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- Mowing & Maintenance Services for Former West Virginia Ordnance Works, Point Pleasant, WV
- Solicitation number
- W91237-16-T-0010
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| File | Type | Posted |
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| Award_Synopsis_16-P-0024.pdf | ||
| Figure_22_QualityAssuranceSurveillancePlan.pdf | ||
| Table_2.pdf | ||
| W91237-16-T-0010.pdf | ||
| Synopsis_-_WVOW.pdf |
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Figure 1-8
Site Location & O&M Areas
RMFLW-001RMFLW-001
COLOR INDEX
WATER-BEARING ZONES
PERCHED
DEEP CLAY SAND
DEEP
INTERMEDIATE / DEEP
INTERMEDIATE
SHALLOW
MNGR
PROJECTCHKDDRAWNCHKDINITIATOR
DATE
STARTING
AREA JOB NO. DRAWING NO. REV
A
12345678910111213
B
C
D
E
F
G s a m m c c a w le y lt m w p .d g n
:1
:4
A M
.0 f t in s e i_ t e x t s u b o n ly .t b l
P D
F w it h
L e v e ls .p lt
141516
H
I
J
K
L
M
X
YWRGW-054YWRGW-054
TNTGW-053DTNTGW-053D
RWRGW-049RWRGW-049
P13MW-003
P13MW-005
P13GRW-402
P13GRW-403
P13MW-003
P13MW-005
P13GRW-402
P13GRW-403
YWRGW-051D
RWRGW-053
RWRGW-055
TNTGW-052
RWRGW-048
RWRGW-051
YWRGW-051D
RWRGW-053
RWRGW-055
TNTGW-052
RWRGW-048
RWRGW-051
YWRGW-050
RWRGW-054
YWRGW-051
RWRGW-052
YWRGW-045
YWRGW-046
YWRGW-047
YWRGW-048
YWRGW-048D
YWRGW-049
YWRGW-049D
YWRGW-050D
RWRGW-050
YWRGW-050
RWRGW-054
YWRGW-051
RWRGW-052
YWRGW-045
YWRGW-046
YWRGW-047
YWRGW-048
YWRGW-048D
YWRGW-049
YWRGW-049D
YWRGW-050D
RWRGW-050
IWSLGW-002IIWSLGW-002I
IWSLGW-001S
IWSLGW-001I
IWSLGW-001S
IWSLGW-001I
TNTGW-054TNTGW-054
TNTGW-055TNTGW-055
N 700,500
N 703,500
N 706,500
E
,6
,0
,6
,0
,6
,0
,6
,0
,6
,0
KC S.DOWNEY
SCALE
1000 FEET 500
N 697,500
N 694,500
500112
CA SAM SAM
MASON COUNTY, WEST VIRGINIA
WEST VIRGINIA ORDNANCE WORKS
12MAY15
500112-LTM15-10
ACTIVE WELLS AT WVOW
FIGURE 2-9
LEGEND:
RWRGW-030
ZONES ARE ABSENT.
AGED BEDROCK OUTCROPS. WATER-BEARING
GENERALIZED AREAS OF PENNSYLVANIAN
POND & POND DESIGNATION
CREEK, RIVER, STREAM
RAILROAD
ROADS
TOPOGRAPHY
EXTRACTION WELL
MONITORING WELL
N 700,500
,6
,0
,6
,0
,6
,0
,6
,0
,6
,0
N 697,500
N 694,500
ACDGW-001
ACDGW-002
BGEGW-006
BGEGW-007
BGEGW-008
BGELW-002
BGELW-007
BGWGW-003
BGWGW-004
BGWLW-008
MCYGW-001
MCYGW-002MCYGW-002D
MZAGW-001
MZAGW-002
NGMW-001NGMW-002
NGMW-003
NPHGW-002NPHGW-002D
NPHGW-034 NPHGW-034D
P03GW-018
P13GW-022
P13GW-022D
P13GW-023I
P13GW-023S
P13GW-048D
P13GW-049
P13OB-004
PASGW-001
PASGW-002
PASGW-004
PASGW-005
PASGW-006
PASGW-007
PASGW-008
PCWGW-001
PCWGW-002
PCWGW-003
PCWGW-004
PCWGW-005
PCWGW-006
PCWGW-007
PCWGW-008
PCWGW-009
PCWGW-010
PPLGW-008
PPLGW-008D
PPLGW-009
PPLGW-009D
PPLGW-010
PPLGW-010D
PPLGW-011
PPLGW-011D
PPLGW-012 PPLGW-012D
PPLGW-013
PPLGW-013D
PPLGW-014
PPLGW-032PPLGW-032D
PPLLF-001
PPLLF-002
PPLLF-003
PPLLF-004
PPLLF-005
PPLLF-006
PPLLF-007
PPLLW-003D
PPWGW-002A
PPWGW-004
PPWGW-005
PPWGW-011
PPWGW-012
PPWGW-013
PWSGW-001
PWSGW-002
PWSGW-003
RWLGW-001D
RWLGW-001S
RWLGW-002D
RWLGW-002I
RWLGW-002S
RWLGW-024
RWLGW-026
RWLLW-004D
RWRDW-001
RWREW-101
RWREW-103
RWREW-105
RWREW-107
RWREW-109
RWRGW-002
RWRGW-003
RWRGW-003D
RWRGW-004
RWRGW-004D
RWRGW-005
RWRGW-029
RWRGW-030
RWRGW-031
RWRGW-033
RWRGW-045 RWRGW-045D
RWRGW-046
RWRGW-047
RWRMW-001
RWRMW-002
RWRPT-001
SAAGW-001D
SAAGW-002
SAAGW-005
SAAGW-042
TNTGW-005
TNTGW-009D
TNTGW-010
TNTGW-010D
TNTGW-011
TNTGW-013
TNTGW-014
TNTGW-015
TNTGW-016
TNTGW-017
TNTGW-019
TNTGW-020
TNTGW-021
TNTGW-037
TNTGW-043
TNTGW-045
TNTGW-048
TNTLW-005D
TNTLW-006
TNTLW-006D
TNTTW-002
TNTTW-002D
TNTTW-004
TNTTW-004D
TNTTW-006
TNTTW-007
TNTTW-009
TNTTW-010
TNTTW-011
TNTTW-012
W07GW-002
W21GW-003
YWLGW-025
YWLGW-025D
YWRGW-002
YWRGW-002D
YWRGW-027
YWRGW-027D
YWRGW-028
YWRGW-041
YWRGW-044
YWRMW-001A
TNTGW-049
TNTGW-050
TNTGW-051
PPWGW-003
TNTGW-047
P17GW-038
P13PT-001
TNTGW-012D
NAAGW-001
NAAGW-001D
RWLGW-001I
YWRDW-001
TNTTW-005
MCYGW-001
ACDGW-001
ACDGW-002
BGEGW-006
BGEGW-007
BGEGW-008
BGELW-002
BGELW-007
BGWGW-003
BGWGW-004
BGWLW-008
MCYGW-001
MCYGW-002MCYGW-002D
MZAGW-001
MZAGW-002
NGMW-001NGMW-002
NGMW-003
NPHGW-002NPHGW-002D
NPHGW-034 NPHGW-034D
P03GW-018
P13GW-022
P13GW-022D
P13GW-023I
P13GW-023S
P13GW-048D
P13GW-049
P13OB-004
PASGW-001
PASGW-002
PASGW-004
PASGW-005
PASGW-006
PASGW-007
PASGW-008
PCWGW-001
PCWGW-002
PCWGW-003
PCWGW-004
PCWGW-005
PCWGW-006
PCWGW-007
PCWGW-008
PCWGW-009
PCWGW-010
PPLGW-008
PPLGW-008D
PPLGW-009
PPLGW-009D
PPLGW-010
PPLGW-010D
PPLGW-011
PPLGW-011D
PPLGW-012 PPLGW-012D
PPLGW-013
PPLGW-013D
PPLGW-014
PPLGW-032PPLGW-032D
PPLLF-001
PPLLF-002
PPLLF-003
PPLLF-004
PPLLF-005
PPLLF-006
PPLLF-007
PPLLW-003D
PPWGW-002A
PPWGW-004
PPWGW-005
PPWGW-011
PPWGW-012
PPWGW-013
PWSGW-001
PWSGW-002
PWSGW-003
RWLGW-001D
RWLGW-001S
RWLGW-002D
RWLGW-002I
RWLGW-002S
RWLGW-024
RWLGW-026
RWLLW-004D
RWRDW-001
RWREW-101
RWREW-103
RWREW-105
RWREW-107
RWREW-109
RWRGW-002
RWRGW-003
RWRGW-003D
RWRGW-004
RWRGW-004D
RWRGW-005
RWRGW-029
RWRGW-030
RWRGW-031
RWRGW-033
RWRGW-045 RWRGW-045D
RWRGW-046
RWRGW-047
RWRMW-001
RWRMW-002
RWRPT-001
SAAGW-001D
SAAGW-002
SAAGW-005
SAAGW-042
TNTGW-005
TNTGW-009D
TNTGW-010
TNTGW-010D
TNTGW-011
TNTGW-013
TNTGW-014
TNTGW-015
TNTGW-016
TNTGW-017
TNTGW-019
TNTGW-020
TNTGW-021
TNTGW-037
TNTGW-043
TNTGW-045
TNTGW-048
TNTLW-005D
TNTLW-006
TNTLW-006D
TNTTW-002
TNTTW-002D
TNTTW-004
TNTTW-004D
TNTTW-006
TNTTW-007
TNTTW-009
TNTTW-010
TNTTW-011
TNTTW-012
W07GW-002
W21GW-003
YWLGW-025
YWLGW-025D
YWRGW-002
YWRGW-002D
YWRGW-027
YWRGW-027D
YWRGW-028
YWRGW-041
YWRGW-044
YWRMW-001A
TNTGW-049
TNTGW-050
TNTGW-051
PPWGW-003
TNTGW-047
P17GW-038
P13PT-001
TNTGW-012D
NAAGW-001
NAAGW-001D
RWLGW-001I
YWRDW-001
TNTTW-005
MCYGW-001
YWREW-502B
YWREW-502A
YWREW-502B
YWREW-502A
YWREW-501BYWREW-501B
YWREW-501AYWREW-501A
YWRPT-001YWRPT-001
P13MW-012P13MW-012
P13MW-011
P13MW-010
P13MW-011
P13MW-010
CB&I Federal Services LLC
RWREW-101
YWRGW-052YWRGW-052
YWRGW-053YWRGW-053
P13MW-004P13MW-004
P13MW-002P13MW-002
TNTGW-059TNTGW-059
TNTGW-060TNTGW-060
P13OB-003P13OB-003
TNTGW-058TNTGW-058
TNTGW-057TNTGW-057
TNTGW-056TNTGW-056
P13MW-009
P13MW-006
P13MW-008
P13MW-009
P13MW-006
P13MW-008
P13MW-007P13MW-007
Figure 9-10
Barricades North and South
Figure 11
Well Inspection Checklist Example
WVOW
Mowing Contract Figure 11
Well Inspection Checklist Example
Figure 12 a-c
Photographs
Flush Mount Well Standpipe with Bollards and Concrete base
Extraction Well with Bollards
Standpipe with Paint Removed Well Standpipe and Bollards with primer
WVOW
Mowing Contract
Figure 12a Photographs
Contract
Figure 12b Photographs
Red Water Reservoir RCRA Caps TNT Washer Flaker House Cap 6
TNT Washer Flaker House Cap 8 Burning Grounds Cap
Contract
Figure 12c Photographs
Main Access Road North of Yellow Water Treatment Building
Main Access Road leading to Red Water Reservoir
Red Water Reservoir Levy (winter) Red Water Reservoir Levy (summer)
Contract
Figure 12c Photographs
Example of a faded warning sign Main Access Road leading to Red Water Reservoir, mow and clear vertically all access roads and paths
Access road from Burning Grounds to Pond 30 Monitoring well prior to string trimming
Figure 13 a-d
Roads & Paths To Be Mowed
Contract
Figure 13a Roads &
Paths to be Mowed
Red Water Reservoir Area
Contract
Figure 13b Roads &
Paths to be
Yellow Water Reservoir Area and OU-11 Sellite Area
Contract
Figure 13c Roads &
Paths to be
Burning Grounds, TNT Manufacturing Area and ESI-8
Contract
Figure 13d Roads &
Paths to be
Wells near Mason County Airport
Figure 14-14a
Drainage Areas @ RWR To Be Mowed
Contract Figure 14 Drainage Areas @
RWR to be
Red Water Reservoir Drainage Ditches, See also Figure 14a
Contract
Figure 14a Drainage Areas @
RWR to be Mowed
Red Water Reservoir Drainage Areas
Underdrain at RWR Cap
RWR Pond
Figure 15-15a
YWR Outfall Ditch
Contract Figure 15
YWR
Outfall Ditch
Yellow Water Reservoir Outfall Ditch, See also Figure 15a
Treatment Building
Contract
Figure 15a
YWR
Outfall Ditch
Yellow Water Reservoir Outfall Ditch
YWR outfall
15 foot clearance on this side of ditch
Access road
GATE
Figure 16
Safety Inspection Checklist
Item Description Yes No N/A
1. Signature sheet
a. Includes the name, signature, and title of the Plan Preparer (Qualmed person, i.e. corporate safety staff person, QC)
b. Includes the name, signature,and tiUe of the Plan Approver {e.g.
owner, company president, regional vice presiden
c. Includes the name{s), signature(s), and title{s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel(contractor))
2.Background information
a. Includes the Contractor Name.
b. Includes the Contract Number.
c. Includes the Project Name.
d. Includes the Brief Project Description.
e. Includes the Location of the Project {map).
f. Includes a means to evaluate the work being done (see AHA requirements in 01.A.13) and associated hazards involved.
g. Addresses the identified hazards involved and the control measures to be taken.
3. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthfulworkplace for all employees.
4.Responsibilities and Lines of Authorities a.Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level - including their resumes.
b.Includes the lines of authority.
5. Training- new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements 6.Procedures for job site inspections - assignment of responsibilities and frequency CESO Checklist A-01,Sep 14
U.S.Army Corps of Engineers Safety Inspection Checklist
Abbreviated Accident Prevention Plan
Inspector Name (Print) Inspector Signature
This checklist serves as a guide only. It does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated XX September 2014.The references Included In this checklist correspond to the applicablesections of EM 385-1-1.
If service, supply and R&D contracts with limited scopes are awarded, the contractor may submit an abbreviated Accident Prevention Plan. This APP shall address the following areas at a minimum. If other areas of the EM 385-1-1 are pertinent to the contract, the contractor must assure these areas are addressed as well.
Remarks (Any NO or N/A Item)
Date of Inspection
Location (Plant or Facility) Contract Number
Contractor Name Project Name
Date of Inspection
7.Procedures for reporting man-hours worked and reporting and investigating any accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative
(CO/COR).
8.Emergency Planning. Employees working alone shall be provided an effective means of emergency communication. This may be cellular phone, two-way radio or other acceptable means. The selected means of communication must be readily available and must be in working condition.
9.Drinking Water provisions, toilet and washing facilities.
10.First Aid and CPR training (at least two employees on each shift shall be qualified/certified to administer first aid and CPR) and provision of first aid kit (types/size).
11.Personal Protective Equipment
a. Work Clothing - Minimum Requirements. Employees to wear clothing suitable for the weather; minimum requirements for work shall be short-sleeve shirt, long pants (excessively long or baggy pants are prohibited) and leather work shoes. If AHA determines safety-toed (or other protective) footwear is necessary (i.e., mowing, weed eating, chain saw use, etc), they shall be wom.
b.Eye and Face Protection. Eye and face protection shall be worn as determined by an analysis of the operations being performed HOWEVER, all involved in chain saw use, chipping,stump grinding, pruning operations, grass mowing, weed eating and blowing operations shall be provided safety eyewear (Z87.1) as a minimum.
c. Hearing Protection. Hearing protection must be worn by all exposed to high noise activities {includes grass mowing/trimming, chainsaw operations, tree chipping, stump grinding and pruning) d.Head Protection. Hard hats shall comply with ANSIZ89.1 and shall be wom by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in {b) above e.High Visibility Apparel shall comply with ANSI/ISEA 107, Class 2 requirements at a minimum and shall be worn by all workers exposed to vehicular or equipment traffic.
f.Protective Leg chaps shall be wom by all chainsaw operators.
g. Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts,abrasions, punctures, bums and chemicalirritants.
h. If work is being performed around water and drowning is a hazard, PFD's must be provided and worn as appropriate.
12.Machine Guards and safety devices. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.
CESO Checklist A-01,Sep 14
U.S.Army Corps of Engineers Safety Inspection Checklist
Abbreviated Accident Prevention Plan Remarks (Any NO or N/A item)
Date of Inspection
13. Hazardous Substances. When any hazardous substances are procured, used, stored or disposed, a hazard communication program must be in effect and MSDSs shall be available at the worksite. Employees shall have received training in hazardous substances being used. When the eyes or body of any person may be exposed to corrosives, irritants or toxic chemicals, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within 10 seconds of the worksite.
14. Traffic control shall be accomplished in accordance with DOrs
MUTCD.
15. Control of Hazardous Energy (Lockout/Tagout). Before an employee perfonns any servicing or maintenance on any equipment where the unexpected unergizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of
16. Driving, working on (i.e., working with equipmenUmowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly.
Other Remarks
CESO Checklist A-01,Sep 14
Remarks (Any NO or N/A Item)
U.S.Army Corps of Engineers Safety Inspection Checklist
Abbreviated Accident Prevention Plan
Figure 17
Quality Control Plan Example
EXAMPLE FOR CONTRACTOR’S USE
QUALITY CONTROL PLAN
FOR
MOWING OF VARIOUS LOCATIONS AND PERFORMING GROUNDWATER
MONITORING WELL INSPECTION AND REPAIR
FORMER WEST VIRGINIA ORDNANCE WORKS
POINT PLEASANT, MASON COUNTY, WEST VIRGINIA
CONTRACT NO. ______________________________
1.0 PURPOSE
The Contractor shall state the purpose of the Quality Control Plan (QCP). Basically describe the policy and specific actions that the Contractor shall implement to insure that high quality products are furnished to the Government. Specifically, the preparation, internal quality control review and revision, and revision following Government comments for all submittals that prepared for this project. The Contractor shall also state actions he shall implement to assure quality repair of the groundwater monitoring wells.
2.0 REFERENCES
The Contractor shall cite the following references:
• ER 1110-1-12 Quality Management, 1 June 1993
• CEORDR 1110-1-9, Quality Control and Quality Assurance, 3 March 1995
• CEORH Regulation No. 1110-2-4, Quality Management Plan
• CELRHR 5-2-7, Quality Management Plan,1 May 1999
• Appendix B, Engineering Sub plan; Paragraph 8, Contractor Quality Control Plan
• Applicable ISO 9001 processes developed for this type of work
The following website is provided to the Contractor to gain information on the Quality Control, Quality Management, and ISO 9001 requirements of the Huntington District:
http://www.lrh.usace.army.mil/Articles/index.cfm?id=2236&pge_prg_id=10438&pge_id=1284
3.0 GENERAL
Information shall be provided as to:
• Project type, e.g., DERP-FUDS program
• Project location, e.g., West Virginia Ordnance Works, Point Pleasant, WV
• Project customer, e.g., USACE, Huntington District
• General project description, e.g., mowing of various sites and performing groundwater monitoring well inspection and repair http://www.lrh.usace.army.mil/Articles/index.cfm?id=2236&pge_prg_id=10438&pge_id=1284
• Project objectives, e.g., perform maintenance and repair in accordance with the approved O&M Plan, February 2008, and per the contract scope of work.
4.0 TRAINING
List any special training that field personnel have that is applicable for this specific project.
Certifications and/or proof or training shall be referenced and attached in an appendix to the
QCP.
5.0 RESPONSIBILITIES/INTERNAL QUALITY CONTROL
Responsibilities. State the responsibilities of the various individuals who shall provide services for this project. At a minimum, responsibilities range from preparation and internal review of the submittals, performing the groundwater monitoring well inspection, preparing and submitting the groundwater monitoring well inspection report, and repairing the groundwater monitoring wells.
Internal Quality Control. The Contractor shall list all individuals performing the work as well as the individuals who shall oversee the work and review the submittals (the Internal Quality Control Team, IQCT) prior to submission to the Government. Tasks that shall be performed by these individuals shall also be noted. Quality control review checklists for each submittal shall be prepared and included in an appendix to the QCP. These checklists shall list the items of work that the IQCT member was responsible for reviewing. Example checklists are included in CELRHR 5-2-7, Quality Management Plan. Note: Individuals preparing the various reports or plans CANNOT be the same individual who performs the internal quality control review; IQCT members must be independent and not directly involved with the report and/or plan preparation.
6.0 PROJECT SCHEDULE
The proposed schedule of work shall be stated: planned timeframes for submittals, performing the mowing operations, performing the groundwater monitoring well inspection, and repairing the groundwater monitoring wells.
7.0 RESUMES
The Contractor shall provide abbreviated resumes for all individuals performing work and internal quality reviews for this project. These should be included in an appendix to the QCP.
Figure 18
Contract Discrepancy Report
Figure 19
Accident Investigation Report Form
H1EDDJTP
RFA RECORDABLE FIRST AID
NRI NONRECORDABLE INJURY
SOURCE OF INJURY NAME
Figure 20
Transmittal Form
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Figure 21
Pay Request/Estimate Form
| Figures 1 - 15a - updated Oct 2015.pdf |
| 2014 Figures 1-10 Final |
| Figure 11-15a |
| Slide Number 1 |
| Slide Number 2 |
| Slide Number 3 |
| Slide Number 4 |
| Slide Number 5 |
| Slide Number 6 |
| Slide Number 7 |
| Slide Number 8 |
| Slide Number 9 |
| Slide Number 10 |
| Slide Number 11 |
| Slide Number 12 |
| Slide Number 13 |
| Figure 16 - CESO Checklist A-01 AbbrevAPPFINAL.pdf |
| Table 1 |
| Figure 19 -Accident Report 3394.pdf |
| Untitled |
| Untitled |
| LOCATION: |
| CONTRACT NUMBER: |
| CONTRACTOR: |
| PROJECT: |
| INSPECTOR: |
| 1: Off |
| 2: Off |
| 3: Off |
| t1: |
| 4: Off |
| 5: Off |
| 6: Off |
| t2: |
| 7: Off |
| 8: Off |
| 9: Off |
| 10: Off |
| 11: Off |
| 12: Off |
| 13: Off |
| 14: Off |
| 15: Off |
| 16: Off |
| 17: Off |
| 18: Off |
| 19: Off |
| 20: Off |
| 21: Off |
| 22: Off |
| 23: Off |
| 24: Off |
| 25: Off |
| 26: Off |
| 27: Off |
| 28: Off |
| 29: Off |
| 30: Off |
| 31: Off |
| 32: Off |
| 33: Off |
| 34: Off |
| 35: Off |
| 37: Off |
| 38: Off |
| 39: Off |
| 40: Off |
| 41: Off |
| 42: Off |
| 43: Off |
| 44: Off |
| 45: Off |
| 46: Off |
| t3: |
| t4: |
| t5: |
| t6: |
| t7: |
| t8: |
| t9: |
| t10: |
| t11: |
| t12: |
| t13: |
| t14: |
| t15: |
| DATE: |
| 47: Off |
| 48: Off |
| 49: Off |
| t16: |
| 50: Off |
| 51: Off |
| 52: Off |
| 53: Off |
| 54: Off |
| 55: Off |
| 56: Off |
| 57: Off |
| 58: Off |
| 59: Off |
| 60: Off |
| 61: Off |
| 62: Off |
| 63: Off |
| 64: Off |
| 65: Off |
| 66: Off |
| 67: Off |
| 68: Off |
| 69: Off |
| 70: Off |
| 71: Off |
| 72: Off |
| 73: Off |
| 74: Off |
| 75: Off |
| 76: Off |
| 77: Off |
| 78: Off |
| 79: Off |
| 80: Off |
| 81: Off |
| 82: Off |
| 83: Off |
| 84: Off |
| 85: Off |
| t17: |
| t18: |
| t19: |
| t20: |
| t21: |
| t22: |
| t23: |
| t24: |
| t25: |
| t26: |
| t27: |
| t28: |
| 86: Off |
| 87: Off |
| 88: Off |
| 89: Off |
| 90: Off |
| 91: Off |
| 92: Off |
| 93: Off |
| 94: Off |
| 95: Off |
| 96: Off |
| 97: Off |
| t29: |
| t30: |
| t31: |
| t32: |
| t33: |
| Report Number: |
| EROC: |
| Civilian: Off |
| Military: Off |
| Injury: Off |
| Injury 2: Off |
| Fire Involved: Off |
| Fire Involved 2: Off |
| Motor Vehicle Involved: Off |
| Motor Vehicle Involved 2: Off |
| Motor Vehicle Involved 3: Off |
| Diving: Off |
| Diving 2: Off |
| Property Damage Other: Off |
| Property Damage OTher 2: Off |
| Contractor: Off |
| Public: Off |
| Fatal: Off |
| Name: |
| Job: |
| Other: Off |
| Age: |
| Sex: Male |
| On Duty: Off |
| TDY: Off |
| Off Duty: Off |
| EMP_STAT Army Active: Off |
| EMP_STAT Permanent: Off |
| EMP_STAT Temporary: Off |
| EMP_STAT Other: Off |
| EMP_STAT Army Reserve: Off |
| EMP_STAT Foreign National: Off |
| EMP_STAT Student: Off |
| Date of Accident: |
| Time of Account: |
| Location: |
| Prime: |
| Subcontractor: |
| Waste Other Specified: |
| Waste Other: Off |
| Waste DERP: Off |
| Waste Superfund: Off |
| Waste IRP: Off |
| Contract Type Other Specified: |
| Contract Dredge: Off |
| Contract Service: Off |
| Contract Construction: Off |
| Contract A/E: Off |
| Contract Other: Off |
| Contract Number: |
| Contract Civil Works: Off |
| Contract Military: Off |
| Contract Number Other: Off |
| Contract Other Specify: |
| Construction Activity: [ 0. N/A] |
| BPA: [ 1] |
| Severity of Illness: [NOI - NO INJURY] |
| Severity of Illness Code Number: [NOI] |
| Secondary Body PartsAffected: [ N/A] |
| Primary Body Part Code Num: [N/A] |
| Primary Body Parts Affected: [ N/A] |
| Secondary Body Part Code Num: [ N/A] |
| Nature of Illness: [ N/A] |
| Nature Code Num: [N/A] |
| Activity at Time of Accident: [ N/A] |
| Floation Yes: Off |
| Vehicle Pickup/Van 1: Off |
| Vehicle Pickup/Van 2: Off |
| Vehicle Automobile 1: Off |
| Vehicle Automobile 2: Off |
| Vehicle Truck 1: Off |
| Vehicel Truck 2: Off |
| Vehicle Other 1: Off |
| Vehicle Other 2: Off |
| Type of Vehicle Other Specified: |
| Collision Side Swipe: Off |
| Collision Broadside: Off |
| Collision Other: Off |
| Collision Head On: Off |
| Collision Roll Over: Off |
| Collision Other Specified: |
| Collision Rear End: Off |
| Collision Backing: Off |
| Name of Item 1: |
| Name of Item 2: |
| Name of Item 3: |
| Type of Vessel: [ N/A] |
| Vessel Code Num: [ N/A] |
| Estimated Days Lost: 00.00 |
| Estimated Days Hospitalized: 00.00 |
| Estimated Days Restricted Duty: 00.00 |
| Type Injury: [ N/A] |
| Type Code Num: [ N/A] |
| Source Injury: [ N/A] |
| Source Code Num: [ N/A] |
| Floatation No: Off |
| Floatation NA: Off |
| Front Seat Belts Used: Off |
| Rear Seat Belts Used: Off |
| Front Seat Belts Not Used: Off |
| Front Seat Belts Not Available: Off |
| Rear Seat Belts Not Used: Off |
| Rear Seat Belts Not Available: Off |
| Ownership 1: |
| Ownership 2: |
| Ownership 3: |
| Amount of Damage 1: |
| Amount of Damage 2: |
| Amount of Damage 3: |
| Type of Collision: [ N/A] |
| Collision Code Num: [ N/A] |
| EMP_STAT Volunteer: Off |
| EMP_STAT Seasonal: Off |
| Employment Status Other Specified: |
| CONSTRUCTION EQ: [ 0. N/A] |
| Contract Code Num: [ N/A] |
| SSN: |
| GRADE: |
| Design Yes: Off |
| H_Factors No: Off |
| H_Factors Yes: Off |
| Factors No: Off |
| Factors Yes: Off |
| Practices No: Off |
| Practices Yes: Off |
| Procedures No: Off |
| Procedures Yes: Off |
| Condition No: Off |
| Maintenance No: Off |
| Condition Yes: Off |
| Maintenance Yes: Off |
| Design No: Off |
| Hazard Analysis No: Off |
| Hazard Analysis Yes: Off |
| Drugs Yes: Off |
| Protective Equiment Yes: Off |
| Drugs No: Off |
| Protective Equiment No: Off |
| Support Factors No: Off |
| Support Factors Yes: Off |
| Office Factors No: Off |
| Office Factors Yes: Off |
| Agent Factors No: Off |
| Agent Factors Yes: Off |
| Trinaing On Job: Off |
| Traingin Classroom: Off |
| Trained No: Off |
| Trained Yes: Off |
| Training Date: |
| Beginning Actions Date: |
| Completed Actions Date: |
| Org Identifier: |
| Office Symbol: |
| Date: |
| Management Review 1 Comments: |
| Management Review 2 Comments: |
| Concur 1: Off |
| Concur 3: Off |
| Concur 2: Off |
| Non Concur 3: Off |
| Non Concur 1: Off |
| Non Concur 2: Off |
| Saftery Office Comments: |
| Command Approval Comments: |
| Accident Description Continued: |
| Direct Cause Continued: |
| Indrirect Causes Continued: |
| Actions Taken etc: |
| Transmittal No: |
| TO: |
| FROM: |
| CONTRACT NO: |
| New Transmittal: |
| Resubmittal: |
| undefined_4: |
| undefined_5: |
| undefined_6: Off |
| undefined_7: |
| ITEM NO 1: |
| DESCRIPTION OF ITEM SUBMITTED 1: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow1: |
| NO OF COPIES dRow1: |
| SPEC PARA NO eRow1: |
| DRA SHERow1: |
| Row1: |
| Row1_2: |
| Row1_3: |
| ITEM NO 2: |
| DESCRIPTION OF ITEM SUBMITTED 2: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow2: |
| NO OF COPIES dRow2: |
| SPEC PARA NO eRow2: |
| DRA SHERow2: |
| Row2: |
| Row2_2: |
| Row2_3: |
| ITEM NO 3: |
| DESCRIPTION OF ITEM SUBMITTED 3: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow3: |
| NO OF COPIES dRow3: |
| SPEC PARA NO eRow3: |
| DRA SHERow3: |
| Row3: |
| Row3_2: |
| Row3_3: |
| ITEM NO 4: |
| DESCRIPTION OF ITEM SUBMITTED 4: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow4: |
| NO OF COPIES dRow4: |
| SPEC PARA NO eRow4: |
| DRA SHERow4: |
| Row4: |
| Row4_2: |
| Row4_3: |
| ITEM NO 5: |
| DESCRIPTION OF ITEM SUBMITTED 5: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow5: |
| NO OF COPIES dRow5: |
| SPEC PARA NO eRow5: |
| DRA SHERow5: |
| Row5: |
| Row5_2: |
| Row5_3: |
| ITEM NO 6: |
| DESCRIPTION OF ITEM SUBMITTED Type size model numberetc bRow6: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow6: |
| NO OF COPIES dRow6: |
| SPEC PARA NO eRow6: |
| DRA SHERow6: |
| Row6: |
| Row6_2: |
| Row6_3: |
| ITEM NO 7: |
| DESCRIPTION OF ITEM SUBMITTED Type size model numberetc bRow7: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow7: |
| NO OF COPIES dRow7: |
| SPEC PARA NO eRow7: |
| DRA SHERow7: |
| Row7: |
| Row7_2: |
| Row7_3: |
| ITEM NO 8: |
| DESCRIPTION OF ITEM SUBMITTED Type size model numberetc bRow8: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow8: |
| NO OF COPIES dRow8: |
| SPEC PARA NO eRow8: |
| DRA SHERow8: |
| Row8: |
| Row8_2: |
| Row8_3: |
| ITEM NO 9: |
| DESCRIPTION OF ITEM SUBMITTED Type size model numberetc bRow9: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow9: |
| NO OF COPIES dRow9: |
| SPEC PARA NO eRow9: |
| DRA SHERow9: |
| Row9: |
| Row9_2: |
| Row9_3: |
| ITEM NO 10: |
| DESCRIPTION OF ITEM SUBMITTED Type size model numberetc bRow10: |
| MFG OR CONTR CAT CURVE DRAWING OR BROCHURE NO See instruction no 8 cRow10: |
| NO OF COPIES dRow10: |
| SPEC PARA NO eRow10: |
| DRA SHERow10: |
| Row10: |
| Row10_2: |
| Row10_3: |
| REMARKS: |
| Contractor Signature: |
| ENCLOSURES RETURNED: |
| undefined_9: |
File details come from the government source that posted it. Updated .