A02_Appendix_D.pdf

MVN Form 385-43R Proponent: CEMVN-SS September 29, 2009

ACCIDENT PREVENTION PROGRAM

ADMINISTRATIVE PLAN

(EM385-1-1 (Sept 08) Pages 3-5 & App A) Accepted copy must be at work site!

1. Contractor 2. Contract Name & No. 3. Date

4. Project Superintendent 5. Shift/day 5a. Hours/shift 5b. Maximum employees/shift

5c. Describe major scope of work and location (Ref. EM 385-1-, Page A-2, Item 2(b)).

6a. Training - List subjects to be discussed with employees in safety indoctrination (Ref. EM 385-1-, Page A-4, Item 6(a)).

6b. TRAINING - List mandatory training and certifications that are applicable to this project (e.g., confined space entry, explosive actuated tools, crane operator, diver’s certification, vehicle operator, HAZWOPER training and certification, PPE, boat captains and any requirements for periodic retraining/recertification. List the Contractor’s Designated SSHO (Site Safety and Health Officer) and attached a copy of his/her (OSHA 30 hours training certificate). (Ref. EM 385-1-1, page 11, paragraph 01.A.17)

6c. List major equipment & Operators and training i.e. cranes, dozers, vessels, drill rig(s) etc.

6d. List special equipment i.e. radioactive equipment (Moisture Density Gage), etc.

7. Responsibility & Authority - Who is responsible for safety?

Project: Corporate: Line of Authority?

8. Who will conduct safety inspection? 8a. How? 8b. When?

9a. Is safety & health policy attached? 9b. Is safety program attached? 9c. Day & hour weekly safety meeting to be held:

10. How will subcontractor & supplies be controlled (Ref. EM 385-1-1, App A, Item 5)?

11. What are their safety responsibilities (EM 385-1-1, Appendix A, Item 5)?

Appendix D-1 Accident Prevention Program

ACCIDENT PREVENTION PROGRAM

ADMINISTRATIVE PLAN

(EM385-1-1 (Sept 08) Pages 3-5 & App A) Accepted copy must be at work site!

12. Who will report accidents, exposure data (Ref. EM 385-1-1, Appendix A, Item 3 and Section 01.D)?

13. MEDICAL SUPPORT. Outline on-site medical support and off-site medical arrangements (Ref. EM 385-1-1, Appendix A, Item 3):

14. Outline procedures for conducting hazard assessments & written certification of PPE (Ref. EM 385-1-1, Section 05.A)

Who? When? How?

15. Names of first aid attendants having certificates (Ref. EM 385-1-1, Section 03.D)

Type of certificate & expiration date Names of USCG licensed boat operators.

Type licence & expiration date.

(Ref. EM 385-1-1, Paragraph 19.A.02)

Appendix D-2

ACCIDENT PREVENTION PROGRAM

ADMINISTRATIVE PLAN

(EM385-1-1 (Sept 08) Pages 3-5 & App A) Accepted copy must be at work site!

Proposed layout of temporary buildings and facilities (including subcontractors) and traffic patterns including access roads, haul roads, R.R.s. utilities, etc (Ref. EM 385-1-1, Section 4).

The will pursue a positive program of training, inspections (Company) and hazard control throughout the term of this contract. Mr./Ms. has responsibility and authority for enforcing them.

Contractor’s Signature Date C.O.R. Signature and Date

Appendix D-3

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