Sewage_Lift_Station_Replacement_SOW.pdf

U.S. Army Corps of Engineers® Buffalo District

Statement of Work Black Rock Lock, Buffalo, New York FY18 Sewage Lift Station Replacement

Customer:

Lockmaster, Black Rock Lock

Prepared By:

Michael Ferrari, NY/PA O&M U.S. Army Corps of Engineers Buffalo District 1776 Niagara Street Buffalo, NY 14207

June 2018 RTA

1 General Description of Work

1.1 Base Bid Item(s)

1.1.1 Base Bid Item 1 - Demolition of existing Lift Tank and New Floor

1.1.2 Base Bid Item 2 - Install New Pump system and Tank

2 Point of Contact 3 Pre-Bid Site Visit 4 Project/Contractual References 5 Detailed Description of Work

5.1 Detailed Description of Work – Base Bid Item(s)

5.1.1 Base Bid Item 1 - Demolition of existing Lift Tank and New Floor

5.1.2 Base Bid Item 2 - Install New Pump system and Tank

6 Project Information

6.1 Basis for Award

6.2 Period of Performance

6.2.1 Pre-Construction Submittals

6.3 Pre-Construction Meeting

6.4 Work Schedule

6.5 Material/Equipment Information

6.6 Dimension/Quantity Verification

6.7 Material Storage

6.8 Site Cleanup

7 Quality Assurance (QA)

7.1 Overview

7.1.1 Government Project Manager (PM)

7.1.2 Government Quality Assurance (QA)

7.1.3 Government Inspections

7.1.4 Product Data Sheets

7.2 Contractor Quality Control (CQC)

7.2.1 Quality Control Program (QCP)

8 Communication 9 Repair/Restoration of Government Property 10 Work Stoppage, Contract Cancellation Actions 11 Material Change Orders 12 Liquidated Damages 13 Inspection/Testing

13.1 Pre-Final/Final Inspection

14 Completion 15 Payment 16 Warranty

16.1 Warranty Period

16.2 Repairs

17 Safety 18 Security

18.1 Access and General Protection/Security Policy and Procedures

18.1.1 Candidate Pre-Screening

18.1.2 Background Investigation

18.1.3 Access Badge

18.1.4 Suspicious Activity Reporting Training

18.2 Start of Work

18.3 Arrival/Departure

18.4 Video/Camera Equipment

19 Submittals

19.1 Bid Submittals

19.2 Pre-Construction Submittals

19.3 Project Completion Submittals

Attachment #1 – Bid Schedule Attachment #2 – Directions to Black Rock Lock Attachment #3 – Government Safety Requirements Attachment #4 – Blank Activity Hazard Analysis Attachment #5 – USACE Buffalo District Monthly Man Hour Exposure Report Attachment #6 – Photo of Current Lift pit and Tank

General Description of Work The contractor must perform the following work under this contract:

Base Bid Item(s)

Base Bid Item 1 - Demolition of existing Lift Tank and New Floor

Base Bid Item 2 - Install New Pump system and Tank

Point of Contact

For scheduling project site visits and/or questions regarding this Statement of Work:

U.S. Army Corps of Engineers, Buffalo District Attn: Contracting Officer 1776 Niagara Street Buffalo, New York 14207

Phone: 716-879-4126 Facsimile: 716-879-4353

Pre-Bid Site Visit There will be one (1) scheduled pre-bid site visit for prospective bidders. The date and time of the visit will be posted on FBO. The location of the visit will be Black Rock Lock at US Army Corps of Engineers Buffalo District Reservation, 62 Dann Street, Buffalo, New York 14207. Prospective bidders are urged to attend to gain information that will be necessary in the preparation of bid submittals. Due to maintenance, operation and security requirements, unscheduled visits will not be honored. Following a visit to the project site, a question and answer session will be held. During this session, prospective bidders are asked to direct all questions concerning the project to the Buffalo District Contracting Office (DCO).

Project/Contractual References EM 385-1-1, 30 Nov 2014, U.S. Army Safety and Health Requirements Manual

Detailed Description of Work

Detailed Description of Work – Base Bid Item(s)

Base Bid Item 1 - Demolition of existing Lift Tank and New Floor

The contractor must prepare the existing lift station to be removed. The tank must be drained as much as possible with current connections. The contractor must disconnect power for the existing pump. Any piping and controls must be disconnected from the tank. The lid, pump and components must be removed from in the tank. The tank must be rinsed down and the residual water and any solids must be removed from the tank. The tank must be demolished and removed from the pit.

The contractor must dispose of all biological waste and materials off-site in accordance with all Federal, state, and local laws and regulations.

The influent water line must be sleeved and the sleeve must be sealed to the boring in the current pit floor. The pit area must be filled with 2B stone/gravel to 6” below the sill from the pit area to the ram cylinder area. The perimeter of the pit area must have holes for #5 rebar bored 6” deep, 6” on center in the horizontal plane to accommodate 12” pieces of rebar bonded into the holes. A 6” x 4’ x 8’ floor of 4000 PSI concrete must then be poured and finished with a 1/4” per 8’ pitch towards the gate cylinder area.

A masonry wall approximately 6” x 3’ x 4’ must be constructed between the gate cylinder area and the pit area and around the discharge pipe to prevent high water from entering the pit area in a high water situation. The wall must be constructed with a sleeve around the 3”discharge line. The space between the discharge line and the sleeve must be sealed with flexible silicone calking. The wall must have one-way weep valves to allow for water runoff from the sump pit area to the cylinder area.

The contractor must supply a temporary alternative bathroom for use during the time that the bathroom facilities are out of service. A hand sanitation station must be included with the Porta Potty.

An inspection with a Government representative must be documented before moving to Base Bid Item 2.

This line item must be offered as a lump sum, also known as job.

Base Bid Item 2 - Install New Pump system and Tank

The contractor must install a Liberty Pumps, Pro680-Series Duplex Pump System, Model P682XLE51W or like.

To be like the system must be minimum 46 gallon low profile tank with 2, 1/2 HP 115 volt pumps with a 2” discharge and include a duplex pump controller, float operating system, alarm, and have a plug in ready cord.

System must have a minimum 3 year warranty.

The contractor must connect the 2” copper vent and the 4” copper sink/toilet/shower drain for influent to the tank.

The 2 discharge ports must be plumbed to the existing 3” galvanized pressure pipe.

The contractor must hard wire the pumps operating system to the existing breaker panel located in the closet next to the pit area. All connections in the pit area must be waterproof. A GFI breaker must be installed in the breaker panel per NEC sizing for the equipment it is protecting.

The contractor must insure that all lines, supply and waste, are protected from freezing by using the existing system controller and installing new heat tape on all lines. The current System is manufactured by Urecon and is a model UTC-2030. All connections in the pit areas must be waterproof or made waterproof.

All measurements must be field verified by the contractor. All components must be designed for outdoor weather exposure.

This line item must be offered as a lump sum, also known as job.

Project Information

Basis for Award The Government must award the contract to the offeror who provides the lowest priced technically acceptable offer.

In order to be considered technically acceptable, the contractor must:

Have a minimum of (5) years’ experience on projects of a similar nature. The contractor must supply the names, locations, and client contact information for two (2) projects of similar size and scope that have been accomplished within the previous five (5) years as part of the bid submittals.

Period of Performance The project completion date is set at ninety (90) calendar days following the initial award of the contract. In the event the contractor is unable to meet the project completion date, requests for extensions must be made in writing. The request must explain, in detail, why the original project completion date will not be met. The request must be sent to the DCO along with an informational copy to the Project Manager (PM). The request must be made as soon as possible, but not later than ten (10) calendar days prior to the original completion date. This request must not negate penalties for liquidated damages unless an extension is granted by the DCO in writing.

Pre-Construction Submittals All pre-construction submittals, as stated in Section 19.2 of this SOW, must be provided to the Government within fourteen (14) calendar days following the award of the contract. The contractor must allow up to twenty-one (21) calendar days from time of receipt for Government review of submittals. Work may not begin until Government approval of all submittals required in Section 19.2 of this Statement of Work.

Project Timeline As part of the pre-construction submittals, the contractor must supply a timeline or schedule for accomplishing the work showing the following minimum milestones and completion dates: submittal completion date, start date, 100% completion date.

Pre-Construction Meeting Following the award of the contract and review and acceptance of the contractor’s pre-construction submittals, the prime contractor must attend a mandatory pre-work conference. The meeting must be scheduled by the Government, and conducted on-site, at the US Army Corps of Engineers Buffalo District Reservation, at a time and date to be announced following the award of the contract.

Work Schedule All scheduled work is to be performed Monday through Friday 0800-1600 hours, excluding Federal holidays. If the contractor desires to work beyond the previously stated hours and days, written permission to do so must be obtained from the Government. Schedule changes must be requested at minimum 24 hours in advance, unless there is an emergency situation.

Material/Equipment Information Contractor must provide all labor, tools, ladders, scaffolding, equipment, supplies and materials needed to complete the work described herein, unless otherwise noted herein that any of these items will be provided by the Government.

Dimension/Quantity Verification Contractor must independently measure and verify all dimensions and quantities given herein prior to ordering materials and supplies for the project. This information must be provided to the Government QA person as part of the pre-work submittals.

Material Storage If temporary storage of project material is requested, the contractor must make a written request to the Government’s QA person and receive written approval from the Government. If material is found to be hazardous, flammable, combustible, etc., the contractor will be required to provide the appropriate hazardous material storage locker. Storage locations will be discussed at the pre-bid site visit and during the pre-con meeting. See Section 17of this SOW for further information.

Site Cleanup All excess, waste, and removed material related to this project must become the contractor’s property and must be promptly removed from the site and disposed of or reused/recycled in accordance with applicable local, state, and Federal regulations. Documentation describing disposal of material must be furnished to the Government as part of the project closeout files. The contractor must not dispose of any project generated waste in Government receptacles or on Government grounds.

Quality Assurance (QA)

Overview

Government Project Manager (PM) The Government has appointed a Project Manager (PM) for this project. The PM must ensure all questions of a technical nature concerning the contractual work are answered.

Government Quality Assurance (QA) The Government will appoint a Quality Assurance (QA) person to ensure all work is accomplished in accordance with contractual documents. The QA person for this contract will be identified after the contract is awarded. The QA person serves as the liaison between the contractor, PM, and the DCO. The QA person does not have the authority to modify contractual agreements.

Government Inspections Contractor must allow inspection by the Government PM, QA person, DCO personnel, and District Safety and Health personnel, at any time during the life cycle of the project. The contractor must provide safe access for Government personnel visiting the project.

Product Data Sheets The contractor must provide to the Government product data sheets from the manufacturer for all materials used on this job, as part of the pre-construction submittals. All materials must be delivered to the project site in new condition, in their original containers and wrapping material, with labels clearly showing all product information.

Contractor Quality Control (CQC) Contractor Quality Control (CQC) is the means by which the contractor ensures that the construction, to include that of subcontractors and suppliers, complies with the requirements of this contract.

Quality Control Program (QCP) The contractor must implement a written Quality Control Program (QCP) for performing contractual work and must designate an on-site QCP supervisor. The contractor must provide copies of the QCP for review by the Government QA and PM. The QCP is one of the pre-construction submittals. The QCP must include, at minimum, include the following to cover all construction operations, both on-site and off-site, including work by subcontractors, fabricators, supplies, and purchasing agents:

The name, qualifications (in resume format), duties, responsibilities, and authorities of the person assigned the QCP supervisor.

Procedures for scheduling, reviewing, certifying, and managing submittals, including those of subcontractors, off-site fabricators, supplies, and purchasing agents.

Procedures for procurement, storage of materials and equipment, coordination of subcontractor’s activities, and inspections and tests require to be sure that the specified materials are used and installation is acceptable to produce the required end product. The plan must list any required tests to be performed (See Section 13), state who will be responsible for the results, and who will prepare and sign reports.

Procedures for tracking construction deficiencies from identification through acceptable corrective action.

These procedures must establish verification that identified deficiencies have been corrected.

Acceptance of the contractor’s QCP is required prior to the start of construction. At the pre-construction meeting, the QCP will be discussed along with the relationship between the contractor and the Government. The PM must be available at all times to discuss the planned QC operations. It may be advantageous for the contractor to make incremental submittals of the plan. The Government reserves the right to require the contractor to make changes in his QCP plan and operations including removal of personnel, as necessary, to obtain the quality specified.

Communication

During the execution of the contract, the PM must receive weekly status reports from the contractor on issues such as milestones met and/or missed, and issues standing in the way of project completion. The DCO must be the communication hub for the Government QA Person, PM, and the contractor regarding clarification of contractual issues. By adhering to the established lines of communication, it will reduce or avoid generation of duplicate requests for information, which may inadvertently result the Government or the contractor to the acceptance of contractual changes without official approval by the DCO.

Repair/Restoration of Government Property Contractor, at no expense to the Government, is required to protect all Government facilities, grounds, equipment, sidewalks, and pavement during construction. All Government structures, grounds, and equipment disturbed by contractor during the performance of work must be returned to a pre-work condition prior to request of final payment.

Damages to Government property that were caused by contractor and/or sub-contractor will be repaired at no expense to the Government by the prime contractor.

Work Stoppage, Contract Cancellation Actions The Lock Master of Black Rock Lock, PM, or Government QA person may issue temporary “Stop Work” notification if they find activities or job site conditions are in violation of Federal, Department of Defense, State or local health, safety and/or environmental standards, laws and regulations. The District Safety Officer (DSO), the DCO, and the PM must be contacted immediately after a Stop Work notification order is issued or rescinded. Violation of health, safety or environmental regulations committed by the contractor must not be grounds for compensation by the Government to the contractor. Refer to contractual documents provided by the District Contracting Office regarding additional work stoppage and/or contract cancellation actions.

Material Change Orders Once equipment and materials are approved and accepted by the Government, the contractor must not substitute equipment or materials without providing a detailed explanation for the substitution. Changes in materials will require full justification and approval from the DCO. Modifications to contractual documents must be reviewed by the contractor, Government QA person and PM, and approved by the Government’s DCO. Requests for modifications must be in writing explaining the reasons for the modification, detailed description of the modification and what the benefits are and an estimated cost broken down by materials, labor and equipment.

Liquidated Damages Liquidated damages of $150 per work day will be assessed if the work is not completed within the time period described in Section 6.2 of this Statement of Work. Liquidated damages must be assessed beginning the day following the end of the initial period.

Inspection/Testing

Pre-Final/Final Inspection Upon completion of the work, the Government will perform a pre-final inspection to verify that the project is complete. A Government pre-final punch list may be developed as a result of this inspection. If contractual requirements are not met, this list must be provided to the DCO, who will bring them to the attention of the contractor.

The contractor’s QC supervisor must ensure that all items on this list have been corrected in a timely manner before notifying the Government, so that a final inspection with the Government and contractor can be scheduled. The contractor’s QC supervisor, PM, DCO representative, and QA person must be in attendance at the final acceptance inspection.

Completion The contract will not be deemed fulfilled until all submittals, products, services, equipment, material, installation, construction work, and final inspection is provided by the contractor under the terms of the contractual documents and found satisfactory to the DCO.

Payment The project will be paid for on a lump sum basis, the price for which includes all labor, materials, equipment, mobilization/demobilization, disposal, and other costs required to complete the work. Partial payment(s) may be made; this will be discussed at the pre-construction meeting.

Warranty

Warranty Period Contractor must, at a minimum, warranty all workmanship against deficiencies for a period of three (3) year(s) from the date of acceptance of the work. The contractor must also provide the manufacturer’s warranty for newly installed equipment and/or materials produced by said manufacturer. The period of warranty must commence at time of Government's acceptance of the work. If within the warranty period the installed equipment/materials incur breakdowns, excessive wear, or become unreliable, the costs to repair or replace installed equipment and materials must be borne by the prime contractor. The warranty must bear the name of the Buffalo District, U.S. Army Corps of Engineers as the recipient of the warranty and display the period of coverage. All warranties must be submitted prior to request of final payment on this contract.

Repairs When repairs are required because of defective workmanship during the warranty period, contractor must make such repairs within 72 hours of notification. When repairs are not performed within the specified time, emergency repairs performed by others will not void the warranty and contractor must reimburse the Government for the cost of said repairs. Contractor must not bill the Government for costs of repair work and delay of payment due to repair work executed to resolve defective workmanship and/or problems with materials used and services provided.

Safety

Refer to Attachment #3 for Government safety requirements.

Security

Access and General Protection/Security Policy and Procedures All contractor and all associated sub-contractors employees must comply with applicable installation, facility and area commander installation/facility access and local security policies and procedures, which will be provided by a Government representative. The contractor must also provide all information required for background checks or background investigation and to meet installation/facility access requirements to be accomplished by the Army Corps of Engineers (USACE) Buffalo District Emergency Management Office. Contractor workforce must comply with all personal identity verification requirements as directed by the Department of Defense (DOD), Headquarters Department of the Army (HQDA) and/or USACE Buffalo District policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any installation or facility change, the Government may require changes in contractor security matters or processes.

1.1.1 Candidate Pre-Screening

The contractor must pre-screen candidates using the E-verify Program (http://www.uscis.gov/e-verify) website to meet the established employment eligibility requirements. The vendor must ensure that the candidate has two valid forms of Government issued identification prior to enrollment to ensure the correct information is entered into the E-verify system. An initial list of verified/eligible candidates must be provided to the COR no later than 3 business days after the initial contract award.

1.1.2 Background Investigation

For all prime and subcontractor employees working at the Black Rock Lock, the following Personally Identifiable Information (PII) must be provided for the US Army Corps of Engineers to perform a limited background check:

Complete name, social security number, driver’s license number, date of birth, place of birth, and current address of residence. This information is mandatory before any workers will be allowed to enter the facility. The contractor must allow up to twenty-one (21) calendar days from time of receipt for Government completion of background checks. Work may not begin until Government clearance of employees is given to the prime contractor.

1.1.3 Access Badge

In order to grant access to the Buffalo District Reservation and Black Rock Lock, all employees will be required to turnover a valid photo ID on a daily basis to the security guard. Employees must be given a visitor badge which must be worn at all times on the premises. The photo ID will be returned once the employee leaves the premises.

1.1.4 Suspicious Activity Reporting Training

The contractor and all associated sub-contractors must receive a brief/training provided by the PM on the local suspicious activity reporting program. This locally developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the project manager, security representative or law enforcement entity. This training must be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance with the results reported to the PM no later than five calendar days after the completion of the training.

Start of Work Contractor must notify the PM of their planned arrival at the project to start work at least seven (7) calendar days in advance. Contractor must submit a weekly work schedule thereafter by no later than the Friday before the coming work week.

Arrival/Departure Contractor is required to notify the Government QA person or Lockmaster of their arrival to and departure from the project site. A similar notification is required if there must be any deviation or cancellation of a scheduled work day during the life of the project.

Video/Camera Equipment Contractor must not transport or use video or camera equipment while working at Black Rock Lock unless permission to do so is requested through the Lockmaster and approval is granted by the Buffalo District Security Officer.

Submittals

Bid Submittals The following submittals are required from the contractor under this Scope of Work to be submitted with the bid proposal:

Complete Bid Schedule (See Attached) The product data and specification sheets for the following materials to be used by the contractor:

o Pumping system.

o Concrete mix/testing core samples

Contractor experience as stated in Section 6.1

Pre-Construction Submittals All submittals are required as per the timeline described in Section 6.1 of this SOW:

Abbreviated Accident Prevention Plan (APP) with Activity Hazard Analysis (AHA’s): Safety and health submittals as described in Attachment #3 of this Scope of Work will be submitted to the DCO. Safety and health submittals will be reviewed and accepted in writing by the DSO prior to commencement of work.

All materials/equipment data sheets provided under the contract, including but not limited to:

o Pumping system and controls.

o Concrete

Contractor timeline showing start and completion of contractual work Contractor employees Personally Identifiable Information (PII)

Project Completion Submittals All submittals are required as per the timeline described in Section 6.1 of this SOW:

All required submittals required under this contract.

Manufacturer warranty for newly installed equipment and material.

Contractor warranty for all work performed under this contract.

Applicable equipment O&M manuals, shop drawings, maintenance and repair instructions.

All required training on inspection and preventive maintenance of newly installed equipment and materials.

Documentation for disposal of project waste material.

Monthly Man-Hour Exposure Report

END OF STATEMENT OF WORK

Attachment #1 – Bid Schedule Attachment #2 – Directions to Black Rock Lock Attachment #3 – Government Safety Requirements Attachment #4 – Blank Activity Hazard Analysis Attachment #5 – USACE Buffalo District Monthly Man Hour Exposure Report Attachment #6 – Photo of Current Lift pit and Tank

Attachment #1 – Bid Schedule Black Rock Lock, Buffalo, New York

Sewage Lift Station Replacement April 2018

BID SCHEDULE

FY18 Sewage Lift Station Replacement Black Rock Lock, Buffalo, New York

Item No.

Description Unit Quantity Unit Price Bid

Total Item Cost

1 Demolition of Lift Tank & New Floor job 1 0.00

2 Install New Pump System and Tank job 1 0.00

3 Masonry Wall job 1 0.00

4 Hard Wire Pumps job 1 0.00

5 Waterproof All Lines and Heat Tape job 1 0.00

6 Fill Pit Area job 1 0.00

7 Temporary Alternative Facilities job 1 0.00

8 Site Cleanup job 1 0.00

Total 0.00

Total Project Cost: $0.00

Attachment #2 – Directions to Black Rock Lock

Attachment #3 – Government Safety Requirements

The contractor must follow all applicable safety requirements detailed in the Unified Facilities Guide Specifications (UFGS) 01-35-26 and Safety & Health Requirements Manual EM 385-1-1. Required submittals are listed below.

Submittals required prior to performance of each bid item:

Activity Hazard Analysis (AHA) (attached); to include Lockout-Tagout (LOTO) procedures.

Proof of qualifications for a designated Competent Person/Site Safety and Health Officer (SSHO); to include proof of LOTO competency and a resume including three (3) years of consecutive similar project experience managing or supervising safety.

Submit reports as required Accident Reports via Eng Form 3394 Accident Investigation Report Monthly Man-Hour Exposure Reports

Overarching UFGS and EM 385-1-1 requirements, all contractor accidents involving injuries, illnesses or property damage, occurring during the execution of this contract must be reported to USACE immediately within the contractor becoming aware of its occurrence. Reporting injuries, illness or property damage to the Contracting Officer Representative (COR) may be sufficient. Based upon the severity of the injury, illness or property damage, more detailed reporting may be required. More detailed notification will include contractor name; contract title; type of contract; name of activity, installation or location where accident occurred; date and time of accident; names of personnel injured; extent of property damage, if any; extent of injury, if known, and brief description of accident (to include type of construction equipment used, PPE used, etc

Work must not begin until the AHA has been submitted to, and accepted by the USACE Buffalo District Contracting Officer or COR. The AHA must be prepared following the format found in USACE publication USACE Safety and Health Requirements Manual EM 385-1-1. The following documents must be considered in the preparation of the APP:

USACE EM 385-1-1 (30 Nov 2014) Safety and Health Requirements Manual;

UFGS 01 35 26 (November 2015) Governmental Safety Requirements;

USDOL OSHA 29 CFR 1926 Safety and Health Regulations for Construction;

USDOL OSHA 29 CFR 1910 General Industry Safety and Health Standards.

During the performance of work, the contractor must create procedures for control and safety of USACE personnel conducting their normal daily activities transgressing between buildings in the vicinity of the work area. Contractor is responsible for his personnel and for familiarizing each of his subcontractors and all visitors with safety requirements.

Contractor must advise the Contracting Officer of any special safety restriction he has established so that Government personnel can be notified of these restrictions. The SSHO must be present on-site whenever project-related work is being executed. The buddy system must be utilized. The contractor must permit safety inspections of all work being performed.

Attachment #4 – Blank Activity Hazard Analysis

*Note: This is an un-editable image. See attachment of PDF document for editable XML version.

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

Involved Personnel

Official Forms can be found:

http://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/EM_385-1-1.pdf

Attachment #5 – USACE Buffalo District Monthly Man Hour Exposure Report

Contract No. __________________________________________________

Month/Year __________________________________________________

P/

R WEEK

WEE

K

DAYS

PER

PROJECT NAME &

LOCATION

TYPE

OF

CONTRA

CTOR

MANHO

URS

# OF LOST

WORKDAYS

# OF DAYS

SINCE LAST

BEGIN

NING

ENDI

NG WEEK

OPERA

TION NAME

WORKE

D

DUE TO

INJURY

LOST

WORKDAY

TOTALS 0.0 0.0

Attachment #6 – Photo of Current Lift pit and Tank