Amendment_02_Package_W912P422B0001_Cleveland_Dredge_08Feb.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

Amendment 02 is being issued for the follow ing reason:

1. Response to questions from contractors questions from site visit.

2. Issue updated Bid Schedule "A" and Schedule "B".

3. To change the bid opening from 15 February 2022 to 22 February 2022.

1. CONTRACT ID CODE PAGE OF PAGES

1 2

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 08-Feb-2022

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W912P422B0001

X 9B. DATED (SEE ITEM 11)

20-Jan-2022

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

08-Feb-2022

CODE

U.S. ARMY ENGINEER DISTRICT, BUFFALO

1776 NIAGARA STREET

BUFFALO NY 14207-3199

W912P4 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W912P422B0001

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION 00 10 00 - SOLICITATION

The required response date/time has changed from 15-Feb-2022 03:00 PM to 22-Feb-2022 03:00 PM.

SECTION 00 21 13 - INSTRUCTIONS TO BIDDERS

The following have been modified:

52.252-3 ALTERATIONS IN SOLICITATION (APR 1984)

Portions of this solicitation are altered as follows:

0001 Amendment 01.

1. Updated Bid Schedule “A” and Bid Schedule “B” has been attached.

2. Answers to questions from Contractors are attached.

0002 Amendment 02.

1. Answers to questions from Contractors from site visit are attached.

2. To change the bid opening from 15 February 2022 to 22 February 2022.

3. Updated Bid Schedule “A” and Bid Schedule “B” has been attached.

(End of Summary of Changes)

AMENDMENT NO. 2

W912P421B00001

CLEVELAND, OHIO

CLEVELAND HARBOR

DREDGING

FY22

CONTRACTOR QUESTIONS,

GOVERNMENT REPLIES,

UPDATED BID FORM, PLANS,

AND SPECIFICATIONS

03 FEBRUARY 2022

CONTRACTOR QUESTIONS WITH GOVERNMENT REPLIES

1. Will contractors be required to dredge all available areas between stations 28+00 to 38+00and 65+00 to 68+00 which includes various types of fixed overhead obstructions, and over subaqueous pipelines.

Government Response: Contractors will not be required to dredge in areas where overhead obstructions or subaqueous pipelines pose a hazard to standard dredge equipment. The notes on Sheet C-101 have been revised.

2. Historically for the fall dredging cycle and sometimes spring cycle 50,000 cy is not available and the contractor would have to go beyond station 30+00 to reach 50,000 cy in available qty.

This year however material downstream of station 30+00 will be disposed of at the government furnished disposal site. Due to the Port of Cleveland putting a penalty on material received at less than 50,000 CYs, will the variation in estimated quantity clause be applied to items 2 and 5on bid schedule A?

Government Response: The bid document (Schedule A) has been revised to allow dredged sediment from stations 0+00 to 40+00 with revised estimated quantities, to be placed into the Contractor-furnished placement site. Schedule B has been revised for the stationing and estimated quantities.

3. What are the evaluation factors to determine whether Bid Schedule A or Bid schedule B will be awarded?

Government Response: The contract award will be made to the lowest bidder on either Schedule A or Schedule B. The Schedule being awarded will be based on a determination as to which best meets the needs of the Government.

4. Will the Contractor be authorized to construct haul roads from mats or other materials to aid in the placement of granular material evenly distributed throughout the disposal CDF?

Government Response: The Contractor may construct haul roads, utilize mats and make needed site improvements in accordance with an approved Material Placement Plan as noted in specification section 01 35 13.

5. Does USACE know the stability of the CDF sites soils within the planned disposal area with regard to movement of equipment on them? Can as built information from the CDF regrading project be provided? If CDF regrading is not done, what is the intended soil condition when that project is complete?

Government Response: Specific soil conditions within the disposal area have not been determined. Conditions within the Confined Disposal Facility (CDF) were available for inspection by prospective bidders during the on-site pre-bid site visit. The re-grading project is scheduled to be substantially complete prior to the dredging to provide the sediment placement capacity noted in the Contract Documents. Some regrading work could be ongoing at the site, outside of the sediment placement area (final grading of stockpile area, seeding, etc.).

6. Section 01 35 13, Paragraph 3.4 Order of Work, Pg. 85 States that dredging must start fromthe upper dredging limit and proceed downstream, unless directed differently by theContracting Officer. In regards to Mechanical Placement in CDF10B will the contractor beallowed to dredge softer material downstream (Sta. 30+00) before the upstream material thatis much harder (Sta 0+00-30+00), due to placement within the CDF?

Government Response: The Contractor will be permitted to determine the sequence of dredge areas to facilitate mechanical sediment placement as out lined in the approved Material Placement Plan. Specification section 01 35 13 has been revised to clarify this issue.

7. Can the bid due date be extended to allow contractors time to review all government responses once they are issued?

Government Response: The bid due date has been extended from 15 February 2022 to 22 February 2022.

The following changes have been made to the bid form, specifications, and plans.

They are shown on the following pages.

1. Bid Schedule A

a. Line items 2, 3, 5, 6: '30+00' has been changed to '40+00'

b. Line items 2 and 5: Estimated quantity has changed to 60,000

c. Line items 3 and 6: Estimated quantity has changed to 65,000

2. Bid Schedule B

a. Line items 2, 3, 5, 6, 7: '30+00' has been changed to '40+00'

b. Line items 2: Estimated quantity has changed to 60,000

c. Line items 3: Estimated quantity has changed to 115,000

3. Specifications

a. Section 01 35 13

(1) Paragraph 3.4 ORDER OF WORK has been updated

4. Plans

a. Sheet C-101

(1) Notes 6 and 8A have been updated.

Item Unit No. Description Unit Price

1 Mobilization and Demobilization JA $

2 Dredging: Upper Cuyahoga River (STA 0+00 to 40+00) w/placement in Contractor-furnished Placement Site CY $ $

3 Dredging: Remaining Cuyahoga River (STA 40+00 to 297+00) and the Old River (STA 11+00(A) to 56+42(A)) w/hydraulic placement in Government-furnished Placement Site CY $ $

Total Estimated Amount (Items 1 ~ 3) $

4 Mobilization and Demobilization JA $

5 Dredging: Upper Cuyahoga River (STA 0+00 to 40+00) w/placement in Contractor-furnished Placement Site CY $ $

6 Dredging: Remaining Cuyahoga River (STA 40+00 to 297+00) and the Old River (STA 11+00(A) to 56+42(A)) w/hydraulic placement in Government-furnished Placement Site CY $ $

Total Estimated Amount (Items 4 ~ 6) $

Total Estimated Amount (Items 1 through 6) $

60,000 -

65,000 -

60,000 -

SECTION 00 10 00

BIDDING SCHEDULE "A"

The work pursuant to terms and conditions of this contract will consist of dredging and placement of dredged material into a Contractor-furnished Placement Site and Government-furnished Placement Site, as shown on the contract drawings, in accordance with these specifications.

Quantity Amount Estimated Estimated

Spring Dredging

Fall Dredging

65,000 -h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight

Note 3: If an option item is exercised, the Government reserves the right to limit the quantity of material up to the estimated quantity of the option.

Note 4: If any portion of the option is exercised, it will be exercised at any time prior to 15 Oct 2021.

Note 5: Bidders are not required to provide a bid on each bid schedule. If a bidder is not bidding on both schedules, bidders must put “No Bid” for each line item on the bid schedule that bidders do not want considered for award. However, the Government reserves the right to make award to the lowest bidder on either bid schedule.

Note 1: Complete all items on the bid schedule. Failure to complete all items on the bid schedule may render the bid non-responsive.

Note 2: The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. Evaluation of options will not obligate the Government to exercise the option(s). With regard to the options on all schedules - each schedule will be evaluated individually and no combination of schedules will be permitted. Only one Schedule will be awarded per this solicitation.

Item Unit No. Description Unit Price

1 Mobilization and Demobilization JA $

2 Dredging: Upper Cuyahoga River (STA 0+00 to 40+00) w/mechanical placement in Government-furnished Placement Site CY $ $

3 Dredging: Remaining Cuyahoga River (STA 40+00 to 297+00) and the Old River (STA 11+00(A) to 56+42(A)) w/mechanical placement in Government-furnished Placement Site CY $ $

Total Estimated Amount (Items 1 ~ 3) $

4 Mobilization and Demobilization JA $

5 Dredging: Upper Cuyahoga River (STA 0+00 to 40+00) w/mechanical placement in Government-furnished Placement Site CY $ $

Total Estimated Amount (Items 4 ~ 5) $

6 Dredging: Remaining Cuyahoga River (STA 40+00 to 297+00) and the Old River (STA 11+00(A) to 56+42(A)) w/mechanical placement in Government-furnished Placement Site CY $ $25,000 -

60,000 -

25,000 -

115,000 -

Option "A" Spring Dredging

SECTION 00 10 00

BIDDING SCHEDULE "B"

The work pursuant to terms and conditions of this contract will consist of dredging and mechanical placement of dredged material into the Government-furnished Placement Site, as shown on the contract drawings, in accordance with these specifications.

Estimated Estimated Quantity Amount

Spring Dredging

Fall Dredging h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight h5cosklm Highlight

7 Dredging: Remaining Cuyahoga River (STA 40+00 to 297+00) and the Old River (STA 11+00(A) to 56+42(A)) w/mechanical placement in Government-furnished Placement Site CY $ $

Total Estimated Amount (Items 1 through 7) $

25,000 -

Note 1: Complete all items on the bid schedule. Failure to complete all items on the bid schedule may render the bid non-responsive.

Note 2: The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. Evaluation of options will not obligate the Government to exercise the option(s). With regard to the options on all schedules - each schedule will be evaluated individually and no combination of schedules will be permitted. Only one Schedule will be awarded per this solicitation.

Note 3: If an option item is exercised, the Government reserves the right to limit the quantity of material up to the estimated quantity of the option.

Option "B" Fall Dredging

Note 5: If any portion of Option "B" is exercised, it will be exercised at any time prior to 15 Oct 2022.

Note 4: If any portion of Option "A" is exercised, it will be exercised at any time prior to 31 July 2022.

Note 6: Bidders are not required to provide a bid on each bid schedule. If a bidder is not bidding on both schedules, bidders must put “No Bid” for each line item on the bid schedule that bidders do not want considered for award. However, the Government reserves the right to make award to the lowest bidder on either bid schedule.

FY22 CLEVELAND HARBOR DREDGE AMENDMNET NO. 2

W912P422B0001

Offices indicated below:

Department of the Army U.S. Army Engineer District, Buffalo Ohio Area Office 1035 East 9th Street Cleveland, OH 44114 Tel.: (216) 685-1206 Fax: (216) 522-2470

b. Send National Dredging Quality Managment Program submittals to the following office:

Department of the Army U.S. Army Engineer District, Mobile South Atlantic Division Silent Inspector (SI) Support Center 109 St. Joseph Street Mobile, AL 36602 Tel.: 1-(877) 840-8024 Fax.: (251) 694-3638

3.3.2 Deviations

For submittals which include proposed deviations requested by the Contractor, check the column "variation" of ENG Form 4025. State, in writing, the reason for any deviations and annotate such deviations on the submittal. The Government reserves the right to rescind inadvertent approval of submittals containing unnoted deviations.

3.4 ORDER OF WORK

a. For hydraulic sediment placement, start dredging from the upper dredging limit and proceed downstream,unless directed differently by the Contracting Officer.

b. For mechanical sediment placement, determine the sequence of dredge areas to facilitate sediment placement as stated in the approved Material Placement Plan.

-- End of Section --

SECTION 01 35 13 Page 1036 03/02/22

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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)

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);

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);

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.

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U.S. ARMY CORPS OF ENGINEERS, BUFFALO DISTRICT

ACTIVITY HAZARDS ANALYSIS (AHA)

For use of this form, see EM 385-1-1; the proponent agency is CELRB-SO.

CELRB FORM 385-02 AHA, 2020

PREVIOUS EDITIONS ARE OBSOLETE.

Page of

FREQUENT

LIKELY

OCCASIONAL

SELDOM

UNLIKELY

E

H

M

L

OVERALL RISK ASSESSMENT CODE (RAC) (Use Highest Code)

SEVERITY

PROBABILITY

NEGLIGIBLE

RISK ASSESSMENT CODE (RAC) MATRIX

CRITICAL

“Severity” is the outcome/degree if an incident, near miss, or accident did occur.

CATASTROPHIC

“Probability” is the likelihood to cause an incident, near miss, or accident.

MARGINAL

NOTES:

Step 1: Review each “Hazard” with identified safety “Controls” and determine RAC (See above)

Step 2: Identify the RAC for each “Hazard” on AHA. Annotate the overall highest RAC at the top of AHA.

Risk Code: E (Extremely High Risk), H (High Risk), M (Moderate Risk), or L (Low Risk)

Step 3: Identify any equipment, training, and inspection requirements.

Step 4: Identify the names of the Competent Person(CP)/Qualified Person(QP) required for a particular activity specified in EM 385-1-1/OSHA and provide proof of their competency/qualification.

JOB STEPS

Break down the job into individual steps, e.g., mobilization, erect forms, erect scaffolding, install reinforcement bar, remove forms, demobilization.

HAZARDS

Identify the hazards, what are the man, machine, and environmental hazard factors of an operation. Note: include hazards that could potentially change the risk, such as weather, changing site conditions, abnormal operating procedures, etc. Do a change analysis when site conditions change.

Controls (Actions to Eliminate or Minimize Hazards)

List the controls needed to eliminate or reduce the risks. Controls can be in the form of educational controls (training), physical controls (barriers, guards, signs, etc.), Administrative Controls, Personal Protective Equipment, or Engineering Controls. Risk avoidance is another alternative, are there ways to do the job differently so that risks aren't encountered.

RAC

EQUIPMENT

List equipment needed for the job.

TRAINING REQUIREMENTS

List any specialized training or certifications needed for the job.

INSPECTION REQUIREMENTS

List any inspection requirements, before, during, or after the job is completed.

1.0 darwin.chen@usace.army.mil

2011-11-29

Forms Design Team

Darwin Chen

Activity Hazards Analysis

2011-11-29

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ENDING

DAYS PER

PROJECT NAME & LOCATION

TYPE OF

OPERATION

CONTRACTOR

NAME

MANHOURS

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# OF LOST WORK-DAYS

DUE TO INJURY

# OF DAYS SINCE LAST

LOST WORK-DAY

TOTALS

Contractor No:

Month and Year:

PR Row1:

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OF DAYS SINCE LAST LOST WORKDAYRow1:

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DAYS PER WEEKRow2:

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PR Row7:

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PR Row10:

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PR Row11:

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OF LOST WORKDAYS DUE TO INJURYRow11:

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PR Row12:

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WEEK ENDINGRow12:

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PROJECT NAME LOCATIONRow14:

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CONTRACTOR NAMERow14:

MANHOURS WORKEDRow14:

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TYPE OF OPERATIONRow15:

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OF DAYS SINCE LAST LOST WORKDAYRow20:

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WEEK BEGINNINGRow21:

WEEK ENDINGRow21:

DAYS PER WEEKRow21:

PROJECT NAME LOCATIONRow21:

TYPE OF OPERATIONRow21:

CONTRACTOR NAMERow21:

MANHOURS WORKEDRow21:

OF LOST WORKDAYS DUE TO INJURYRow21:

OF DAYS SINCE LAST LOST WORKDAYRow21:

PR Row22:

WEEK BEGINNINGRow22:

WEEK ENDINGRow22:

DAYS PER WEEKRow22:

PROJECT NAME LOCATIONRow22:

TYPE OF OPERATIONRow22:

CONTRACTOR NAMERow22:

MANHOURS WORKEDRow22:

OF LOST WORKDAYS DUE TO INJURYRow22:

OF DAYS SINCE LAST LOST WORKDAYRow22:

PR Row23:

WEEK BEGINNINGRow23:

WEEK ENDINGRow23:

DAYS PER WEEKRow23:

PROJECT NAME LOCATIONRow23:

TYPE OF OPERATIONRow23:

MANHOURS WORKEDTOTALS:

OF LOST WORKDAYS DUE TO INJURYTOTALS:

OF DAYS SINCE LAST LOST WORKDAYTOTALS:

ENG FORM 3394, AUG 2021 PREVIOUS EDITIONS ARE OBSOLETE. Page of

U.S. Army Corps of Engineers (USACE)

MISHAP NOTIFICATION AND INVESTIGATION

For use of this form, see instructions in the attachments and USACE ER 385-1-99; the proponent agency is CESO.

Requirement Control Symbol

RCS-CESO-21-0001

DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority 10 U.S.C. 7013, Secretary of the Army; 5 U.S.C. 7902, Safety Programs; Public Law 91-596, Occupational Safety and Health Act of 1970; DoD Instruction 6055.1, DoD Safety and Occupational Health Program; Army Regulations 385-10, Army Safety Program;

DoD Instruction 6055 .07, Mishap Notification, Investigation, Reporting, and Record Keeping; and E.O. 9397 (SSN), as amended.

Principal Purpose Information collected is to provide the USACE leaders, soldiers, families and civilians in injury, illness, and loss data to effectively manage its safety and occupational health program.

Routine Uses In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b) as follows: To the Department of Labor, the Federal Aviation Agency, the National Transportation Safety Board, and to Federal, State, and local agencies and applicable civilian organizations, such as the National Safety Council, for use in a combined effort of accident prevention. In some cases, data must also be disclosed to an employee's representative under the provisions of 29 CFR

1960.29. Records will be made available consistent with applicable laws and regulations. Information will be withheld from the public only if authorized by 5 U.S.C. Section 552 (Freedom of Information Act (FOIA), 5 U.S.C. 552a (Privacy Act)), or other statutory or regulatory authority.

Disclosure Failure to provide all the required information on the report may result in the rejection of report submission.

1. WHO IS REPORTING MISHAP

a. Name: b. Phone number:

c. Email address: d. Signature:

e. Report type:

1. Near Miss Report. (No injury/illness, or property damage. Complete all fields with underlined text.) Date:

2. Initial Accident Report. (For accident notification within 24 hrs, Complete all fields with underlined text.) Date:

3. Final Accident Report. (For reporting findings from accident investigation, complete full form.) Date:

f. Mishap Type. (Check all that apply)

Fatality Injury/Illness Property Damage Near Miss

g. Were any of the following items associated with the mishap ? (If yes, check all that apply)Yes No

Electrical and/or Hazardous Energy Working at Heights Diving

Load Handling Equipment or Rigging

Occupational Health Exposure

2. WHO WAS INVOLVED IN THIS MISHAP?

a. Name:

b. Personnel Classification: c. Time employee began work:

d. Gender: e. Date of birth (for Government personnel only): f. Age:

g. Date hired: h. Primary language:

i. Is individual a supervisor? Yes No j. Duty status at time of mishap: k. Years experience in job:

l. What was individual doing when mishap occurred? (Select activity from the drop downs below.)

1. General activities: 2. Vehicle/Equipment/Vessel:

3. Sports/Recreation: 4. Other not listed:

m. Did individual utilize all OSHA/EM 385-1-1 required Personal Protective Equipment (PPE) for activity? Yes No N/A

If no, identify missing PPE:

n. Was a Personal Flotation Device used? Yes No N/A o. Was a seat belt used? Yes No N/A

ENG FORM 3394, AUG 2021 Page of

p. Government personnel only:

4. Center/Division/Lab: 5. District:

1. Prime Contractor name:

q. Contractor personnel only:

2. Contract number: 3. Contract type: 4. Funding type:

Other not listed:

r. If mishap occurred on a contractor site, provide the following:

1. Employer/Contractor name:

3. Grade:2. Rank:

2. Individual's occupation/trade:

1. Job series:

h. If treatment was given away from the work-site, where was it given? (For Government Personnel Only)

j. Estimated days away from work: k. Estimated days of restricted/transferred duty:

Was OSHA notified? If yes, how many nights? Yes Noi. Was employee hospitalized as an in-patient? Yes No

Country:Zip:State: City:

Address:

Treatment facility name:

g. Was employee treated in an emergency room ? Yes No N/Af. Was treatment given away from work site? Yes No

Source of injury/illness: Cause of injury/illness:

Primary body part affected:

c. Identify body part(s) affected by injury/illness:

b. Type of Injury/Illness:a. Severity of injury/illness?

Secondary body part affected:

d. Identify cause and source of injury/illness:

If yes, provide name of physician or health care professional provider?

e. Was employee treated by a physician or health care professional provider? Yes No

Note: OSHA requires reporting all work-related fatalities within 8 hours and in-patient hospitalizations, amputations and loss of an eye within 24 hours to OSHA.

3. WHAT TYPE OF INJURY/ILLNESS OCCURRED?

4. WHAT HAPPENED?

a. What was the primary activity occurring at the time of the mishap?

Other, not listed:

b. What happened? Provide a detailed description of the mishap. (Do not include any personally identifiable information (name, etc.).)

Note: Provide supporting photos, charts, diagrams, etc. with this report.

c. What other organizations or agencies have been notified about this mishap?

b. USACE Office/Program/Project name:

a. List all property/material involved in the mishap. (Include damaged and undamaged property.)

i. Type of item:

Item A Item B Item C

ii. Name of item(s):

iv. Ownership of item:

v. Dollar cost of damage:

a. Date the mishap occurred: b. Time mishap occurred:

c. What day did mishap occur on? d. What period of day did mishap occur?

a. Did the mishap occur on a military Base/Post? Yes No

c. Select the location type most closely associated with the mishap:

d. Identify exact location where mishap occurred:

e. Latitude: f. Longitude:

iii. Collision type:

Country:Zip:State: City:

Address:

5. WHAT TYPE OF PROPERTY/MATERIAL WAS INVOLVED?

6. WHEN DID THE MISHAP OCCUR?

7. WHERE DID THE MISHAP OCCUR?

8. WHY DID THE MISHAP OCCUR? (Recommend completing this section for Near Misses.)

A. Performance Causal Factors

2. Describe action(s) taken, anticipated or recommended to eliminate cause(s):

If yes, select the error that contributed most to the mishap:

1. Did a problem with resources contribute to this mishap occurring?

1. Did a problem with performance contribute to this mishap occurring? Yes No

Yes No

B. Support Causal Factors

C. Standards/Policy/Planning Causal Factors

1. Did an organizational standard/policy/or plan contribute to this mishap occurring?

2. Was a written Activity Hazard Analysis (AHA) or equivalent completed and accepted by Government Designated Authority (GDA) for task(s) being performed at time of mishap? (If yes, attach a copy to this report)

If yes, was the AHA available and used by worker?

3. Was a written work plan (critical lift plan, fall protection plan, etc.) required, completed and accepted by the GDA for task(s) being performed at time of mishap?

If yes, was the plan available and used by worker?

4. Describe action(s) taken, anticipated or

1. Did any leader/supervisory mistake/task error contribute to this mishap occurring?

1. Did any individual mistakes/task errors contribute to this mishap occurring?

4. Describe action(s) taken, anticipated or

3. Describe action(s) taken, anticipated or

1. Did any material failure contribute to this mishap occurring?

1. Did a problem with training contribute to this mishap occurring?

If yes, select type of training: Classroom On the jobCertification/License

Other, describe:

What was date of most recent training?

2. Which failure is most closely associated with the material failure/malfunction?

1. Did any physical environment contribute to this mishap occurring?

2. Was individual trained to perform the activity/task?

3. Describe action(s) taken, anticipated or

2. Did the safety climate/culture contribute to the mishap?

3. Did challenges with teamwork contribute to the mishap?

D. Training Causal Factors

E. Leader/Supervisor Causal Factors

F. Individual Causal Factors

G. Physical Environment Causal Factors

H. Material Causal Factors

I. Environmental Causal Factors

If yes, select the factor that contributed most to the mishap:

1. Did any environmental condition contribute to this mishap occurring?

recommended to eliminate hazard:

If yes, describe:

1. Did the design of the facility/building contribute to the mishap?

J. Facility/Building Design

b. Who is responsible for the corrective action plan?

a. Have all corrective action(s) to prevent mishap recurrence been completed?

c. What date will/have all corrective action(s) be/been completed by:

d. Additional information:

recommended to eliminate hazard(s):

If yes, describe the hazard(s):

1. Did a hazard(s) contribute to the mishap?

K. Existing Hazard

9. Corrective Action plan

10. Additional Information

ENG FORM 3394, AUG 2021

PREVIOUS EDITIONS ARE OBSOLETE.

ENG FORM 3394, AUG 2021

U.S. Army Corps of Engineers (USACE)

For use of this form, see instructions in the attachments and USACE ER 385-1-99; the proponent agency is CESO.

Requirement Control Symbol RCS-CESO-21-0001

DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority 10 U.S.C. 7013, Secretary of the Army; 5 U.S.C. 7902, Safety Programs; Public Law 91-596, Occupational Safety and Health Act of 1970; DoD Instruction 6055.1, DoD Safety and Occupational Health Program; Army Regulations 385-10, Army Safety Program;

DoD Instruction 6055 .07, Mishap Notification, Investigation, Reporting, and Record Keeping; and E.O. 9397 (SSN), as amended.Principal Purpose Information collected is to provide the USACE leaders, soldiers, families and civilians in injury, illness, and loss data to effectively manage its safety and occupational health program.Routine Uses In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b) as follows: To the Department of Labor, the Federal Aviation Agency, the National Transportation Safety Board, and to Federal, State, and local agencies and applicable civilian organizations, such as the National Safety Council, for use in a combined effort of accident prevention. In some cases, data must also be disclosed to an employee's representative under the provisions of 29 CFR

1960.29. Records will be made available consistent with applicable laws and regulations. Information will be withheld from the public only if authorized by 5 U.S.C. Section 552 (Freedom of Information Act (FOIA), 5 U.S.C. 552a (Privacy Act)), or other statutory or regulatory authority.Disclosure Failure to provide all the required information on the report may result in the rejection of report submission.

1. WHO IS REPORTING MISHAP

e. Report type:

f. Mishap Type. (Check all that apply)

g. Were any of the following items associated with the mishap ? (If yes, check all that apply)

2. WHO WAS INVOLVED IN THIS MISHAP?

i. Is individual a supervisor?

l. What was individual doing when mishap occurred? (Select activity from the drop downs below.)

m. Did individual utilize all OSHA/EM 385-1-1 required Personal Protective Equipment (PPE) for activity?

n. Was a Personal Flotation Device used?

o. Was a seat belt used?

p. Government personnel only:

q. Contractor personnel only:

r. If mishap occurred on a contractor site, provide the following:

h. If treatment was given away from the work-site, where was it given? (For Government Personnel Only)

Was OSHA notified?

i. Was employee hospitalized as an in-patient?

g. Was employee treated in an emergency room ?

f. Was treatment given away from work site?

c. Identify body part(s) affected by injury/illness:

d. Identify cause and source of injury/illness:

e. Was employee treated by a physician or health care professional provider?

Note: OSHA requires reporting all work-related fatalities within 8 hours and in-patient hospitalizations, amputations and loss of an eye within 24 hours to OSHA.

3. WHAT TYPE OF INJURY/ILLNESS OCCURRED?

4. WHAT HAPPENED?

Note: Provide supporting photos, charts, diagrams, etc. with this report.

a. List all property/material involved in the mishap. (Include damaged and undamaged property.)

i. Type of item:

Item A

Item B

Item C

ii. Name of item(s):

iv. Ownership of item:

v. Dollar cost of damage:

a. Did the mishap occur on a military Base/Post?

iii. Collision type:

5. WHAT TYPE OF PROPERTY/MATERIAL WAS INVOLVED?

6. WHEN DID THE MISHAP OCCUR?

7. WHERE DID THE MISHAP OCCUR?

8. WHY DID THE MISHAP OCCUR? (Recommend completing this section for Near Misses.)

A. Performance Causal Factors

1. Did a problem with resources contribute to this mishap occurring?

1. Did a problem with performance contribute to this mishap occurring?

B. Support Causal Factors

C. Standards/Policy/Planning Causal Factors

1. Did an organizational standard/policy/or plan contribute to this mishap occurring?

2. Was a written Activity Hazard Analysis (AHA) or equivalent completed and accepted by Government Designated Authority (GDA) for task(s) being performed at time of mishap? (If yes, attach a copy to this report)

If yes, was the AHA available and used by worker?

3. Was a written work plan (critical lift plan, fall protection plan, etc.) required, completed and accepted by the GDA for task(s) being performed at time of mishap?

If yes, was the plan available and used by worker?

1. Did any leader/supervisory mistake/task error contribute to this mishap occurring?

1. Did any individual mistakes/task errors contribute to this mishap occurring?

1. Did any material failure contribute to this mishap occurring?

1. Did a problem with training contribute to this mishap occurring?

If yes, select type of training:

1. Did any physical environment contribute to this mishap occurring?

2. Was individual trained to perform the activity/task?

2. Did the safety climate/culture contribute to the mishap?

3. Did challenges with teamwork contribute to the mishap?

D. Training Causal Factors

E. Leader/Supervisor Causal Factors

F. Individual Causal Factors

G. Physical Environment Causal Factors

H. Material Causal Factors

I. Environmental Causal Factors

1. Did any environmental condition contribute to this mishap occurring?

1. Did the design of the facility/building contribute to the mishap?

J. Facility/Building Design

a. Have all corrective action(s) to prevent mishap recurrence been completed?

1. Did a hazard(s) contribute to the mishap?

K. Existing Hazard

9. Corrective Action plan

10. Additional Information

1.0 darwin.chen@usace.army.mil

2021-06-28

Forms Design Team

Darwin Chen

2021-07-30

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APP Checklist Site Activity Page 1 of 4

APP Checklist with Attachments

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…