APP_Checklist_(Oct_2015).pdf

APP Checklist

CONTRACTOR ACCIDENT PREVENTION PLAN (APP) CHECKLIST

(EM 385-1-1, Appendix - A, dated 30 Nov 2014)

Minimum Basic Outline for APP The APP is the Contractor Safety and Health Program Document. The following Site Specific Areas will be addressed:

NOTE: 1. Contractor will complete Checklist and Submit with their APP.

NOTE: 2. Contractor APP WILL be submitted in format below.

NOTE: 3. Safety Office will review Contractor APP and return to PM /COR.

NOTE: 4. Contractor APP's ARE NOT APPROVED by the USACE, only found as Acceptable or Non-Acceptable.

Safety Office Review Status: ACCEPTED BY/DATE: NOT ACCEPTED BY/DATE:

Contractor Name: _______________________________________________________

Contract No: _________________________________

Project Title & Location: Included? Location

Page(s) Yes No N/A

ALL CHECKLIST ITEMS WILL BE COMPLETED!

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 Approval by company/corporate officers authorized to obligate the company (e.g. owner company president, regional vice president etc.)

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 (map);

equipment to be used; anticipated high risk activities

e. Major phases of work anticipated and activities that will require an AHA

3. STATEMENT OF SAFETY AND HEALTH POLICY. Provide a copy of your current corporate/company Safety & 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 for his own employees, all sub-contractors and all others on the worksite.

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. Per EM 385-1-1 01.A.17, the SSHO is required to have as a minimum the OSHA 30-hour Construction Safety course and construction industry safety experience; and must be on-site at all times when work is 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 and details of the employers Risk Management Process (i.e.AHAs)

Project Title & Location: Included? Location

Page(s) Yes No N/A

e. Requirements for activity specific AHAs to be submitted and accepted at preparatory meetings, prior to work being performed;

f. Requirements that no work by the Contractor shall be performed unless a designated CP/SSHO is present at the job site;

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

h. Lines of authority;

i. 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.

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. MISHAP REPORTING AND INVESTIGATION. 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/incidents as soon as possible but not more than 4 hours afterwards to the Contracting Officer/Representative (KO/COR). The contractor shall thoroughly investigate the incident/accident per Section 01.D and, if applicable, submit the findings of the investigation along with appropriate corrective actions to the KO/COR in the prescribed format as soon as possible. Implement corrective actions as soon as reasonably possible and provide notice to the KO/COR when corrective actions are completed;

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. Fatigue Management Plan (01.A.20);

b. Emergency Plans (01.E);

c. Site Sanitation/ Housekeeping Plan (Section 02.B);

Page(s) Yes No N/A

d. Medical Support Agreement (03.A.01; 03.A.03);

e. Blood Borne Pathogen Program (03.A.05);

f. Exposure Control Plan (03.A.05);

g. Automatic External Defibrillator (AED) Program (03.B.04);

h. Site Layout Plan (04.A);

i. Access / Haul Road Plan (04.B);

j. Hearing Conservation Program (05.C);

k. Respiratory Protection Plan (05.G);

l. Health Hazard Control Program (06.A);

m. Hazard Communication Program (06.B.01);

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

o. Lead Compliance Plan (06.C.02 & specifications);

p. Asbestos Abatement Plan (06.C.03 & specifications);

q. Radiation Safety Program (06.F);

r. Abrasive Blasting Procedures (06.I.01);

s. Heat Stress Monitoring Plan (HSMP) (06.J.02);

t. Cold Stress Monitoring Plan (CSMP) (06.J.04);

u. Indoor Air Quality Management Plan (06.L);

v. Mold Remediation Plan (06.L.04);

w. Chromium (VI) Exposure Evaluation (06.M);

x. Crystalline Silica Evaluation (06.N.02) ;

y. Lighting Plan for Night Operations (07.A.06);

z. Traffic Control Plan (08.C.05);

aa. Fire Prevention Plan (09.A.01);

bb. Wild Land Fire Management Plan (09.L);

cc. Arc Flash Hazard Analysis (11.B);

dd. Assured Equipment Grounding Control Program (AEGCP) (11.D.05, Appendix E);

ee. Hazardous Energy Control Program & Procedures (12.A.01);

ff. Standard Pre-Lift Plan – Load Handling Equipment (16.A.03);

gg. Critical Lift Plan – Load Handling Equipment (16.H);

hh. Naval Architecture Analysis – Load Handling Equipment (Floating) (16.L);

ii. Floating Plant Inspection and Certification (19.A.01);

jj. Severe Weather Plan for Marine Activities (19.A.03);

kk. Emergency Plan for Marine Activities (19.A.04);

ll. Man Overboard/Abandon Ship Procedures (19.A.04);

mm. Float Plan for Launches, Motorboats, and Skiffs (19.F.04);

nn. Fall Protection & Prevention Plan (21.D);

oo. Demolition/Renovation Plan (to include engineering survey) (23.A);

pp. Rope Access Work Plan (24.H2);

qq. Excavation / Trenching Plan (25.A.01);

rr. Fire Prevention and Protection Plan for Underground Construction (26.D.01);

ss. Compressed Air Work Plan for Underground Construction (26.D.01);

tt. Erection and Removal Plan for Formwork and Shoring (27.C);

uu. Precast Concrete Plan (27.D.01);

vv. Lift Slab Plans (27.E);

ww. Masonry Bracing Plan (27.F.01);

xx. Steel Erection Plan (28.B);

yy. Explosives Safety Site Plan (ESSP) (29.A);

Page(s) Yes No N/A

zz. Blasting Safety Plan (29.A; 26.J);

aaa. Dive Operations Plan (30.A.14 & 30.A.16);

bbb. Safe Practices Manual for Diving Activities (30.A.15);

ccc. Emergency Management Plan for Diving (30.A.18);

ddd. Tree Felling and Maintenance Program (31.A.01);

eee. Aircraft/Airfield Construction Safety & Phasing Plan (CSPP) (32.A.02);

fff. Aircraft/Airfield Safety Plan Compliance Document (SPCD) (32.A.02);

ggg. Site Safety and Health Plan for HTRW (33.B);

hhh. Confined Space Entry Procedures (34.A.05);

iii. Confined Space Program (34.A.06);

10. RISK MANAGEMENT PROCESSES. Detailed project-specific hazards and controls shall be provided by an Activity Hazard Analysis (01.A.14, 01.A.15) for each major phase/activity of work.