATING THE APPARENT CONDITION AND

CONSIDERED UTILIZATION POTENTIAL OF CONTRACTOR EQUIPMENT, TOOLS ETC.

CONDITION CODES: (A) NEW, APPARENT CONDITION (B) USED, SERVICEABLE AND APPARENT GOOD CONDITION

(C) USED, SERVICEABLE (D) USED, UNSERVICEABLE (E) N/A NOT APPLICABLE

NOTE: DUE TO THE SIMILARITY IN SERVICES AND THE EQUIPMENT AND TOOLS USED TO PERFORM THESE SERVICES; SECTIONS II., V., VI., VII., VIII., X., XIII. AND XIV. HAVE BEEN COMBINED.

1. RIDING EQUIPMENT (e.g., Tractors, etc.)

a.

EQUIPMENT ITEM

b.

MODEL NUMBER

c.

SERIAL NUMBER

d. ROLLOVER

PROTECTION

e.

SEATBELTS

f.

PHOTO(s) g.

CONDITION

CODEYES NO YES NO YES NO

2. POWER LAWN MOWERS (Self-Propelled)

CODENOYES

f.

NOYES

e.

BACK

GUARD

NOYES

d. GUARDS (discharge, belts, etc.)

3. POWER LAWN MOWERS (Push Type) e.

BACK

GUARD

NOYES

d. GUARDS (discharge, belts, etc.)

CELRH FORM 2800, MAY 2010 Page 2 of 4

4. TRIMMERS (String Type)

SECTION III - EQUIPMENT (Continuation)

6. PESTICIDE APPLICATION EQUIPMENT

5. HAND TOOLS (List hand tools displayed and describe their general condition) e.

CONDITION

d. PHOTO(s)c.

7. COMMENTS

SECTION IV.

NOYES

d. PHOTO(s)b.

SERIAL NUMBER

(If applicable) c.

SAFETY FEATURES

(If applicable)

1a.

2. COMMENTS

e.

BACK

GUARD

NOYES

d. GUARDS (discharge, belts, etc.)

NOTE: USE THIS SECTION TO EXPAND UPON OR TO PROVIDE FURTHER ELABORATION, THAT WILL AIDE THE DETERMINATION PROCESS AND IN THE UNDERSTANDING OF ANY CONCLUSION OR DETERMINATION (e.g., rating or condition codes selected) MADE ON THE ADEQUACY OF PROPOSED EQUIPMENT TO PROVIDE SERVICES REQUESTED UNDER SECTION III.

NOTE: USE THIS SECTION TO ELABORATE ON ANY OF THE FOREGOING OBSERVED ITEMS AND TO PROVIDE SUPPLEMENTARY INFORMATION THAT COULD ASSIST IN THE EVALUATION PROCESS. FOR EXAMPLE, SHOULD ANY ITEMS DEEMED NECESSARY TO PROVIDE THE SERVICES REQUIRED UNDER SECTION IV. (and noted in the "SPECS") NOT BE AVAILABLE FOR INSPECTION (e.g., expendable items such as brooms, brushes, toilet bowl swabs, etc.) NOTE HERE THE RESPONSE PROVIDE TO QUERIES INTO THE

PROPOSED ACQUISITION, ETC.

CELRH FORM 2800, MAY 2010 Page 3 of 4

SECTIONS II - V - VI - VII - VIII - X - XIII AND XIV

NOYES

d. PHOTO(s)c.

SAFETY FEATURES

(If applicable) b.

SERIAL NUMBER

(If applicable) e.

CONDITION

CODE

2. COMMENTS

SAFETY SECTION

NOTE: PROVIDE HERE COMMENTS ON PERSONAL PROTECTIVE EQUIPMENT AND ANY ITEMS TO TOPICS OF SAFETY NOT ADDRESSED IN THE PRECEDING SECTIONS. THE FOLLOWING IS A LIST OF SOME ITEMS THAT SHOULD BE ADDRESSED; USE THE COMMENTS SECTION TO PROVIDE EXPLANATORY STATEMENTS. FOR THOSE ITEMS OF PERSONAL EQUIPMENT (e.g., safety shoes) THAT ARE NOT NORMALLY OR REASONABLY EXPECTED TO BE SEEN FOR THIS INSPECTION, IT IS SUFFICIENT TO PROVIDE REMARKS ON

THESE ITEMS IN THE COMMENT SECTION.

NOYES

b. PHOTO(s) c.

CONDITION

CODE

WELDING SAFETY EQUIPMENT

c.

CONDITION

b. PHOTO(s)1a.

LEG CHAPS

PERSONAL FLOTATION DEVICES

EAR PLUGS

BLAZE ORANGE SAFETY VEST

PROTECTIVE MASK

BREATHING APPARATUS

HARD HATS

EYE PROTECTION

GLOVES

SAFETY SHOES (Steel toe, spark proof)

PROTECTIVE CLOTHING

NOTE: USE THIS SECTION TO SHOW HOW THE FIRM OR CORPORATION REPRESENTATIVES PROPOSE TO ENSURE THE GOVERNMENT THEY HAVE ADEQUATE EQUIPMENT TO PERFORM THE SERVICES THAT MAY BE REQUIRED UNDER THESE SECTIONS. FOR EXAMPLE AND FOR ANY EQUIPMENT NOT OBSERVED ON THE DATE OF INSPECTION, DESCRIBE THE METHOD (e.g., rental, acquisition, etc.) PROPOSED OR EVIDENCE USED BY THE FIRM REPRESENTATIVE TO ENSURE THE AVAILABILITY OF SUCH

EQUIPMENT.

d. INSPECTOR'S SIGNATURE

CELRH FORM 2800, MAY 2010 Page 4 of 4

2. COMMENTS

SAFETY (Continued)

SUMMARY SECTION

1. PROVIDE HERE A WRITTEN SUMMARIZATION OF THE INSPECTION RESULTS TOGETHER WITH A FINAL RATING OF THE FIRM OR CORPORATION. INSPECTION RESULTS AND THIS SUMMARIZATION MUST SUPPORT A CONCLUSION MADE ON THE ADEQUACY OF

EQUIPMENT TO PROVIDE THE SERVICES UNDER THE REQUIREMENT CONTRACT.

b. NAME AND JOB TITLE (Last, First MI)

c. DATE OF INSPECTION (YYYYMMDD)

U.S. ARMY CORPS OF ENGINEERS PERSONNEL CONDUCTING THIS INSPECTION

1a. E-MAIL ADDRESS

2. OTHER DOCUMENTATION AND OR PHOTO(s) ARE ATTACHED

CELRH FORM 2800, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 4

VERSION 1.1

SECTION III - EQUIPMENT

CONTRACTOR EQUIPMENT AND SUPPLY INSPECTION

The proponent agency is CELRH-CT.

CONTRACT SESSIONS: THE FOLLOWING CODES ARE TO BE USED IN SUBJECTIVELY EVALUATING THE APPARENT CONDITION AND CONSIDERED UTILIZATION POTENTIAL OF CONTRACTOR EQUIPMENT, TOOLS ETC.

CONDITION CODES: (A) NEW, APPARENT CONDITION (B) USED, SERVICEABLE AND APPARENT GOOD CONDITION

(C) USED, SERVICEABLE (D) USED, UNSERVICEABLE (E) N/A NOT APPLICABLE

NOTE: DUE TO THE SIMILARITY IN SERVICES AND THE EQUIPMENT AND TOOLS USED TO PERFORM THESE SERVICES; SECTIONS II., V., VI., VII., VIII., X., XIII. AND XIV. HAVE BEEN COMBINED.

1. RIDING EQUIPMENT (e.g., Tractors, etc.)

d. ROLLOVER PROTECTION e.

SEATBELTS

f.

PHOTO(s) g.

CONDITION CODE

YES

NO

YES

NO

YES

NO

2. POWER LAWN MOWERS (Self-Propelled)

CONDITION CODE

NO

YES

f.

PHOTO(s)

NO

YES

e.

BACK GUARD

NO

YES

d. GUARDS (discharge, belts, etc.)

3. POWER LAWN MOWERS (Push Type)

YES

f.

PHOTO(s)

NO

YES

e.

BACK GUARD

NO

YES

d. GUARDS (discharge, belts, etc.)

CELRH FORM 2800, MAY 2010 Page 2 of 4

4. TRIMMERS (String Type) SECTION III - EQUIPMENT (Continuation)

6. PESTICIDE APPLICATION EQUIPMENT

e.

CONDITION CODE

NO

YES

d. PHOTO(s) c.

SERIAL NUMBER

b.

MODEL NUMBER

a.

EQUIPMENT ITEM

SECTION IV.

NO

YES

d. PHOTO(s) b.

SERIAL NUMBER

(If applicable) c.

SAFETY FEATURES

(If applicable) 1a.

YES

f.

PHOTO(s)

NO

YES

e.

BACK GUARD

NO

YES

d. GUARDS (discharge, belts, etc.)

NOTE: USE THIS SECTION TO EXPAND UPON OR TO PROVIDE FURTHER ELABORATION, THAT WILL AIDE THE DETERMINATION PROCESS AND IN THE UNDERSTANDING OF ANY CONCLUSION OR DETERMINATION (e.g., rating or condition codes selected) MADE ON THE ADEQUACY OF PROPOSED EQUIPMENT TO PROVIDE SERVICES REQUESTED UNDER SECTION III.

NOTE: USE THIS SECTION TO ELABORATE ON ANY OF THE FOREGOING OBSERVED ITEMS AND TO PROVIDE SUPPLEMENTARY INFORMATION THAT COULD ASSIST IN THE EVALUATION PROCESS. FOR EXAMPLE, SHOULD ANY ITEMS DEEMED NECESSARY TO PROVIDE THE SERVICES REQUIRED UNDER SECTION IV. (and noted in the "SPECS") NOT BE AVAILABLE FOR INSPECTION (e.g., expendable items such as brooms, brushes, toilet bowl swabs, etc.) NOTE HERE THE RESPONSE PROVIDE TO QUERIES INTO THE

PROPOSED ACQUISITION, ETC.

CELRH FORM 2800, MAY 2010 Page 3 of 4

SECTIONS II - V - VI - VII - VIII - X - XIII AND XIV

NO

YES

d. PHOTO(s) c.

SAFETY FEATURES

(If applicable) b.

SERIAL NUMBER

(If applicable) 1a.

EQUIPMENT ITEM

e.

CONDITION CODE

SAFETY SECTION

NOTE: PROVIDE HERE COMMENTS ON PERSONAL PROTECTIVE EQUIPMENT AND ANY ITEMS TO TOPICS OF SAFETY NOT ADDRESSED IN THE PRECEDING SECTIONS. THE FOLLOWING IS A LIST OF SOME ITEMS THAT SHOULD BE ADDRESSED; USE THE COMMENTS SECTION TO PROVIDE EXPLANATORY STATEMENTS. FOR THOSE ITEMS OF PERSONAL EQUIPMENT (e.g., safety shoes) THAT ARE NOT NORMALLY OR REASONABLY EXPECTED TO BE SEEN FOR THIS INSPECTION, IT IS SUFFICIENT TO PROVIDE REMARKS ON

THESE ITEMS IN THE COMMENT SECTION.

NO

YES

b. PHOTO(s) c.

CONDITION CODE

1a.

EQUIPMENT ITEM

WELDING SAFETY EQUIPMENT

c.

CONDITION CODE

NO

YES

b. PHOTO(s) 1a.

EQUIPMENT ITEM

LEG CHAPS

PERSONAL FLOTATION DEVICES

EAR PLUGS

BLAZE ORANGE SAFETY VEST

PROTECTIVE MASK

BREATHING APPARATUS

HARD HATS

EYE PROTECTION

GLOVES

SAFETY SHOES (Steel toe, spark proof)

PROTECTIVE CLOTHING

NOTE: USE THIS SECTION TO SHOW HOW THE FIRM OR CORPORATION REPRESENTATIVES PROPOSE TO ENSURE THE GOVERNMENT THEY HAVE ADEQUATE EQUIPMENT TO PERFORM THE SERVICES THAT MAY BE REQUIRED UNDER THESE SECTIONS. FOR EXAMPLE AND FOR ANY EQUIPMENT NOT OBSERVED ON THE DATE OF INSPECTION, DESCRIBE THE METHOD (e.g., rental, acquisition, etc.) PROPOSED OR EVIDENCE USED BY THE FIRM REPRESENTATIVE TO ENSURE THE AVAILABILITY OF SUCH

EQUIPMENT.

CELRH FORM 2800, MAY 2010 Page 4 of 4 SAFETY (Continued)

SUMMARY SECTION

U.S. ARMY CORPS OF ENGINEERS PERSONNEL CONDUCTING THIS INSPECTION

1.1 Forms Design Team CEIT-PMO-I CELRH FORM 2800 Contractor Equipment and Supply Inspection MAY 2010 Mark Cooper CELRH FORM 2800 Contractor Equipment and Supply Inspection MAY 2010 mark.a.cooper@usace.army.mil 20110422 20110422