Checklist.pdf

ACCIDENT PREVENTION PLAN REVIEW CHECKLIST

Contract No.: __________________________________________________________________________________

Description: ___________________________________________________________________________________

Transmittal #: _________________________________________________________________________________

PLAN IS (circle one): Acceptable Unacceptable - see below

ITEMS REQUIRED IN ACCIDENT PREVENTION PLAN (CIRCLE AS APPLICABLE):

(NOTE: If any statement in a REQUIRED plan or section = N, then the plan is UNACCEPTABLE.)

LEGEND:

Y = Yes N = No A = Acceptable U = Unacceptable R = Required NR = Not Required

1. SIGNATURE SHEET (REQUIRED)

a. Includes the name, signature, and title of the Plan Preparer (corporate safety staff person, QC).

b. Includes the name, signature, and title of the Plan Approver, e.g., owner, company president, regional vice president (HTRW activities require approval of a Certified Industrial Hygienist, a Certified Safety Professional may approve the plan for operations involving UST removal where contaminants are known to be petroleum, oils, or lubricants).

c. Includes the name(s), signature(s), and title(s) for Plan Concurrence (provide concurrence of other applicable corporate and project personnel (contractor)), e.g., Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC.

2. BACKGROUND INFORMATION (REQUIRED)

a. Includes the Contractor Name.

b. Includes the Contract Number.

c. Includes the Project Name.

d. Includes the Brief Project Description.

e. Includes the Location of the Project (map).

f. Includes the Contractor Accident Experience (Copy of OSHA 200 Form, or equivalent documentation).

g. Includes the Listing of Phases of Work and Hazardous Activities Requiring an Activity Hazard Analyses (AHA).

Y N

Y N

Y N

Y N

3. STATEMENT OF SAFETY AND HEALTH POLICY (REQUIRED)

Includes a copy of the corporate safety policy. (In addition to the corporate policy statement, a copy of the corporate safety program may provide a portion of the information required by the accident prevention plan.)

4. RESPONSIBILITIES AND LINES OF AUTHORITIES (REQUIRED)

a. Includes the identification and job responsibilities of personnel responsible for safety - at both corporate and project level – including their resumes.

b. Includes the lines of authority.

5. SUBCONTRACTORS AND SUPPLIERS (REQUIRED) -

a. Includes the identification of subcontractors and suppliers (if known).

b. Includes the means of controlling and coordinating subcontractors and suppliers.

c. Includes the safety responsibilities of subcontractors and suppliers.

d. Includes the method of addressing subcontractor safety plans.

6. TRAINING (REQUIRED)

a. Includes the list of subjects to be discussed with employees at safety indoctrination.

b. Includes the list of mandatory training and certifications applicable to this project.

c. Includes the identity requirements for emergency response training.

d. Includes the outline requirements (who attends, when given, who will conduct, etc.) for supervisory and employee safety training (meetings).

e. Includes the list of names and dates of first aid and CPR training for at least two (2) employees

Y N

Y N Y N

Y N on site.

7. SAFETY AND HEALTH INSPECTIONS (REQUIRED)

a. Includes the name(s) of individual(s) responsible for conducting safety inspections.

b. Indicates when inspections will be conducted (minimum every two (2) weeks).

c. Furnished sample forms upon which inspections will be recorded.

d. Indicated deficiency tracking system and follow-up procedures.

e. Includes Any external inspections/certifications which may be required.

Y N

Y N

Y N

8. SAFETY AND HEALTH EXPECTATIONS, INCENTIVE PROGRAMS, AND COMPLIANCE (REQUIRED)

a. Includes the company's written safety program goals, objectives, and accident experience goals.

b. Includes a brief description of the company's safety incentive programs (if any).

c. Includes the policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements).

d. Includes the written company procedures for holding managers and supervisors accountable for safety.

9. ACCIDENT REPORTING - The Contractor shall identify who shall complete the following, how, and when

(REQUIRED):

a. The plan identifies who shall complete the Exposure data (man-hours worked), how, and when.

b. The plan identifies who shall complete accident investigations, reports, and logs. how, and when.

c. The plan identifies who shall make immediate notification of major accidents how, and when.

10. MEDICAL SUPPORT (REQUIRED)

a. On-site medical support is completely addressed.

b. Off-site medical arrangements are completely addressed.

c. Approximate driving time to nearest hospital or emergency physician is included.

11. PERSONAL PROTECTIVE EQUIPMENT (REQUIRED)

a. Plan includes procedures identifying who will be conducting hazard assessments.

b. Plan includes procedures identifying when hazard assessments will be conducted.

c. Plan includes procedures identifying how hazard assessments will be conducted.

d. Plan includes how the contractor will ensure users of personal protective and safety equipment (PPE) are trained to know the following: when PPE, and what PPE, is necessary; how properly to don, doff, adjust, and wear PPE; limitations of the PPE; and proper care, inspection, testing, maintenance, useful life, storage, and disposal of the PPE.

e. Includes a procedure for when the employer has reason to believe that any affected employee who has been trained does not have the understanding and skill required of the training, the employer shall retrain the employee.

f. Includes a written certification that identifies the name of each employee trained, the date(s)

Y N

Y N Y N

Y N of the training, and the subjects taught.

12. PLANS (PROGRAM, PROCEDURES) REQUIRED BY THE SAFETY MANUAL (to be added by appendix to the plan as applicable to this project; see APPENDIX "A" for specific paragraph references) (ACCEPTABLE /

UNACCEPTABLE / NOT REQUIRED)

a. Written hazard communications program

1.) Addresses training (to include potential safety and health effects from exposure).

2.) Addresses OSHA-compliant labeling of containers.

3.) Addresses current inventory of hazardous chemicals on site.

4.) Addresses the location and use of Material Safety Data Sheets (MSDSs).

5.) Addresses when hazardous substances are brought onto the job site, how all employees potentially exposed to the substance will be advised of information in the MSDS for the substance.

A U NR

Y N

Y N

6.) Includes a method to ensure a copy of the MSDS for each hazardous substance at the project will be maintained in an inventory and will be provided to the designated authority and made available to all potentially exposed employees.

7.) Includes an emergency response inventory that shall include the approximate quantities (e.g., liters, kilograms, gallons, pounds) that will be on site at any given time.

8.) Includes a current site map attached to the inventory showing where inventoried hazardous substances are stored.

9.) Includes a method to ensure the inventory and the site map will be updated as frequently as necessary to ensure accuracy.

b. Emergency response plan

1.) Is in writing.

2.) Includes a method for reviewing with all affected employees.

3.) Includes a test procedure to ensure their effectiveness.

4.) Includes escape procedures and routes.

5.) Includes critical plant operations.

6.) Includes employee accounting following an emergency evacuation.

7.) Includes rescue and medical duties.

8.) Includes a means of reporting emergencies.

9.) Includes persons to be contacted for information or clarification.

10.) Is integrated with off-site emergency support.

11.) Includes a process of evaluation of operations, materials, and equipment involving potential exposure to hazardous substances, agents, or environments by a qualified industrial hygienist, or other competent person, to formulate a hazard control program.

12.) Includes a method to ensure that the hazard evaluation program is approved by the designated authority before the start of operations.

13.) Includes a method to ensure that emergency phone numbers are conspicuously placed for all employees to access.

* = Fire, sinking, flooding, man overboard, severe weather, hazardous material incidents

Severe Marine Fire Weather Spills Emergencies*

R NR

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

Y N Y N Y N Y N

c. Wildfire prevention plan

1.) The plan has provisions to ensure annual updating.

2.) The plan includes an analysis of wildfire causes and special fire hazards and risks.

3.) The plan includes proposed measures to reduce fire occurrence and decrease fire damage.

4.) The plan includes procedures for public education and fire prevention sign posting (including procedures for keeping the public informed of the current fire danger rating).

5.) The plan includes provisions for cooperative efforts with all other neighboring fire protection agencies/organizations.

e. Layout plans (04.A.01)

1.) Includes temporary construction buildings.

2.) Includes facilities.

3.) Includes fencing.

4.) Includes access routes.

5.) Includes anchoring systems for temporary structure.

6.) Ensures temporary facility spacing meets the requirements of 09.A.17 and 09.A.18.

7.) Ensures temporary power distribution approval requirements of Section 11are met.

8.) Ensures temporary ramp, trestle, scaffold, and platform approval requirements of Sections 21 and 22 are met.

f. Written respiratory protection plan (05.E.01). The program shall be in accordance with the requirements contained in this section, the OSHA respirator standards, ANSI Z88.2, NIOSH Respirator Decision Logic (Department of Health and Human Services NIOSH Publication No. 87-108) and, for work around identified or suspected military chemical agent operations, AR 11-34.

1.) The program is site specific.

2.) Includes the selection of respiratory protective equipment.

3.) Includes the fit testing of respiratory protective equipment.

4.) Includes the use of respiratory protective equipment.

5.) Includes the maintenance of respiratory protective equipment.

6.) Includes the storage of respiratory protective equipment.

7.) Includes the training requirements for personnel required to use respiratory protective equipment.

8.) Includes a method to determine if employees are physically and medically qualified to wear respiratory protection devices.

A U NR

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

g. Health hazard control program (06.A.02)

1.) Includes a method to ensure all operations, materials, and equipment will be evaluated to determine the presence of hazardous environments or if hazardous or toxic agents could be released into the work environment.

2.) The activity and/or position hazard analysis is used for the evaluation. If so, the analyses shall identify all substances, agents, and environments that present a hazard and recommend hazard control measures.

3.) The analyses identifies that it serves as certification of hazard assessment.

4.) The analysis identifies the workplace and activity evaluated.

5.) The analysis identifies the name of the person certifying that the evaluation has been performed.

6.) The analysis identifies date of the evaluation.

7.) The analyses identifies operations, materials, and equipment involving potential exposure to hazardous substances, agents, or environments and that they shall be evaluated by a qualified industrial hygienist, or other competent person, to formulate a hazard control program.

h. Lead abatement plan (06.B.05 & specifications)

Submit to District Safety and Occupational Health Manager for review.

i. Asbestos abatement plan (06.B.05 & specifications)

j. Abrasive blasting (06.H.01)

1.) Includes an employee-monitoring program.

2.) Includes an air-monitoring program.

3.) Includes a medical surveillance program.

4.) Includes training requirements.

5.) Includes use of personal protective devices.

6.) Includes use of personal protective clothing.

7.) Includes use of personal hygiene facilities and practices.

8.) Includes use of engineering controls.

9.) Includes itinerant work practices.

10.) Includes use of abrasive blasting requirements from 29 CFR 1910.94(a).

11.) Includes housekeeping program.

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

k. Confined space (06.I)

1.) At each facility or activity, the contractor has designated a competent person to evaluate the potential for permit-required confined spaces (PRCSs).

2.) Each facility or activity has developed a process to complete an evaluation to identify PRCSs using the procedures and decision logic presented in EM 385-1- 1, Figure 6-1.

3.) The project is PRCS free. [If the answer is no, continue with rest of the questions; if it is yes, go to the next section(hazardous energy control plan).]

4.) The Program identifies where a list of confined spaces (permit-required and non-permit required) will be maintained on site and how it will be updated as new confined spaces are discovered.

5.) Includes how confined spaces will be reevaluated whenever they or their characteristics change in a way that could lead to reclassification as a PRCS.

6.) The contractor, as part of its PRCS program, will explain how it will provide, maintain, and assure the proper use of testing and monitoring equipment.

7.) The contractor, as part of its PRCS program, will explain how it will provide, maintain, and assure the proper use of ventilating equipment needed to obtain acceptable entry conditions communications equipment.

8.) The contractor, as part of its PRCS program, will explain how it will provide, maintain, and assure the proper use of PPE used where engineering controls and work practices do not adequately protect USACE personnel.

9.) The contractor, as part of its PRCS program, will explain how it will provide, maintain, and assure the proper use of lighting equipment.

10.) The contractor, as part of its PRCS program, will explain how it will provide, maintain, and assure the proper use of equipment, such as ladders, needed for safe ingress and egress by authorized entrants.

11.) The contractor, as part of its PRCS The contractor, as part of its PRCS program, will explain how it will provide, maintain, and assure the proper use of rescue and emergency equipment.

12.) Program, will explain how it will provide, maintain, and assure the proper use of any other equipment necessary for safe entry into and rescue from permit spaces.

13.) Includes a system for the preparation, issuance, use, and cancellation of PRCS entry permits (ENG Form 5044-R).

14.) The program includes plans and procedures for summoning rescue and emergency services, for rescuing entrants from PRCSs, and for preventing unauthorized personnel from attempting a rescue.

15.) The program includes employee training requirements, instructor certification, date of training and personnel receiving the training.

16.) Includes practice training where each member of the rescue team/emergency makes practice PRCS rescues at least once every 12 months. That simulate the configurations and hazards of the PRCS from which rescue is to be performed.

17.) Includes all aspects of off-site rescue and emergency services.

l. Hazardous energy control plan (lockout/tagout) (12.A.07)

(1) Includes a statement of the intended use of the procedure.

(2) Includes a means of coordinating and communicating hazardous energy control activities.

(3) Includes procedural steps and responsibilities for shutting down, isolating, blocking, and securing systems to control hazardous energy.

(4) Includes procedural steps and responsibilities for the placement, removal, and transfer of lockout and tagout devices.

(5) Includes procedural steps and responsibilities for placing and tagging, and moving or removing and untagging, protective grounds.

(6) Includes requirements for testing the system to verify the effectiveness of isolation and lockout and tagout devices.

(7) Includes a description of any emergencies which may occur during system lockout or tagout and procedures for safely responding to those emergencies.

(8) Includes requirements when authority for removal of hazardous energy control devices must be transferred from the authorized employee to another individual, and the names of the individuals qualified for receiving such transfer.

m. Critical lift procedures (16.C.17)

1.) Critical lift procedure requires the plan to be prepared and documented before the lift by the crane operator, lift supervisor, and rigger.

2.) The critical lift procedure requires copy be provided to the designated authority.

3.) The critical lift procedure requires that the plan shall be reviewed and signed by all personnel involved with the lift.

4.) The critical lift procedure requires the plan to specify the exact size and weight of the load to be lifted and all crane and rigging components which add to the weight. The manufacturer's maximum load limits for the entire range of the lift, as listed in the load charts, shall also be specified.

5.) The critical lift procedure requires the plan to specify the lift geometry and procedures, including the crane position, height of the lift, the load radius, and the boom length and angle, for the entire range of the lift.

6.) The critical lift procedure requires the plan to designate the crane operator, lift supervisor and rigger and state their qualifications.

7.) The critical lift procedure requires the plan to include a rigging plan which shows the lift points and describes rigging procedures and hardware requirements.

8.) The critical lift procedure requires the plan to describe the ground conditions, outrigger or crawler track requirements, and, if necessary, the design of mats, necessary to achieve a level, stable foundation of sufficient bearing capacity for the lift. For floating cranes or derricks, the plan describes the operating base (platform) condition and any potential list.

9.) The critical lift procedure requires the plan to list environmental conditions under which lift operations are to be stopped.

10.) The critical lift procedure requires the plan to specify coordination and communication requirements for the lift operation.

11.) The critical lift procedure requires, for tandem or tailing crane lifts, the plan to specify the make and model of the cranes, the line, boom, and swing speeds, and requirements for an equalizer beam.

n. Floating plant contingency plan for severe weather (19.A.03)

1.) The plan is part of the activity hazard analysis.

2.) The plan includes a description of the types of severe weather hazards the plant may potentially be exposed to and the steps which will be taken to guard against the hazards.

3.) The plan includes the time frame for implementing the plan (using as a reference the number of hours remaining for the storm to reach the work site if it continues at the predicted speed and direction), including the estimated time to move the plant to the safe harbor after movement is started.

4.) The plan includes the name and location of the safe location.

5.) The plan includes the name of the vessels which will be used to move any non-self-propelled plant, and their type, capacity, speed, and availability.

6.) The plan includes river gage readings at which floating plant must be moved away from dams, river structures, etc., to safe areas.

7.) The plan includes that USCG approved PFD (type I, II, III, or V) shall be worn by all personnel on decks exposed to severe weather, regardless of other safety devices used.

8.) The plan includes a sufficient number of vessels of adequate size and horsepower, each designed, outfitted, and equipped for towing service, shall be available at all times to move both self- and non self-propelled plant against tides, current, and winds during severe weather conditions.

9.) The plan includes how contractors working in an exposed marine location will monitor the NOAA marine weather broadcasts and will use other local commercial weather forecasting services as may be available.

o. Access and haul road plan (21.I.10)

1.) The plan includes equipment usage, traffic density, and hours of operation.

2.) The plan includes road layout and widths, horizontal and vertical curve data, and sight distances.

3.) The plan includes sign and signalperson requirements, road markings, and traffic control devices.

4.) The plan includes drainage controls.

5.) The plan includes points of contact between vehicles and the public, and safety controls at these points of contact.

6.) The plan includes maintenance requirements, including roadway hardness and smoothness and dust control.

p. Demolition plan (engineering and asbestos surveys) (23.A.01)

q. Emergency rescue (tunneling) (26.A.05)

r. Underground construction fire prevention and protection plan (26.D.01)

(1) The plan defines specific work practices to be implemented for preventing fires.

(2) The plan includes response measures to be taken in case of fire to control and extinguish the fire.

(3) The plan includes required equipment for fire prevention and protection.

(4) The plan includes the personnel requirements and responsibilities for fire prevention and protection.

(5) The plan includes the requirements for daily and weekly fire prevention and protection inspections.

(6) The plan includes how it will be incorporated in either the accident prevention plan or the activity hazard analysis and posted at the job site.

(7) The plan includes how it will be reviewed with all affected personnel as often as is necessary for them to maintain a working knowledge of emergency responsibilities and procedures.

s. Underground construction compressed air plan (26.I.01)

1.) The plan includes requirements for a medical lock and its operation.

2.) The plan includes an identification system for compressed air workers.

3.) The plan includes communications system requirements.

4.) The plan includes requirements for signs and record keeping.

5.) The plan includes special compression and decompression requirements.

6.) The plan includes man lock and decompression chamber requirements.

7.) The plan includes requirements for compressor systems and air supply.

8.) The plan includes ventilation requirements.

9.) The plan includes electrical power requirements.

10.) The plan includes sanitation considerations.

11.) The plan includes fire prevention and fire protection considerations.

12.) The plan includes requirements for bulkheads and safety screens.

t. Formwork and shoring erection and removal plans (27.B.02)

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

u. Lift slab plans (27.D.01)

1.) Lift-slab operations are planned and designed by a registered engineer or architect.

2.) Plans and designs include detailed instructions and sketches indicating the prescribed method of erection.

3.) Includes a requirement to submit the plans and designs to the Designated Authority for review.

v. SHP and SSHP

w. Blasting plan (29.A.01)

1.) The plan includes a method to obtain permission in writing from the Government's designated authority before explosive materials are brought on the job site (periodic replenishment of approved supplies does not require written approval).

2.) The plan includes a list the names, qualifications, and responsibilities of personnel involved with explosives.

3.) The plan delineates the contractor's requirements for handling, transportation, and storage of explosives.

4.) The plan includes loading procedures.

5.) The plan includes safety signals.

6.) The plan includes danger area clearance.

7.) The plan includes methods for securing the site.

8.) The plan includes vibration and damage control.

9.) The plan includes post-blast inspection and misfire procedures.

10.) The plan includes post-blast ventilation requirements.

x. Diving plan (30.A.13)

1.) The plan includes the names and duties of dive team members, including diving supervisor.

2.) The plan includes the date, time, and location of the dive operation.

3.) The plan includes the diving mode to be utilized (SCUBA, surface-supplied air, etc.), giving a description of the backup air supply.

4.) The plan includes the nature of work to be performed by the divers and requirements for inspections.

5.) The plan includes the surface and underwater conditions, to include visibility, temperature, thermal protection, and currents.

6.) The plan includes the activity hazard analysis for each phase of work, to include the hazards associated with flying after diving.

Y N

Y N

Y N

7.) The plan includes the maximum depth and bottom time (altitude adjustments to dive tables shall be made for dives made at altitudes of 300 m (1000 ft) or more above sea level).

8.) The plan includes the emergency management plan, to include emergency procedures, means of notification, telephone numbers (for ambulance, doctors, and recompression chamber), and locations of evacuation route, nearest USCG rescue center, and emergency assistance.

9.) The plan includes the lockout/tagout procedures, including procedures for dealing with differential water pressures due to unequal water elevations.

10.) The plan includes the equipment certification, procedures, and checklists and requirements for special tools and equipment.

11.) The plan includes the following statement: "If for any reason the dive plan is altered in mission, depth, personnel, or equipment, the USACE Command Diving Coordinator (UDC) at the district level shall be contacted and shall review any revision prior to actual operation."

y. Plan for prevention of alcohol and drug abuse (Defense Federal Acquisition Regulation Supplement Subpart 252.223-7004, Drug-Free Work Force)

1.) The program includes the following, or appropriate alternatives, employee assistance programs emphasizing high level direction, education, counseling, rehabilitation, and coordination with available community resources.

2.) The program includes the following, or appropriate alternatives, supervisory training to assist in identifying and addressing illegal drug use by Contractor employees.

3.) The program includes the following, or appropriate alternatives, provision for self-referrals as well as supervisory referrals to treatment with maximum respect for individual confidentiality consistent with safety and security issues.

4.) The program includes the following, or appropriate alternatives, provision for identifying illegal drug users, including testing on a controlled and carefully monitored basis.

5.) The program includes the following, or appropriate alternatives, appropriate personnel procedures to deal with employees who are found to be using drugs illegally. (Provisions of this clause pertaining to drug testing programs does not apply to the extent they are inconsistent with state or local law, or with an existing collective bargaining agreement; provided that with respect to the latter, the Contractor agrees that those issues that are in conflict will be a subject of negotiation at the next collective bargaining session.).

13. The contractor shall provide information on how they will meet the requirements of major sections of EM 385-1-1 in the accident prevention plan. Particular attention shall be paid to excavations, scaffolding, medical and first aid requirements, sanitation, personal protective equipment, fire prevention, machinery and mechanized equipment, electrical safety, public safety requirements, and chemical, physical agent, and biological occupational exposure prevention requirements. Detailed site-specific hazards and controls shall be provided in the activity hazard analysis for each phase of the operation.

REMARKS:

Signature of Reviewer __________________________________________ Date review completed_________________