Attachment_O_-_Tower_Climbing_Plan.pdf

DATA INPUT PAGE

Pg 1 Contract ID __________________________________

Work order number:__________________

Company Name ____________________________________

Company Address___________________________________

City, State, Zip _____________________________________

Phone number ________________________________

1.0 Plan Preparer name ______________________

Company name _______________________ phone# ______________

Plan Approver Name ______________________________

Company name _______________________ phone# ______________

Plan Concurrence Name ______________________________

Company name _______________________ phone# ______________

Project Health and Safety Acknowledgement Form 1-1 name ________________date__________company________________ name ________________date__________company________________ name ________________date__________company________________ name ________________date__________company________________ name ________________date__________company________________ name ________________date__________company________________ name ________________date__________company________________ name ________________date__________company________________

2.0 District name ____________________________________

Safety Director Name ___________________

Safety Directors phone number___________

EMR year________

EMR number_______

DATA INPUT PAGE

4.0 RESPONSIBILITIES AND LINES OF AUTHORITIES

name___________ title_______________ phone#_____________ name___________ title_______________ phone#_____________ name___________ title_______________ phone#_____________ name___________ title_______________ phone#_____________

_______________ Tower foreman _____________ Team leader

5.0 subcontractor name ______________________________

9.0 Accident reporting PE name ___________________

10.0 Persons Trained in CPR ___________________ /_________________ must have 2 onsite

Corporate Safety manager name______________ phone_____________

11.0 project manager name ___________________________

Activity Hazard Analysis Date prepared _______________

ACCIDENT PREVENTION PLAN

Prepared for:

Department of the Army Corps of Engineers

Contract ID: _______________________

WORK ORDER# _________

Prepared by:

1.0 SIGNATURE SHEET

Plan Preparer: ______________________________ Name _____________________

Plan Approver: _____________________________ Authorized to obligate Name ______________________ Company to APP Plan ______________________ ____________

Plan Concurrence: ____________________________ Name ______________________

Team personnel assigned to this project shall be familiar with the possible hazards involved, the safety procedures, and other information outlined in this plan. Prior to the commencement of work, the Team Leader will discuss additional procedures to be implemented, addressing any other site-specific conditions that may arise. All on-site personnel of _______________________ and all subcontractors must sign the following Plan Acknowledgement Form (Figure 1-1).

By signing below, the undersigned certify they have had the opportunity to read and ask questions about this APP, and that they understand the procedures, equipment, and restrictions of this plan and agree to abide by them.

Figure 1-1 Project Health and Safety Acknowledgement Form

No. Name Signature Date Company

2.0 BACKGROUND INFORMATION (EM 385-1-1, Appendix A, Section 2)

2.a Contractor: _______________________.

2.b Contract Number: XX00-0000-XX-ACE00 ACE-IT Work order# _________

2.c Project Name: ______________ District OP Project / Tower Site Maintenance

2.d Brief Project Description:

The objective of this project is to inspect/repair existing communications towers.

If an inspection is involved the climbing of said tower is required in order to measure and document each s tructural member, as well as the documentation of the m odel num ber and/or size of installed antennas and lines and other major points to insure structural integrity. If a repair or other requested work is performed reference the statement of work attached.

If an inspection is to be perf ormed the primary site activity consists of qualified tower climbers ascending the tower, taking measurements of each structural component and appurtenance, and descending the tower. Also required are tension m easurements of any guy wires or viewing of anchor points. Nothing shall be removed from or added to the towers unless a repair is required.

Qualified tower personnel shall climb the tower, and a site foreman shall oversee the tower climb from the ground, assuring that the climbing inspection/repair goes smoothly and without incident, all safety procedures are followed, and all information is properly obtained.

For m ore detailed Tower site survey data point see attached Tower inspection document.

2.e Contractor accident experience:

___________________ has performed numerous field investigation projects.

___________________ has an excellent accident prevention record, as shown in the attached OSHA 300A form, or other attached documents, additional information available upon request from _______________________, our Corporate S afety Director, at _____________________. Our ________ EMR was _______. Our tea m will work hard to prevent accidents, by f ollowing this Accident Prevention Plan, and the USACE Manual, EM 385-1-1.

2.f Hazard/Risk Analysis

The field operations involves all work contained in the attached statement of work.

(SOW) In most cases some form of tower climb will be required to r esolve repairs or perform inspections.

The following activities have been determined to be high hazard activities warranting Activity Hazard Analysis (AHA) as required by EM 385-1-1, 01.A.14. Job Safety Analyses (JSAs) & Job Hazard Analyses (JHAs) are equivalent and acceptable substitutes.

• Inspection/Repair of devices of each tower via climbing.

3.0 STATEMENT OF SAFETY AND HEALTH POLICY

___________________ is committed to providing a safe and healthy work environment for its employees. To maintain a safe work environment, ___________________ has established a Corporate Health and Safety Program to promote the following objectives:

Reduce the risk of injury, illness, and loss of life to our employees.

Maintain compliance with federal, state, and other applicable safety regulations; and minimize ______________________ employees’ work exposure to potential physical, chemical, biological, and radiological hazards.

A copy of our Corporate Health and Safety Program is appended to this plan and a copy of the Program will be maintained on site with this APP.

4.0 RESPONSIBILITIES AND LINES OF AUTHORITIES

Name Title Phone #

Lines of Authority will be as follows:

On site, ______________________, the Team Leader has overall responsibility for Health and Safety. He will be assisted by __________________, the Tower Foreman. The Tower Forem an is responsible for the Tower Tech’s day to day safety and health, ensuring compliance with this APP, providing daily safety briefings, performing daily H&S and PPE inspections, and overall compliance with _______________________ Corporate Safety Program. The Team Leader will report all safety violations to the Project Manager. Employees cited for H&S violations will counseled and disciplined in accordance with the guide lines established in ______________________ Corporate Safety Program, which has been attached. All site personnel will be briefed and encouraged to report H&S issues of which they are aware.

5.0 SUBCONTRACTORS AND SUPPLIERS

a. Subcontractor Name and role.

_______________________ is providing the tower climbers for the field portion of this project.

b. All subcontractors will be provided a copy of this Accident Prevention Plan.

Subcontractors will review the Plan with their employees and supervisors and each individual is expected to sign the signature sheet identified in 1.0 above, certifying that they have read, understand and will comply with the requirements of this plan. Subcontractors will provide Company Specific Programs and Activity Hazard Analysis to the Prime Contractor for inclusion in the APP. Subcontractor personnel are expected to attend all daily H&S briefings

c. _______________________ requires its subcontractors to work in a responsible and safe manner. Subcontractors for this project will be required to adhere to applicable requirements set forth in the USACE Safety and Health Requirements Manual, EM 385-1-1, November 2014, in their work and safety plans. Safety inspections will be performed by ______________________ prior to the start of each workday.

6.0 TRAINING

a. The following applicable subject matter will be discussed with team members during the project safety indoctrination training, which will be help prior to commencing site activities.

Fall protection Emergency response/notification Personal protective equipment First aid/CPR procedures

b. The following docum ented training and/or certif icates will be available for those involved or assigned to those activities.

First aid/CPR certificates and blood-borne pathogen training for the two site persons req uired to have first aid/CPR training. Training will be in accordance with requirements of _______________________

Documented fall protection training in accordance with _________________________, Fall Protection Program, as outlined in the appended safety manuals. Training certif icates for the tower climbers will be available from the corporate headquarters.

c. All site personnel will be briefed on the site Emergency Res ponse Plan provided in Section 12. Site personnel will be briefed on roles and responsibilities during an emergency, notification, potential emergency situations, rally points, & location of emergency equipment.

d. Daily safety meetings at each site will be held for all inspection team members to discuss the upcoming day’s activities, health and safety issues and to review AHAs. Site-specific hazards that may not have been recognized on the AHA prior to actually visiting each site will be identified and proper safety procedures discussed prior to the start of the climb on each tower.

7.0 SAFETY AND HEALTH INSPECTIONS

a. Daily safety and hea lth inspections will be performed at the site, in accordance with EM 385-1-1, Section 01.A.3.G. Daily safety inspections will be conducted by the Team Leader __________________, and the Tower Foreman ___________________ at a minimum. All inspections will be thoroughly documented and copies will be forwarded up on request. In the event that deficiencies are noted which can not be immediately corrected, the deficiency will be tracked utilizing the process outlined in __________________ Corporate Safety Manual. ___________________ considers the safety and health of our employees and subcontractors first and foremost. All equipment will be inspected prior to the start of each tower climb and again once the tower climb has been completed in order to reduce the possibility of faulty equipment. Climbing-specific safety inspections will be completed each day by the Tower Foreman.

b. The existing fall protection system for purposes of the tower climb will be inspected prior to use by __________________, Team Leader, ____________________, Tower Foreman, or _____________________, Fall Protection System Competent Person.

8.0 SAFETY AND HEALTH EXPECTATIONS, INCENTIVE PROGRAM, AND

COMPLIANCE

a. __________________________ written safety program goals are to maintain a safe work environment that promotes the following:

Reduce the risk of injury, illness and loss of life to employees.

Maintain compliance with federal, state and other applicable safety regulations, and minimize employees’ work exposure to potential physical, chemical, biological, and radiological hazards.

b. ______________________ does not have a safety incentive plan, nor do our subcontractors.

c. _______________________ takes safety very seriously. This Plan and our Company Safety Program has been developed to ensure that we minimize our employees risk of injury and ensure their quality of life.

_______________________ expects all employees to fully comply with all established safety and health policy and to notify their supervisor immediately if they notice a health or safety hazard or someone not complying with established procedures. Violators of our Safety and Health Policies will be disciplined and may be dismissed.

d. Health and safety is everyone’s responsibility, and __________________ takes the health and safety of their employees seriously. Each _______________________ project supervisor has been entrusted with the responsibility to ensure that the policies and procedures outlined in our Company Health and Safety Program and this Accident Prevention Plan are followed to the letter. Each supervisor is to be held responsible for the health and safety of those they supervise.

9.0 ACCIDENT REPORTING

a. _____________________, PE, or ______________________, Tower Foreman will provide exposure data in the form of man-hours worked for the project upon request from the COR.

b. All reportable incidents, OSHA recordable mishaps, lost time injuries, injuries requiring medical attention, fires, accidents involving the public, property damage exceeding $5,000.00, will be investigated by the Team Leader, Tower Foreman, and Project Manager, and reported to the Safety Director. In addition to the internal investigation a report shall be made to the US Army Corps of Engineers’ Goverment Designated Authority (GDA) verbally within 24 hours and a written report of the accident/incident must be submitted on ENG Form 3394, Accident Investigation Form, within 5 working days of the incident.

c. Fatalities will be reported immediately to the COE and the GDA. GDA will immediately notify the SOHO and followup with a report. Fatalities and serious accident scenes will not be disturbed until the USACE district has convened and completed its internal Board of Investigation and then instructed the Contractor that it is okay to resume activities.

NOTE:

Contractors are responsible for notifying OSHA in accordance with 29 CFR

1904.39 within 8 hours when their employee(s) is fatally injured

10.0 MEDICAL SUPPORT

a. In case of minor injuries, ____________________ / _____________________ have had first aid/CPR and blood borne pathogens training and will provide immdiate on-site care.

For serious injuries, call 911 and request emergency medical assistance. Seriously injured persons should not be moved, unless they are in im mediate danger. The table below contains emergency phone numbers. Figure 10-1 is a site map or lis t of maps to the nearest E mergency Medical Care Provider for each site along with written directions and phone numbers. SEE Attached Maps

EMERGENCY NOTIFICATION/CONTACT LIST

CONTACT PHONE NUMBER

Fire 911

Cell# *911 Police 911

Cell# *911 Ambulance 911

Cell *911 Emergency Medical Care Facility (Per Site):

Corporate Health and Safety Manager _____________________ ________________

10.1 Maps to closest medical facility will be attached at the end of the document.

11.0 PERSONAL PROTECTIVE EQUIPMENT

A hazard assessment of each of the anticipated tasks, in each phase of work for this project has been performed by _________________ Project Manager. A list of the phase of work, specific tasks and the necessary personal protective equipment are provided in the following table. Individuals using personal protective equipment have been medically cleared to use such PPE when required and trained in accordance with the applicable following sections of _____________________ Safety and Health Program. Training will occur prior to equipment use and will cover the following topics as they relate to the specific equipment: proper use; inspection;

care; testing; and storage; limitations of the equipment; and proper disposal. Proof of training will be maintained on site and will be available for inspection by the USACE representatives.

Please refer to the appended Safety Manual for details on _____________________ Fall Protection and Personal Protective Equipment Programs.

Task Specific Personal Protective Equipment Phase: Tower Climb/Inspection TASKS Safety Shoe

Steel Toe Hard Hat Safety

Glasses Fall Protection Respiratory

Protection

PPE

Level

Other

Climb Tower X X Available, If necessary

Full body harness – see appended spec sheets for specific climbing hardware details

No D Gloves

Monitor Tower Climb from Ground

X X Available, If necessary

No No D

12.0 PLANS REQUIRED BY THE SAFETY MANUAL

a. Emergency Response Plan: The Emergency Response Plan in regards to this project has been listed in Section 10: Medical Support, including phone numbers, maps and addresses to nearby medical facilities, and COE site point of contact name and phone numbers.

b. Fall protection is a major concern during the tower climb. All tower climbers and foremen have been through the fall protection and climbing program and have met the medical surveillance requirements outline in the corporate Fall Protection Program. Training documentation can be provided and will be available if requested for review.

____________________ is the Project Team Fall Protection Competent Person, Tower Foremen. __________________ will inspect all climbing and safety systems prior to use by team members to ensure structural reliability. Climbers will be protected during this inspection by utilizing 100% tie off. Climbers will tie off to the tower structure using a DBI Sala self-locking carabineer and a 32” lanyard, attached to a DBI Sala body harness, or other approved 100% tie off method. After ___________________ has inspected the climbing system, including the step bolts and safety climb, a maximum of (2) tower climbers may ascend the tower. The exact tower safety climb (fall arrest system) is unknown, however, given that typical safety climbs that are installed on towers must meet or exceed OSHA Federal Register 1910.27, FAA RR-S-001301, ANSI A14.3-1992, and ANSI Z-359, the load provided by (2) tower climbers and their equipment shall be more than sufficiently supported by the existing system. Workers shall not exceed the 310 lbs limit.

Rescue plan

Any rescue begins with a plan. The plan begins with a meeting with the crew before leaving the shop. The crew is to make sure that the truck has sufficient equipment and first aid supplies loaded before leaving. The second step in the plan is to make sure each person knows where the nearest medical help is located near the job site and phone #’s. The third stage is the rescue plan is to assure all workers on the site understand and agree to a workable emergency plan. Every situation is different and every climber should always ask themselves if they were to get hurt, how he would get down from the tower. The personnel on the ground should be ready to ask the same question, what would I need to do if a climber were injured on the tower. Listed below are different rescue techniques.

Self rescue and manual rescue will be the primary plan for all incidents. Outside services will be consulted but climbing personal are the most experienced and efficient method of rescue.

Self Rescue – Self rescue will be the first option of any rescue. If this option is not available then manual or outside services will be utilized.

Manual rescue – A climber can climb to the injured person and pull the victim back to the safety of the structure.

Outside service – Professional rescue services should be used when they are available and the response time is acceptable. (Fire truck or ladder truck)

Winch rescue – If a winch is available and rigged or can be rigged, attach an injured worker to the winch line and lower the victim to the ground.

Ascending and Descending Systems – These are special manually operated devices that are appropriate to many climbing environments and one rescuer operation.

Descending/ Suspension Systems – This is an approved descent and suspension device that can be used to reach a fallen climber and assist the climber to the ground.

Once on site or prior to arriving on site these items will be addressed and answered:

1. A climb evaluation and briefing will be done on site with all personnel and shall include, at a minimum:

a. Determination of rescue method based upon emergency services’ capability.

b. Types of rescue devices using ropes, fisk method and rescue harness.

c. Anchor points, to be determined based on site evaluation.

2. The Tower foreman will contact the local Fire/Rescue and identify their maximum rescue height capability.

3. All climbers will use a full body harness with D-Ring attached on either back, shoulders or waist points. Climber shall remain in 100% tie-off at all times at levels greater than 6 feet.

In choosing the best type of emergency rescue procedure, the following must be considered:

a. Access to the work areas: In some cases, work will be performed in several work areas with different access types and you should plan separate rescue procedures for each area during the pre-climb safety meeting.

b. What is the workspace for the rescuer? You must consider whether the rescuer will be safe using a specific technique given the current situation.

c. Experience and skill: Different techniques shall be practiced (hold rescue excercises periodically).

d. Finally, think about the preparation, inspection and availability of any required equipment.

If a climber were to get injured on a tower and needed assistance getting down, a second experienced climber would approach the injured worker and determine which method of rescue would be appropriate for the time allowed. Most likely a safety rope would be rigged and the injured climber would be attached to the rescuer and both would descend to the ground together using a Fisk or some other type of descending device.

Tower Inspection

Activity Hazard Analyses (AHAs)

Date Prepared Date Revised Revision No.

ACTIVITY HAZARD ANALYSIS

Project Analysis prepared by: Reviewed by: Accepted by:

COE Tower Site Maintenance Visits/Surveys

Project Manager

COE Safety Officer

Activity Hazard Recommended Controls

Climb tower in order to perform repairs or survey of structure.

Tower climbers will be over 6-ft off the ground, and thus fall protection is a concern.

All tower climbers are trained in fall protection and proper use of PPE equipment. The climbing facilities on the tower itself shall be inspected prior to starting the climb in order to ensure that it is capable of supporting the climbers and their equipment.

Tower climbers will in close proximity to on-air antennas, and thus RF must be monitored.

Tower climbers will wear RF monitors, providing monitoring and warning of existing RF levels on the tower or when in close proximity or RF devices shut down until exiting the area.

In case of emergency, the tower climbers must be able to be removed from the tower.

__________________ has sent (2) tower climbers to assist with this project, and both tower climbers are trained in rescue climbing, and will be able to descend the tower with the other crew member in case of emergency.

Activity Hazard Recommended Controls

Those on the ground must be aware of any falling objects. Although tools are tied off to the climber, awareness is necessary in case of accidental failure.

Anyone who is on the ground within the tower compound (or within a 100-ft radius from the tower base, whichever is further) shall wear the necessary PPE, including a hard hat, long pants, steel-toed boots, and eye protection.

Injuries may occur both on the tower and on the ground, depending on the terrain, tower condition, etc.

A first aid kit is included in the truck that will be brought to the job sites. In case of more series injury, section 10 of the APP includes contact numbers and driving directions to local medical facilities. A visual pre-work site hazard assessment shall be conducted in order to minimize or eliminate preventable injuries.

Equipment to be used. Inspection Requirements Training Requirements

Full body harness, hard hats/helmets, lanyards, carabineers, and approved devices designed for use on tower projects.

All climbing equipment shall be inspected prior to each climb. Any equipment that is not in sufficient condition shall not be used and will be immediately replaced.

All tower climbers are trained as a “Qualified Tower Person” as detailed in the ______________ safety manual. They have successfully passed a basic climbing test, fall arrest test, and basic climbing review as mandated by _______________ policy. More details may be found in the __________________ Safety Manual.

EM 385-1-1

30 Nov 14

Activity Hazard Analysis (AHA)

Activity/Work Task:

Overall Risk Assessment Code (RAC) (Use highest code)

Project Location:

Risk Assessment Code (RAC) Matrix

Contract Number:

Severity Probability

Date Prepared:

Frequent Likely Occasional Seldom Unlikely

Prepared by (Name/Title):

Catastrophic E E H H M Critical E H H M L

Reviewed by (Name/Title):

Marginal H M M L L Negligible M L L L L

Notes: (Field Notes, Review Comments, etc.)

Step 1: Review each “Hazard” with identified safety “Controls”. Determine RAC (See above) Probability: likelihood the activity will cause a Mishap (near miss, incident or accident).

Identify as Frequent, Likely, Occasional, Seldom or Unlikely.

RAC Chart

Severity: the outcome if a mishap occurred.

Identify as Catastrophic, Critical, Marginal, or Negligible

E = Extremely High Risk

H = High Risk

Step 2: Identify the RAC (probability vs.

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 1.

2.

1.

2.

1.

2.

1.

2.

Equipment to be Used Training Requirements & Competent or Qualified Personnel name(s)

Inspection Requirements

SITE SPECIFIC MAP DATA REFERENCE SECTION 10.1

Attachment included

Attachments:1

SITE SPECIFIC STATEMENT OF WORK FOR PROJECTS

( Information to be provided by site or as an overall plan for all sites)

SITE TOWER SURVEY

Attachment 2

Jones, Travis L ACE-IT @ ERD-MS

From: Hickman, David ACE-IT @ MVN Sent: Tuesday, November 17, 2015 7:34 AM To: Jones, Travis L ACE-IT @ ERD-MS Subject: FW: ACE-IT Safety Plan (UNCLASSIFIED)

Travis, Finally. Approval from USACE Safety HQ.

Dave

‐‐‐‐‐Original Message‐‐‐‐‐ From: Blaisdell, Andrew A HQ Sent: Tuesday, November 17, 2015 7:29 AM To: Hickman, David ACE‐IT @ MVN <david.c.hickman@usace.army.mil> Subject: RE: ACE‐IT Safety Plan (UNCLASSIFIED)

Dave, Realized I didn’t give you an email after our phone meeting. OK to continue to use the CESO approved form. We should begin to think about adding language in the EM for tower maintenance to standardize the requirements in a more formal manner.

Thanks, Andrew A Blaisdell Safety and Systems Engineering Program Manager;

HQ US Army Corps of Engineers, CESO, 3B70;

441 G Street NW Washington, DC 20314 (o)202‐761‐1988 (c)202‐568‐1707 andrew.a.blaisdell@usace.army.mil andrew.a.blaisdell.civ@mail.mil

‐‐‐‐‐Original Message‐‐‐‐‐ From: Hickman, David ACE‐IT @ MVN Sent: Tuesday, October 13, 2015 10:58 AM To: Blaisdell, Andrew A HQ <Andrew.A.Blaisdell@usace.army.mil> Subject: FW: ACE‐IT Safety Plan (UNCLASSIFIED)

Classification: UNCLASSIFIED Caveats: NONE

Hi Andrew,