A.01.30_Exhibits.pdf

EXHIBITS

LIST OF ATTACHMENTS

EXHIBIT A, Government Furnished Equipment List

EXHIBIT B, Approximate Quantities by Area

EXHIBIT C, Items to be Delivered at Least One Week Prior to Pre-Work Conference

EXHIBIT D, Sample Contractor Work Schedule

EXHIBIT E, Navigation Aids and Signs, Revised 6/07

EXHIBIT F, Project Maps Downstream Recreation Area No. 1, Revised 5/02 Downstream Recreation Area No. 2, Revised 5/02

EXHIBIT G, Required Outline, Contractor Quality Control Plan

EXHIBIT H, Partial Listing of Safety and Security Requirements

EXHIBIT I, Contractor Accident Prevention Plan (Outline)

EXHIBIT J, ENG Form 5007-R, CELRH Form 2813 (Test) and EMCS Checklist

EXHIBIT K, Contract Discrepancy Report (CDR) CELRH Form 2759

EXHIBIT L, Sample Invoice Format

EXHIBIT M, Job Request Form, CELRH Form 2770

EXHIBIT N, Quality Assurance Surveillance Plan

EXHIBIT 0, Sample Safety Forms

EXHIBIT P, Task Order Form (DD Form 1155)

EXHIBIT Q, Playground Inspection Form (CELRH Form 2788)

EXHIBIT R, Contractor Equipment and Supply Inspection, CELRH Form 2800

EXHIBIT A

GOVERNMENT FURNISHED EQUIPMENT LIST

EXHIBIT A

GOVERNMENT FURNISHED EQUIPMENT LIST

Dozer Backhoe/End loader Jon Boat w/Trailer Road grader Air Compressor w/attachments Trailer for transporting Government equipment Portable Water Pumps Dump Truck 2-6 Ton Welder (D.C. 2 cycle gas.)

Portable generator Paint Stripper Fire Fighting Equipment (Fire rakes, backpack, blower, backpack sprayer, fire resistant clothing)

EXHIBIT B

APPROXIMATE QUANTITIES BY AREA

ITEM BELLEPOINT

AREA

MAINTENANCE

SHOP

PINE GROVE

ABUTMENTS

RIVER

BANKS

COUNTY

ROAD

BANKS

FISHING

PIER &

OVERLOOK

WEST

OVERLOOK

HILLSIDE

WEST

LOWER

BANK

MILLER

AVENUE

SIGN

FREEZELAND

TOWER SITE

PROJECT

LAND IN

VA

Acres to be Maintained 18 15 1 2 2 2 2.25 0.5 0.05 1 Benches 13 13 Bulletin Board 1 1 Drinking Fountains 1 Fence Security (ft.) 116 858 106 Fence (Wood) (ft.) 1,304 Fence (Other) 9ft.) 450 Footbridges (ft.) 1 Gates 4 1 Grills 2 Boat Ramp (ft.) 35 Guard Rails (ft.) 180 1,330 Horseshoe Pits 1 Mow & Trim (approx) 5 0.5 1 2 1.25 0.3 2.25 0.5 0.05 1 Parking Areas (Paved) (Sq. Ft.) 43,175 5,500 28,599 Parking Areas (Gravel) (Sq. ft.) 1 12,000 Picnic Shelters 1 Picnic Tables 24 2

Playground Equip. (sets) 1 Restrooms 1 Retaining Walls Roads (Paved) (miles) 0.5 0.3 0.3 Security Street Lights 5 1 3 3 Sewage Lift Stations 1 Stairs (ft.) 70 Trash-garbage cans 19 12 Walkways (1.f.) 966 Dirt Road - VA 6.5 Kiosk 1 Fishing Pier 1

During the life of the Contract, the Government reserves the right to make minor variations in the size and number of items in areas with no change in bid prices for mowing and cleaning services.

APPROXIMATE QUANTITIES BY AREA - EXHIBIT B

EXHIBIT C

ITEMS TO BE PROVIDED ONE WEEK PRIOR TO PRE-WORK CONFERENCE

EXHIBIT C

Contractor shall provide the following, at least 1 week prior to the pre-work conference:

a. Schedule of Cleanings. The schedule provided by the Contractor shall be of sufficient detail to allow the Government to inspect all items of work covered under Section C-3 of the contract as they are being performed (see Exhibit D). Schedule should include daily and non-daily items.

b. Quality Control Plan. A suggested outline for the Contractor's Quality Control Plan is contained as Exhibit G.

c. Contractor Representatives. List of names of Contractor Representatives and contact information.

d. Contractor Quality Control Inspector. List of names of Contractor Quality Control Inspectors.

e. Contractor Accident Prevention Plan. A suggested outline for the Contractor Accident Prevention Plan is contained as Exhibit I.

f. Emergency Work Personnel. A list, with a minimum of 10 names, addresses, and telephone number, of person who will be available for emergency work.

g. Emergency Contacts. A prioritized list, including phone numbers, of those persons (normally Contractor Representatives) to call in case of emergencies.

h. Operators. A list of qualified equipment operators, their qualifications, experience, and certifications for government furnished equipment.

i. CDL License. A list of individuals with valid CDL Operator’s license with endorsements and date of expirations.

j. First Aid and CPR. First Aid and CPR certified individuals on each work crew.

* Above documents shall be typed and legible.

EXHIBIT D

SAMPLE CONTRACTOR WORK SCHEDULE

SAMPLE

TRASH PICKUP AND CLEANING SCHEDULE FOR BLUESTONE LAKE

Effective 6-01-18

TIME AREA

7:00 AM - 7:40 AM Trash Pickup - Area # 1.

Level 1

7:40 AM - 8:40 AM Restroom Cleaning - Area # 1.

Level 1

8:45 AM - 9:15 AM Trash Pickup - Area # 2.

Level 1

9:15 AM - 10:00 AM Restroom Cleaning - Area # 2.

Level 1

EXHIBIT E

NAVIGATION AIDS AND SIGNS

EXHIBIT F

PROJECT MAPS

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IDENTIFICATION

SHEET

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SHEET OF

fiof Engineers

US Army Corps

Huntington District

BLUESTONE LAKEBLUESTONE LAKE

MOWING PLAN

NEW RIVER

200’0 100’

SCALE IN FEET

LEGEND

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MAINTENANCE SHOP

COUNTY ROAD BANKS

BELLEPOINT PARK

RIVERBANK

PINE GROVE & ABUTMENTS

FISHING PIER ACCESS & RT. 20 OVERLOOK

WEST OVERLOOK HILLSIDE

PHASE 4 WORK LIMITS

GOVERNMENT PROPERTY BOUNDARY

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EXHIBIT G

REQUIRED OUTLINE, CONTRACTOR QUALITY CONTROL PLAN

CONTRACTOR QUALITY CONTROL PLAN (OUTLINE)

1. INSPECTION OF SERVICES. Define the method of inspection for each service in the contract including, but not limited to: the individual(s) who shall inspect the service (Quality Control Inspectors); when or with what frequency inspections shall be performed (e.g. daily, following each cleaning, at the completion of each task, etc.); and a copy of the Contractor's inspection forms or other documents identifying the specific tasks involved in the service with shall be inspected.

2. DEFICIENCIES AND CORRECTIVE ACTION. Explain the procedures for identifying deficiencies in the quality of services provided and methods of correction, before the level of performance is unacceptable.

3. RECORDS. Define the method for maintaining records of inspections and records of corrective actions taken, the individual(s) responsible for the records, and location where the records shall be kept.

4. QUALITY CONTROL INSPECTORS. A consolidated list of authorized Quality Control Inspectors.

5. CONTRACTOR REPRESENTATIVES. A list of names and phone numbers of authorized Contractor Representatives.

6. SECURITY. Define and explain the procedures and safeguards which shall be used to protect all equipment, materials, supplies, tools, and other resources provided by the Government to the Contractor including; but not limited to; Contractor audit procedures and inventory systems, if appropriate. Examples of procedures and safeguards include:

a. All pilferable materials shall be kept under constant surveillance and shall be collected at the end of each work day and secured under lock.

b. Keys shall be removed from all vehicles and equipment when not in use.

c. All gates and doors which were opened to allow Contractor personnel access for work shall be closed and locked. Only authorized Contractor personnel or Government personnel shall be permitted to enter secured areas.

The COR or his representative shall be informed immediately if any unauthorized person enters a secured area.

EXHIBIT H

PARTIAL LISTING OF SAFETY AND SECURITY REQUIREMENTS

EXHIBIT H

PARTIAL LISTING OF SAFETY AND SECURITY REQUIREMENTS\

1. The following is a clarification of the Corps of Engineers' policy concerning the use of personal protective equipment for contract employees as defined in the EM 385-1-1, Safety and Health Requirements Manual. This is not meant to be a complete review of required safety equipment, but is simply provided to answer some of the more common questions concerning our safety policy.

The items of equipment listed below should be issued to each employee or made readily available for employee's use, when the work environment requires it:

a. Safety shoes - All employees except park aids performing traffic surveys and clerical personnel are to wear hard toe safety shoes at all times. For those not required to wear steel toed safety shoes, leather work shoes shall be worn.

b. Hard hats - Hard hats are to be worn when operating or working around equipment that lifts overhead (e.g. backhoe-end loader) or working at ground level around mowing equipment. Hard hats will not be required when operating a riding mower, unless other mowing equipment is present. Hard hats will be required during construction type activities and wildfire suppression.

c. Safety glasses or goggles - Safety glasses with side shields or goggles are to be worn when operating equipment or working around equipment that may cause harm from flying debris (e.g.

weed eaters), and when using power or hand tools.

d. Welders - Full face welder's helmets are to be worn during electric arc welding operations, and appropriate shields or warning shall be given or posted to protect other persons from the flash. During oxyacetylene welding or cutting, appropriate goggles or full face shield shall be worn.

e. Gloves - The proper type gloves are to be worn when there is a danger of burns, cuts, scrapes, scratches, wood splinters, or other injury to employee's hands.

f. Ear protection - Ear plugs or muffs shall be worn when operating any device that has been determined to produce 85 decibels or greater on a time-weighted average. It is your responsibility to determine the noise level of your equipment. Each piece of equipment that exceeds 85dB(A) rating should be labeled to indicate the need for hearing protection.

g. Protective leg chaps - Protective leg chaps are to be worn when operating equipment such as a chain saw.

h. P.F.D's (Personal Flotation Device/Life Jacket) - P.F.D's are to be worn at all times when working around the water or on board watercraft.

i. Safety cans - Containers for flammable liquids shall be labeled and meet the requirements specified in Section O9.B.

j. Seat belts - Seat belts are to be worn at all times when operating, or being transported by motor vehicles and when operating mobile equipment with rollover protection.

k. Safety vests - Blaze orange safety vests are to be worn when employees are working adjacent to through highways (e.g. State Route 37).

l. Lock-Out/Tag-Out - Lock-Out/Tag-Out procedures will be used in accordance with EM385- 1-1, Section 12 and in coordination with project personnel.

m. Respiratory Protection – For work involving hazardous atmospheres, Contractors will provide a written Respiratory Protection Plan, which includes training and medical clearance.

Employees shall have a properly fitting respirator, of the appropriate type, prior to working in a respiratory hazard area. All work requiring the use of respirators shall be performed in accordance with EM 385-1-1, Section O.5-G.

n. Confined Space - Procedures outlined in EM 385-1-1, Section 6.1, and OSHA 29, CFR 1910, 146, shall be developed and followed when working in confined space. Such procedures must be approved by the COR prior to initiating them.

2. The Contractor shall conduct monthly safety meetings and weekly "tool box" safety meetings in accordance with EM 385-1-1, Safety and Health Requirements Manual. The Contractor may contact the COR about upcoming work planned, to determine appropriate subjects for the monthly safety meetings. The Government makes no guarantee that the list of upcoming work planned, will actually be ordered nor will work ordered be restricted to said list. The Contractor shall inform the COR of the date, time, and place of the monthly safety meeting, a minimum of 7 days prior to the meeting.

3. Great emphasis will be given to the development and proper use of Activity Hazard Analysis (AHA). When ordered, AHAs will be developed in detail, utilized during job performance, and available to employees at the job site.

4. Transporting employees and equipment to worksites:

a. Vehicles used to transport staff and equipment must be well maintained and never overloaded. Each vehicle occupant must have a seat belt available to him or her and must wear the belt.

b. Personnel and tools must be kept apart during travel. Tools and tool boxes must be secured in a manner which will prevent their causing injury in case of a sudden stop or collision.

c. Tool box lids must be securely latched or locked.

5. Contractor vehicles involved in litter pick-up along project and public roads must be equipped with an orange rooftop revolving light, a rear mounted warning sign and reflective warning tape on the bumper. Employees performing litter pickup along public and project roads must wear High-visibility apparel meeting, at minimum, ANSI/SEA 07-2004 Performance Class 2 requirements.

SECURITY REQUIREMENTS

All Contractors and subcontractor employee(s) working on this contract who require access in and/or around any Huntington District facilities shall receive authorization to be on site at these facilities based upon a favorable background investigation in accordance with “Homeland Security Presidential Directive 12: Policy for a Common Identification Standard for Federal Employees and Contractors” (HSPD 12). The Huntington District Security Management Office shall submit contractor(s) personal information in order to complete the basic background investigation in order to make a recommendation to the Contracting Office of an employee’s suitability for work on Government property. The Procuring Contracting Officer (PCO) has the right to deny any contractor or subcontractor employee from working on the contract based upon the results provided by the Huntington District Security Management Office of the background investigation. The Government, Contractor, and subcontractors shall not permit any employee(s) access to drawings, blueprints, records, photos, sites, or projects until the Huntington District Security Management Office has completed an Operations Security (OPSEC) review of such items and determined they can be released.

Contractors shall submit a complete investigation packet for each contractor and subcontractor employee to the Huntington District Security Management office within 10 working days after award of any contract, or prior to the individual being permitted unescorted access in or on District facilities.

The Contractor must also provide the following: (1) Name of the Contract Specialist with whom he/she is working, (2) Project Name, (3) Contract Number and (4) Task Order Number when applicable.

The documents listed below are required:

SF 85, Questionnaire for Non-Sensitive Positions (see http://www.opm.gov/forms/ to print form). FD 258, Contractor Fingerprint Card (one card for digital prints, two for ink prints) (NOTE: a trained/ qualified individual must take prints, ORI block on the FD 258 must be USOPM000Z) (Contractor Fingerprint Cards (FD-258) may be obtained by Contracting Division by contacting the Huntington District Security Management office).

Contractor shall report any changes in personnel or at any time conditions change at least 5 working days prior to individual(s) need to have access to the site. The Contractor shall provide the same information as listed above for all new employees.

Following submission of paperwork, the Security Management Office will conduct an initial criminal check based upon the information provided. If there are no issues, Security Management Office will make recommendations to the PCO or their Designated Representative. The Security Management Office cannot give approval due to unfavorable report(s). The Security Management Office shall coordinate with Office of Counsel and will jointly make recommendations to the PCO and/or the Designated Representative should a background investigation come back with derogatory information.

The PCO will make the determination whether to allow the Contractor personnel to work on the site based on Security and Office of Counsel recommendations, and the PCO will advise Contractor of the decision.

FOREIGN NATIONALS

The Contractor shall provide the package listed above, as well as additional materials noted below for all Foreign Nationals. The Contractor is to expect additional time in the approval process for all Foreign Nationals due to the level of review and elevation of the review to Headquarters Staff to accomplish. All Foreign Nationals must comply with the following paragraph:

In accordance with Engineering Regulation 380-1-18, “Technology Transfer, Disclosure of Information and Contacts with Foreign Representatives” dated 1 August 1996, Section 4, all foreign nationals who work on Corps of Engineers’ contracts shall be approved by the Headquarters US Army Corps of Engineers (HQ USACE) Foreign Disclosure Officer before beginning work on this contract; this regulation includes subcontractor employees. The Contractor shall submit to the Security Management Office, the names of all foreign nationals proposed for performance under this contract, along with documentation to verify legal admittance into the United States. Such documentation shall include at least one of the following a U.S. passport, Certificate of U.S.

Citizenship (INS Form N-560 or N-561), Certificate of Naturalization (INS Form N-550 or N-570), Alien Registration Card with photograph (INS Form I-151 or I-551), Employment Authorization Card (INS Form I-688A), etc.

In order to assure forms are properly completed, and to minimize time delays, Contractor is encouraged to work closely with the Security Management Office. Per AR 380-10, Foreign Disclosure, All Foreign National Visits must be submitted to the Security Office within 30 days prior to the visit. The Government will return for correction incomplete forms, illegible forms, etc. which will delay the contractor / subcontractor from beginning work.

Security requirements are subject to change in accordance with HSPD-12, Office of Personnel Management, regulation or policy changes, etc. The Government shall add any changes to security requirements by modification to the contract.

The Contractor shall contact the Security Management Office by phone, letter, or email at the following numbers/addresses:

CELRH-SM

502 Eighth Street Huntington, WV 25701

Stephen R. Curry, phone (304) 399-5695; email stephen.r.curry@usace.army.mil Matthew D. Green, phone (304) 399-5294; email matthew.d.green@usace.army.mil Sandra L. Hardwick, phone (304) 399-5612; email sandra.l.hardwick@usace.army.mil

EXHIBIT I

REQUIRED OUTLINE, CONTRACTOR ACCIDENT PREVENTION PLAN

EM385-1-1 APPENDIX A

APPENDIX A

MINIMUM BASIC OUTLINE FOR ACCIDENT PREVENTION PLANS

An Accident Prevention Plan (APP) is a safety and health policy and program document. The following areas are typically addressed in an APP, but an APP shall be job-specific and shall also address any unusual or unique aspects of the project or activity for which it is written.

The APP shall interface with the employer’s overall safety and health program, and a copy shall be available on the work site. Any portions of the overall safety and health program that are referenced in the APP shall be included as appropriate. ANSI/ASSE A10.38 should be referenced for Programmatic Issues.

> For LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS, for example, mowing (only), park attendant, rest room cleaning, the Contracting Officer and SOHO may allow an ABBREVIATED APP (customized APP requirements and waive the more stringent elements of this section). > See 01.A.11 and Appendix A, paragraph 11.

1. SIGNATURE SHEET. Title, signature, and phone number of the following:

a. Plan preparer (Qualified Person, Competent Person, such as corporate safety staff person, QC);

b. Plan must be approved, by company/corporate officers authorized to obligate the company;

c. Plan concurrence (e.g., Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC).

Provide concurrence of other applicable corporate and project personnel (Contractor).

2. BACKGROUND INFORMATION. List the following:

a. Contractor;

b. Contract number;

c. Project name;

d. Brief project description, description of work to be performed, and location; phases of work anticipated (these will require an AHA).

3. STATEMENT OF SAFETY AND HEALTH POLICY. Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. The Contractor’s written safety program goals, objectives, and accident experience goals for this contract should be provided.

4. RESPONSIBILITIES AND LINES OF AUTHORITIES. Provide the following:

a. A statement of the employer’s ultimate responsibility for the implementation of his SOH program;

b. Identification and accountability of personnel responsible for safety at both corporate and project level. Contracts specifically requiring safety or industrial hygiene personnel shall include a copy of their resumes. Qualifications shall include the OSHA 30-hour course or equivalent course areas as listed here:

(1) OSH Act/General Duty Clause;

(2) 29 CFR 1904, Recordkeeping;

(3) Subpart C: General Safety and Health Provisions, Competent Person;

(4) Subpart D: Occupational Health and Environmental Controls, Citations and Safety Programs;

(5) Subpart E: PPE, types and requirements for use;

(6) Subpart F: understanding fire protection in the workplace;

(7) Subpart K: Electrical;

(8 Subpart M: Fall Protection;

(9) Rigging, welding and cutting, scaffolding, excavations, concrete and masonry, demolition; health hazards in construction, materials handling, storage and disposal, hand and power tools, motor vehicles, mechanized equipment, marine operations, steel erection, stairways and ladders, confined spaces or any others that are applicable to the work being performed.

c. The names of Competent and/or Qualified Person(s) and proof of competency/qualification to meet specific OSHA Competent/Qualified Person(s) requirements must be attached. The District SOHO will review the qualifications for acceptance;

d. Requirements that no work shall be performed unless a designated competent person is present on the job site;

e. Requirements for pre-task safety and health analysis;

f. Lines of authority;

g. Policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements) should be identified;

h. Provide written company procedures for holding managers and supervisors accountable for safety.

5. SUBCONTRACTORS AND SUPPLIERS. If applicable, provide procedures for coordinating SOH activities with other employers on the job site:

a. Identification of subcontractors and suppliers (if known);

b. Safety responsibilities of subcontractors and suppliers.

6. TRAINING.

a. Requirements for new hire SOH orientation training at the time of initial hire of each new employee.

b. Requirements for mandatory training and certifications that are applicable to this project (e.g., explosive actuated tools, confined space entry, crane operator, diver, vehicle operator, HAZWOPER training and certification, PPE) and any requirements for periodic retraining/recertification.

c. Procedures for periodic safety and health training for supervisors and employees.

d. Requirements for emergency response training. > See paragraph 9.b. below for a list of requirements that may require emergency response training.

7. SAFETY AND HEALTH INSPECTIONS.

a. Specific assignment of responsibilities for a minimum daily job site safety and health inspection during periods of work activity: Who will conduct (e.g., SSHO, PM, safety professional, QC, supervisors, employees – depends on level of technical proficiency needed to perform said inspections), proof of inspector’s training/qualifications, when inspections will be conducted, procedures for documentation, deficiency tracking system, and follow-up procedures;

b. Any external inspections/certifications that may be required (e.g., USCG).

8. ACCIDENT REPORTING. The Contractor shall identify person(s) responsible to provide the following:

a. Exposure data (man-hours worked);

b. Accident investigations, reports, and logs: Report all accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR). The contractor shall thoroughly investigate the accident and submit the findings of the investigation along with appropriate corrective actions to the CO/COR in the prescribed format as soon as possible but no later than five (5) working days following the accident. Implement corrective actions as soon as reasonably possible;

c. The following require immediate accident notification:

(1) A fatal injury;

(2) A permanent total disability;

(3) A permanent partial disability;

(4) The hospitalization of three or more people resulting from a single occurrence;

(5) Property damage of $200,000 or more.

9. PLANS (PROGRAMS, PROCEDURES) REQUIRED BY THE SAFETY MANUAL.

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans.

Using the EM 385-1-1 as a guide, plans may include but not be limited to:

a. Layout plans (04.A.01);

b. Emergency response plans:

(1) Procedures and tests (01.E.01);

(2) Spill plans (01.E.01, 06.A.02);

(3) Firefighting plan (01.E.01, Section 19);

(4) Posting of emergency telephone numbers (01.E.05);

(5) Man overboard/abandon ship (Section19.A.04); N/A

(6) Medical Support. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (Section 03.A.02; 03.D);

c. Plan for prevention of alcohol and drug abuse (01.C.02);

d Site sanitation plan (Section 02);

e Access and haul road plan (4.B);

f. Respiratory protection plan (05.G); N/A

g. Health hazard control program (06.A);

h. Hazard communication program (06.B.01);

i. Process Safety Management Plan (06.B.04);

j. Lead abatement plan (06.B.05 & specifications); N/A

k. Asbestos abatement plan (06.B.05 & specifications); N/A

l. Radiation Safety Program (06.E.03.a); N/A

m. Abrasive blasting (06.H.01); N/A

n. Heat/Cold Stress Monitoring Plan (06.I.02)

o. Crystalline Silica Monitoring Plan (Assessment) (06.M) ; N/A

p. Night operations lighting plan (07.A.08); N/A

q. Fire Prevention Plan (09.A);

r. Wild Land Fire Management Plan (09.K); N/A

s. Hazardous energy control plan (12.A.01); N/A

t. Critical lift Plan (16.H); N/A

u. Contingency plan for severe weather (19.A.03);

v. Float Plan (19.F.04); N/A

w. Site-Specific Fall Protection & Prevention Plan (21.C); N/A

x. Demolition plan (to include engineering survey) (23.A.01); N/A

y. Excavation/trenching plan (25.A.01); N/A

z. Emergency rescue (tunneling) (26.A.);

aa. Underground construction fire prevention and protection plan (26.D.01); N/A

bb. Compressed air plan (26.I.01); N/A

cc. Formwork and shoring erection and removal plans (27.C); N/A

dd. Precast Concrete Plan (27.D); N/A

ee. Lift slab plans (27.E); N/A

ff. Steel erection plan (27.F.01); N/A

gg. Site Safety and Health Plan for HTRW work (28.B);

hh. Blasting Safety Plan (29.A.01); N/A

ii. Diving plan (30.A.13); N/A

jj. Confined space Program (34.A). N/A

10. RISK MANAGEMENT PROCESSES. Detailed project-specific hazards and controls shall be provided by an Activity Hazard Analysis (0I.A.13) for each major phase/activity of work.

11. ABBREVIATED APP for LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS. 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.

a. Title, signature, and phone number of the plan preparer.

b. Background Information to include: Contractor; Contract number; Project name; Brief project description, description of work to be performed, and location (map); The project description shall provide a means to evaluate the work being done (see AHA requirements in 01.A.13) and associated hazards involved. Contractor’s APP shall address the identified hazards involved and the control measures to be taken.

c. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthful workplace for all employees.

d. Responsibilities and Lines of Authorities – to include a statement of the employer’s ultimate responsibility for the implementation of his SOH program; Identification and accountability of personnel responsible for safety at all levels to include designated site safety and health officer (SSHO) and associated qualifications. The District SOHO will review the qualifications for acceptance.

e. Training - new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements.

f. Procedures for job site inspections - assignment of responsibilities and frequency.

g. 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). An accident that results in a fatal injury, permanent partial or permanent total disability shall be immediately reported to the Contracting Officer.

h. 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.

i. Drinking Water provisions, toilet and washing facilities.

j. 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).

k. Personal Protective Equipment.

(1) WORK CLOTHING - Minimum Requirements. Employees shall wear clothing suitable for the weather however minimum requirements for work shall be short-sleeve shirt, long pants (excessively long or baggy pants are prohibited) and leather work shoes. If analysis determines that safety-toed (or other protective) footwear is necessary (i.e., mowing, weed eating, chain saw use, etc), they shall be worn.

(2) 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.

(3) Hearing Protection. Hearing protection must be worn by all those exposed to high noise activities (to include grass mowing and trimming, chainsaw operations, tree chipping, stump grinding and pruning).

(4) Head Protection. Hard hats shall comply with ANSI Z89.1 and shall be worn by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in (2) above.

(5) 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.

(6) Protective Leg chaps shall be worn by all chainsaw operators.

(7) Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts, abrasions, punctures, burns and chemical irritants.

(8) If work is being performed around water and drowning is a hazard, PFDs must be provided and worn as appropriate.

l. Machine Guards and safety devices. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.

m. 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.

n. Traffic control shall be accomplished in accordance with DOT’s MUTCD.

o. Control of Hazardous Energy (Lockout/Tagout). Before an employee performs any servicing or maintenance on any equipment where the unexpected energizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of this energy.

p. Driving, working on (i.e., working with equipment/mowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly.

EXHIBIT J

EQUIPMENT INSPECTION MAINTENANCE WORKSHEET

ENG FORM 5007-R

VEHICLE OPERATIONAL RECORD FORM

CELRH Form 2813 (Test)

EQUIPMENT MAINTENANCE CHECKS AND SERVICES

EMCS CHECKLIST

EXHIBIT K

CONTRACT DISCREPANCY REPORT

(CDR) (CELRH Form 1104)

EXHIBIT L

SAMPLE INVOICE FORMAT

EXHIBIT L

SAMPLE INVOICE

FROM:

Contractor's Name INVOICE NO:

Address Phone Number INVOICE FOR MONTH OF:

DATE OF INVOICE:

CONTRACT NUMBER:

TO:

Project Name Address

DATE WORK ORDER NUMBER AMOUNT

7-1-2012 Work Order Number 0001 Item No. 0154, Negotiated Work, Job for Sum $3,590.00

TOTAL INVOICE $4,665.00

EXHIBIT O

SAMPLE SAFETY FORMS

ACTIVITY JOB HAZARD ANALYSIS (CELRH FORM 2642)

OSHA 300A LOG

ENG FORM 3394 – ACCIDENT INVESTIGATION REPORT

EXHIBIT P

TASK ORDER FORM

DD FORM 1155

EXHIBIT Q

PLAYGROUND INSPECTION FORM

(CELRH Form 2788)

EXHIBIT R

CONTRACTOR EQUIPMENT AND SUPPLY INSPECTION

(CELRH Form 2800)

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