A02_Appendices_A_-_E.pdf

LOCATION IDENTIFIER MFR Model SN MFR Date

Admin Offices ACCU-1 Carrier 38AK-007---601-- 0295G00141 1995 Conf Rm ACCU-2a Carrier 38CK042640 3294E08851 1994 Conf Rm ACCU-2b Carrier 38CK042640 4394E10863 1994 Locker Rooms ACCU-3a Carrier 38CKB024300 0995E12756 1995 Locker Rooms ACCU-3b Carrier 38CKB024300 0995E12763 1995 Shop-West ACCU-4 Carrier 38CKB030300 0695E10885 1995 Shop-East ACCU-5 Carrier 38AUZA07A0A6A0A0A0 1416C94486 2016 EER-ADMIN ACCU-6 Carrier 38AUZA12A0A6A0A0A0 2311G10134 2011 EER-3 Lennox TSA (S4) 5817E15494 2017 Overlook Goodman GSC130601DB 1305151245 2013 Crows Nest M193 "Condenser 1A" Thermal Zone 7805W500906085 2009 Crows Nest M194 "Condenser 1B" York H1RA060S46G W0N6291648 2006 Crows Nest M196 "Condenser 2" Thermal Zone TZAA-348-DA 7799N500704054 2007

Admin Offices AHU-1a Carrier 58WAV091-16 0195A10207 1995 Admin Offices AHU-1b Carrier 58WAV091-16 0595A13395 1995

Conf Rm AHU-2 Carrier 39LD1032AA1221-L 0795T65147 1995 Conf Rm Furnace Reznor 1995 Locker Rooms AHU-3 Carrier 39LB1031CA1-221-R 0795T65148 1995 Locker Rooms Furnace Reznor 1995 Shop-West AHU-4 Carrier 3494X56236 1994 Shop-East AHU-5a Carrier 595C5A080S211220 5215A45697 2015 Shop-East AHU-5b Carrier 595C5A080S211220 5215A45706 2015 Shop-Low Bay 1 Furnace Reznor 1995 Shop-Low Bay 2 Furnace Reznor 1995 Shop-Delivery Furnace Reznor 1995 EER-Admin Air Handler Carrier 40RR-12 2294F98796 1994 EER-3 Lennox CBX25UH (-10) 1717D16606 2017 Overlook Carrier FA4ANF060 3302A67556 2002 Crows Nest AH-1 Central Envormental Systems K2ES120A25A NKFS006961 1997 Crows Nest AH-2 Snyder General LSL104CV 3XF00058-06 1992

Air Handler/Furnace Information

Condenser Information

Melvin Price HVAC Equipment Inventory

NGRM NGRM AHU Daikin McQuay CAH021GDAM 2014

NGRM Chiller #1 Trane 38AK-007---601-- 2014 NGRM Chiller #2 Trane 38CK042640 2014 NGRM Boiler Lochinvar KBN399 2014 NGRM Boiler Lochinvar KBN399 2014

Chiller/Boiler Information

LOCATION IDENTIFIER MFR Model SN MFR Date Heat Strip

Admin Offices RTU-1 American Standard TTA090A400FA 6093M9NAD 03/2006 Castle ACCU-2 Carrier 38TG030300 2691E42657 Unknown Maintenance Buliding, upper ACCU-3 Carrier 38ARZ008---611-- 2808G30133 Unknown Upper I Wall Control House ACCU-4 Trane 4TWA3060A4000BA 10123PPA2F 03/2010 Middle I Wall Control House ACCU-5 Fujitsu AOU30RLX JPN002110 Unknown

Admin Offices AHU-1 American Standard TWE090A300EL 6253P23BD Jun-06 Castle AHU-2 Carrier 40QB901250 4489H04780 Unknown Maintenance Buliding, upper AHU-3 Carrier 40RM-008--B611HC 3009U15295 Unknown Upper I Wall Control House AHU-4 Trane 4TEC3F60B1000AA 10191Y8D1V 05/2010 Middle I Wall Control House AHU-5 Fujitsu ASU30RLX JPA1923 Unknown

Maintenance Buliding, Lower Package Unit - 1 Bard WA302-C09XXXXXJ 204M072414231-02 N/A EHWC03A-C09 Lower I Wall Control House Widow Unit -1 Friedrich Unknown Unknown Unknown West Wall Control House Window Unit - 2 Friedrich Unknown Unknown Unknown

Locks 27 HVAC Equipment Inventory

Condenser Information

Air Handler/Furnace Information

Package/Window Units

Indoor Air Quality Forms 195

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Appendix B discusses HVAC system components in relation to indoor air quality.

Needs Attention

Not ApplicableOKComponent Comments

Outside Air Intake

Location

Open during occupied hours?

Unobstructed?

Standing water, bird droppings in vicinity?

Odors from outdoors?

(describe)

Carryover of exhaust heat?

Cooling tower within 25 feet?

Exhaust outlet within 25 feet?

Trash compactor within 25 feet?

Near parking facility, busy road, loading dock?

Bird Screen

Unobstructed?

General condition?

Size of mesh? (1⁄2" minimum)

Outside Air Dampers

Operation acceptable?

Seal when closed?

Indoor Air Quality Forms 196

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 2 of 14

Needs Attention

Not ApplicableOKComponent Comments

196 Indoor Air Quality Forms

Actuators operational?

Outdoor Air (O.A.) Quantity (Check against applicable codes and ASHRAE 62-1989.)

Minimum % O.A. __________________

Measured % O.A. _________________ Note day, time, HVAC operating mode under "Comments"

Maximum % O.A. _________________

Is minimum O.A. a separate damper?

For VAV systems: is O.A. increased as total system air-flow is reduced?

Mixing Plenum

Clean?

Floor drain trapped?

Airtightness

■ of outside air dampers

■ of return air dampers

■ of exhaust air dampers

All damper motors connected?

All damper motors operational?

Air mixers or opposed blades?

Indoor Air Quality Forms 197

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 3 of 14

Needs Attention

Not ApplicableOKComponent Comments

Mixed air temperature control setting OF

Freeze stat setting OF

Is mixing plenum under negative pressure? Note: If it is under positive pressure, outdoor air may not be entering.

Filters

Type

Complete coverage?

(i.e., no bypassing)

Correct pressure drop? (Compare to manufacturer's recommendations.)

Contaminants visible?

Odor noticeable?

Spray Humidifiers or Air Washers

Humidifier type

All nozzles working?

Complete coil coverage?

Pans clean, no overflow?

Drains trapped?

Biocide treatment working?

Note: Is MSDS on file?

Spill contaminant system in place?

Indoor Air Quality Forms 198

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 4 of 14

Needs Attention

Not ApplicableOKComponent Comments

198 Indoor Air Quality Forms

Face and Bypass Dampers

Damper operation correct?

Damper motors operational?

Cooling Coil

Inspection access?

Clean?

Supply water temp. OF

Water carryover?

Any indication of condensation problems?

Condensate Drip Pans

Accessible to inspect and clean?

Clean, no residue?

No standing water, no leaks?

Noticeable odor?

Visible growth (e.g., slime)?

Drains and traps clear, working?

Trapped to air gap?

Water overflow?

Indoor Air Quality Forms 199

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 5 of 14

Needs Attention

Not ApplicableOKComponent Comments

Mist Eliminators

Clean, straight, no carryover?

Supply Fan Chambers

Clean?

No trash or storage?

Floor drain traps are wet or sealed?

No air leaks?

Doors close tightly?

Supply Fans

Location

Fan blades clean?

Belt guards installed?

Proper belt tension?

Excess vibration?

Corrosion problems?

Controls operational, calibrated?

Indoor Air Quality Forms 200

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 6 of 14

Needs Attention

Not ApplicableOKComponent Comments

200 Indoor Air Quality Forms

Control sequence conforms to design/specifications?

(describe changes)

No pneumatic leaks?

Heating Coil

Inspection access?

Clean?

Contol sequence conforms to design/specifications?

(describe changes)

Supply water temp. OF

Discharge thermostat?

(air temp. setting OF)

Reheat Coils

Clean?

Obstructed?

Operational?

Steam Humidifier

Humidifier type

Treated boiler water

Standing water?

Indoor Air Quality Forms 201

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 7 of 14

Needs Attention

Not ApplicableOKComponent Comments

Visible growth?

Mineral deposits?

Control setpoint OF

High limit setpoint OF

Duct liner within 12 feet? (If so, check for dirt, mold growth.)

Supply Ductwork

Clean?

Sealed, no leaks, tight connections?

Fire dampers open?

Access doors closed?

Lined ducts?

Flex duct connected, no tears?

Light troffer supply?

Balanced within 3-5 years?

Balanced after recent renovations?

Short circuiting or other air distribution problems? Note location(s)

Pressurized Ceiling Supply Plenum

No unintentional openings?

All ceiling tiles in place?

Indoor Air Quality Forms 202

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 8 of 14

Needs Attention

Not ApplicableOKComponent Comments

202 Indoor Air Quality Forms

Barrier paper correctly placed and in good condition?

Proper layout for air distribution?

Supply diffusers open?

Supply diffusers balanced?

Noticeable flow of air?

Short circuiting or other air distribution problems? Note location(s) in"Comments"

Terminal Equipment (supply)

Housing interiors clean and unob-structed?

Controls working?

Delivering rated volume?

Balanced within 3-5 years?

Filters in place?

Condensate pans clean, drain freely?

VAV Box

Minimum stops %

Minimum outside air % (from page 2 of this form)

Minimum airflow cfm

Minimum outside air cfm

Indoor Air Quality Forms 203

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form Page 9 of 14

Needs Attention

Not ApplicableOKComponent Comments

Supply setpoint OF (summer)

OF (winter)

Thermostats

Type

Properly located?

Working?

Setpoints OF (summer)

OF (winter)

Space temperature OF

Humidity Sensor

Humidistat setpoints % RH

Dehumudistat setpoints % RH

Actual RH %

Room Partitions

Gap allowing airflow at top?

Gap allowing airflow at bottom?

Supply, return each room?

Indoor Air Quality Forms 204

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Needs Attention

Not ApplicableOKComponent Comments

Stairwells

Doors close and latch?

No openings allowing uncontrolled airflow?

Clean, dry?

No noticeable odors?

Return Air Plenum

Tiles in place?

No unintentional openings?

Return grilles?

Balancing capability?

Noticeable flow of air?

Transfer grilles?

Fire dampers open?

Ducted Returns

Balanced within 3-5 years?

Unobstructed grilles?

Unobstructed return air path?

Return Fan Chambers

Clean and no trash or storage?

No standing water?

Floor drain traps are wet or sealed?

204 Indoor Air Quality Forms

Indoor Air Quality Forms 205

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Needs Attention

Not ApplicableOKComponent Comments

No air leaks?

Doors close tightly, kept closed?

Return Fans

Location

Fan blades clean?

Belt guards installed?

Proper belt tension?

Excess vibration?

Corrosion problems?

Controls working, calibrated?

Controls sequence conforms to design/specifications?

(describe changes)

Exhaust Fans

Central?

Distributed (locations)

Operational?

Controls operational?

Toilet exhaust only?

Gravity relief?

Indoor Air Quality Forms 206

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Needs Attention

Not ApplicableOKComponent Comments

Total powered exhaust cfm

Make-up air sufficient?

Toilet Exhausts

Fans working occupied hours?

Registers open, clear?

Make-up air path adequate?

Volume according to code?

Floor drain traps wet or sealable?

Bathrooms run slightly negative rela-tive to building?

Smoking Lounge Exhaust

Room runs negative relative to building?

Print Room Exhaust

Room runs negative relative to building?

Garage Ventilation

Operates according to codes?

Fans, controls, dampers all operate?

206 Indoor Air Quality Forms

Indoor Air Quality Forms 207

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Needs Attention

Not ApplicableOKComponent Comments

Garage slightly negative relative to building?

Doors to building close tightly?

Vestibule entrance to building from garage?

Mechanical Rooms

General condition?

Controls operational?

Pneumatic controls:

■ compressor operational?

■ air dryer operational?

Electric contols?

EMS (Energy Management System) or DDC (Direct Digital Control):

■ operator on site?

■ controlled off-site?

■ are fans cycled "off" while building is occupied?

■ is chiller reset to shed load?

Preventive Maintenance

Spare parts inventoried?

Spare air filters?

Control drawing posted?

Indoor Air Quality Forms 208

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Needs Attention

Not ApplicableOKComponent Comments

PM (Preventive Maintenance) schedule available?

PM followed?

Boilers

Flues, breeching tight?

Purge cycle working?

Door gaskets tight?

Fuel system tight, no leaks?

Combustion air: at least 1 square inch free area per 2000 Btu input?

Cooling Tower

Sump clean?

No leaks, no overflow?

Eliminators working, no carryover?

No slime or algae?

Biocide treatment working?

Dirt separator working?

Chillers

No refrigerant leaks?

Purge cycle normal?

Waste oil, refrigerant properly disposed of and spare refrigerant properly stored?

Condensation problems?

208 Indoor Air Quality Forms

Indoor Air Quality Forms 209

Building: _________________________________________________________ File Number: ________________________________

Completed by: __________________________________ Title: _____________________________ Date Checked: _____________

HVAC Checklist - Long Form

Needs Attention

Not ApplicableOKComponent Comments

Page ___ of ___

QUALITY ASSURANCE SURVEILLANCE PLAN

Mel Price HVAC Maintenance/Repair/Replacement IDIQ Contract

Rivers Project Office 301 Riverlands Way

West Alton, MO 63386

Contract Description: The work covered by this contract and its perspective task orders shall consist of performing HVAC Services to satisfactorily be performed on U.S. Government Lands and/or U.S. Government Sponsored work in accordance with the performance-based specifications contained herein and contained in task orders issued against this contract. The Contractor shall furnish all labor, equipment, materials and supplies necessary to perform HVAC maintenance/repair/replacement services for all associated territory of the U.S. Army Corps of Engineers, Rivers Project.

1. PURPOSE.

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

• What will be monitored.

• How monitoring will take place.

• Who will conduct the monitoring.

• How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Updates shall ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

The following FAR clauses apply:

52.246-4 Inspection of Services – Fixed-Price

2. GOVERNMENT ROLES AND RESPONSIBILITIES.

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (KO) - The KO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The KO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The KO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned KO: Danielle Gainey Organization or Agency: USACE - CEMVS Telephone: 314-331-8520 Email: danielle.m.gainey@usace.army.mil

b. Contract Specialist (KS) - The KS acts as an acquisition consultant and serves as liaison between the TMA Contract Operations Division – Falls Church (COD-FC) and the requesting program office, as well as liaison between the TRICARE Management Activity (TMA) and the supporting contracting office.

Assigned CS: Ginger Bjornson Telephone: 314-331-8054 Email: virginia.e.bjornson@usace.army.mil

c. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. At the conclusion of the contract or when requested by the KO, the COR shall provide documentation to the KO. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. The contractor shall refer any changes they deem may affect contract price, terms, or conditions to the KO for action.

Assigned COR: Ethan Engerski Telephone: 636-899-0070 Email: Ethan.R.Engerski@usace.army.mil

3. CONTRACTOR REPRESENTATIVES:

The following employees of the contractor serve as the contractor’s Program Manager and Task Manager for this contract.

a. Program Manager - <upon award, enter name> Telephone: <enter number> Email: <enter address>

b. Task Manager - <upon award, enter name> Telephone: <enter number> Email: <enter address>

c. Other Contractor Personnel - <upon award, enter name or delete these lines if not applicable> Title: <enter title> Telephone: <enter number> Email: <enter address>

4. PERFORMANCE STANDARDS.

Service Delivery Summary (SDS). The contract service requirements are summarized in performance objectives that relate directly to requirements. The performance threshold briefly describes the minimally acceptable levels of service required for each requirement. The SDS and the Contractor’s Quality Control Plan provide information on contract requirements, the expected level of Contractor performance and the expected method of Government validation and confirmation of services provided. These thresholds are critical to mission success. See SDS table below.

PERFORMANCE OBJECTIVE PWS PARA.

PERFORMANCE

THRESHOLD REMEDY

METHOD OF

ASSESSMENT

PRS No. 1

HVAC System Maintenance/Inspections/Servicing

Continuity of Service

Part IV, Para.1-6

Part IV, Para.

6.0 i

No more than two

(2) deficiencies per year (not performing items listed in PWS paragraph).

No more than one

(1) business day for HVAC outage every three months.

Correct deficiencies within eight

(8) hours of notification

Correct out of service HVAC System(s) within one (1) business day

Periodic Validation

PRS No. 2

Callback Service

Part IV, Para

6.0 l

Arrive within the time specified for the type of call.

No more than 2

Contractor shall complete a written corrective action report delays every month.

PRS No. 3

Non-Standard Service Calls

Part IV, Para.

7.0 a-g

Arrive within the time specified for the type of call.

No more than 2 delays every month.

Contractor shall complete a written corrective action report

5. METHODS OF QA SURVEILLANCE.

Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

Regardless of the surveillance method, the COR shall always contact the contractor's task manager or on-site representative when a defect is identified and inform the manager of the specifics of the problem. The COR shall be responsible for monitoring the contractor’s performance in meeting a specific performance standard.

a. DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

b. PERIODIC INSPECTION. (Uses a comprehensive evaluation of selected outputs.

Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

c. USER SURVEY. (Combines elements of validated user complaints and random sampling.

Random survey is conducted to solicit user satisfaction. Appropriate for high quantity activities that have historically been satisfactory. May also generate periodic and 100% inspections.)

d. VALIDATED USER/CUSTOMER COMPLAINTS. (Relies on the user of the service to identify deficiencies. Complaints are then investigated and validated.

e. 100% INSPECTION. (Evaluates all outputs. May be used where there are written deliverables and stringent requirements such as tasks required by law, safety, or security. May be utilized as deemed appropriate by the Contracting Officer due to multiple repeat in deficiencies)

f. PERIODIC SAMPLING. (Variation of random sampling. However, sample is only taken when a deficiency is suspected. Sample results are applicable only for the specific work inspected.)

g. RANDOM SAMPLING. (Designed to evaluate the outputs of the award requirement by randomly selecting and inspecting a statistically significant sample.)

h. Progress or status meetings.

i. Analysis of contractor's progress reports. (Evaluate cost, schedule, etc.)

Surveillance results may be used as the basis for actions (to include payment deductions) against the contractor. In such cases, the Inspection of Services clause in the Contract becomes the basis for the KO’s actions.

6. RATINGS.

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

EXCEPTIONAL: Performance significantly exceeds contract requirements to the Government’s benefit.

SATISFACTORY: Performance meets contractual requirements.

UNSATISFACTORY: Performance does not meet contractual requirements.

7. DOCUMENTING PERFORMANCE.

a. ACCEPTABLE PERFORMANCE.

The Government shall document positive performance. A report template is attached. Any report may become a part of the supporting documentation for contract actions.

b. UNACCEPTABLE PERFORMANCE.

When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing or via email unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's task manager or on-site representative. A CDR template is attached to this QASP.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for contract payment deductions orr other actions deemed necessary by the KO.

8. FREQUENCY OF MEASUREMENT.

a. Frequency of Measurement.

During contract/order performance, the COR shall take periodic measurements as specified herein and shall analyze whether the negotiated frequency of measurement is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor quarterly to assess performance and shall provide a written assessment. Frequency of assessment meetings shall be increased as required to ensure satisfactory performance is being achieved.

Prepared by: Ethan Engerski

Signature – Contracting Officer’s Representative

PERFORMANCE REPORT

1. CONTRACT NUMBER: <insert number>

2. Prepared by: (Name of COR) <insert name>

3. Date and time of observation:

4. Observation:

<Examples of items to include in a report are:

- Method of surveillance.

- How frequently you conducted surveillance.

- Surveillance results.

- Number of observations.>

Prepared by: <Enter COR’s name>

Signature – Contracting Officer’s Representative Date

CONTRACT DISCREPANCY REPORT (CDR)

1. Contract Number: <insert number>

2. TO: (Contractor Task Manager or on-site representative) <insert name>

3. FROM: (Name of COR) <insert name>

4. Date and time observed discrepancy:

5. DISCREPANCY OR PROBLEM:

<Describe in detail. Identify any attachments.>

5. Corrective action plan:

A written corrective action plan < is / is not > required.

< If a written corrective action plan is required include the following. > The written Corrective Action Plan will be provided to the undersigned not later than < # days after receipt of this

CDR. >

Prepared by: <Enter COR’s name>

Signature – Contracting Officer’s Representative Date

Received by:

Signature - Contractor Task Manager or on-site representative Date

< The COR may initiate a CDR at any time, including whenever the number of recorded defects for a performance standard exceeds the allowable number of defects; anytime unacceptable performance is determined critical in nature and requires formal corrective action; and whenever an unfavorable trend is detected in contractor performance.>

CESO Form A-02 MAR 15

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist

Date of Inspection

Location (Plant or Facility) Contract Number

Contractor Name Project Name

Inspector Name (Print) Inspector Signature

This checklist serves as a guide only, it does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated 30 Nov 2014. The references included in this checklist correspond to the applicable sections of EM 385-1-1.

Item Description Yes No N/A Remarks (Any NO or N/A item)

a. Signature sheet

1. Includes the name, title, signature, telephone number, and qualifications of the Plan Preparer (Qualified person, i.e. corporate safety staff person, QC)

2. Includes the name, title, signature, telephone number, and qualifications 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).

3. Includes the name(s), title(s), signature(s), telephone number(s), and qualifications 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.)

b. Background information

1. Includes the Contractor Name.

2. Includes the Contract Number.

3. Includes the Project Name.

4a. Includes the Brief Project Description.

4b. Includes a Discription of the Work to be Performed.

4c. Includes the Location of the Project (map).

4d. Includes the Equipment to be Used.

4e. Includes the Anticipated High Risk Activities.

5. Includes the Major Phases of Work Anticipated.

(Within these major phases of work identified, activities [includes Definable features of Work (DFOWs) and tasks] to be performed that will require an AHA shall be specifically highlighted. This information can then be used by QC, QA and Safety personnel to track AHA submittals. The AHAs for these activities, tasks of DFOWs are NOT submitted at this time (AHAs created/submitted at this time would not be activity-specific as they are intended to be). > See Sections 01.A.14 and 01.A.15.)

Accident Prevention Plan Checklist (cont’d)

Item Description Yes No N/A Remarks (Any NO or N/A item)

c. Statement of Safety and Health Policy.

1. Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. (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.)

2. Includes Contractor’s written safety program goals.

3. Includes Contractor’s written safety program objectives.

4. Includes the Contractor Accident Experience (Copy of OSHA 300 Forms, or equivalent documentation).

d. Responsibilities and Lines of Authority.

1. Includes 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 (includes the strict enforcement of the program).

2. Includes the identification and accountability of personnel responsible for safety and health at both the corporate and project level – including their resumes. Qualifications shall be in accordance with Section 01.A.17. (Only official OSHA 30-Hour cards will be accepted or, if equivalent training is provided, appropriate instructor qualifications.)

3. Includes equivalent training to the OSHA 30-Hour classes is being presented as qualification, the training shall cover, as a minimum, the areas discussed in Appendix A, Section 3.d.3.(a-d).

4. Includes the names of Competent (CP) and/or Qualified Person(s) (QP) and proof of competency/qualification to meet specific OSHA CP/QP requirements. (Must include copies of proof of CP/QP).

5. Includes requirements and details of the employer’s Risk Management Process. (USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process. Contractors and other individual employer’s may use the AHAs or their own version [Job Safety Analyses (JSAs), Job Hazard Analyses (JHAs), or similar Risk Management assessment tools]. These documents are considered equivalent to, and acceptable substitutes for, the USACE’s AHA provided the data collected is the same as that required by the AHA.)

6. Includes requirements for initial activity-specific AHAs to be submitted and accepted at preparatory meetings, prior to work being performed;

7. Includes requirements that no work by the Contractor shall be performed unless a designated Competent Person/SSHO is present on the job site.

8. Includes policies and procedures regarding non-compliance with safety requirements (to include disciplinary actions for violation of safety requirements).

9. Lines of authority.

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

Item Description Yes No N/A Remarks (Any NO or N/A item)

e. Subcontractors and Suppliers.

1. Includes the list of subcontractors and suppliers.

(If not known at the time of initial APP submittal, the contractor shall include the following statement in their initial APP: “The subcontractors for the following DFOWs/activities are not known at this time, but additional information will be submitted to the APP for acceptance prior to the start of any activities listed”)

2. Includes safety responsibilities of subcontractors and suppliers.

f. Training

1. Includes requirements for new hire SOH orientation training at the time of initial hire of each new employee.

2. Includes 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.

3. Includes procedures for periodic safety and health training for supervisors and employees.

4. Includes the requirements for emergency response training.

g. Safety and Health Inspections

1. Includes specific assignment of responsibilities for a minimum daily jobsite SOH inspection during periods of work activity.

1a. Includes the name(s) of individual(s) responsible for conducting safety inspections. (e.g., PM, safety professional, QC, supervisors, employees)

1b. Includes proof of inspector's training / qualifications.

1c. Indicates when inspections will be conducted.

1d. Indicates procedures for documentation. (Furnished sample forms upon which inspections will be recorded.)

1e. Indicates deficiency tracking system and follow-up procedures.

2. Includes any external inspections / certifications which may be required. (e.g., US Coast Guard)

h. Mishap Reporting and Investigation

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

2a. The plan identifies how, when, and who shall complete mishap investigations, reports, and logs. (The contractor shall report, thoroughly investigate, and analyze all mishaps occurring incidentally to an operation, project or facility for which this manual is applicable.)

2b. The plan identifies how, when, and who shall make immediate notification of major mishaps. (Mishaps shall be reported as soon as possible but not more than 24 hours afterwards to the KO/COR.)

2c. Includes how, when, and who will provide notice to the KO/COR when corrective actions are completed. (Implement corrective actions as soon as reasonably possible.)

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable safety and occupational health risks and associated compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

(1)Include a project-specific compliance plan, as applicable to the work being performed, and as identified below. The plans shall incorporate project-wide procedures to control hazards to which the employees of all project employers may be exposed.

(2) These procedures shall be coordinated with all project employers and shall include project-specific, project-wide emergency response and evacuation procedures, PPE requirements, recordkeeping and reporting requirements, and training requirements.

(3) The plans shall be prepared prior to the start of any work activities on the job site (as much as the information can be known at that point in time). The plans shall be updated throughout the life of the project to include changes in personnel, equipment, conditions, etc. Additional revisions shall be incorporated as necessary to reflect changing site conditions, construction methods, personnel roles and responsibilities and construction schedules.

(4) No activity (DFOW) shall be started on site until the APP is revised and submitted to the GDA for acceptance, with the site-specific plans, programs and procedures required to complete the project.

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures, Assessments, and Evaluations) required by the Safety Manual

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

2. Emergency Plans (01.E):

(a) Procedures & Test (01.E.01)

(b) Spill Plans (01.E.01, 06.A.02)

(c) Fire Fighting Plan (01.E.01; 19.A)

(d) Posting of Emergency Telephone Numbers (01.E.05)

(e) Man overboard/abandon ship (19.A.04)

(f) Plan for prevention of alcohol and drug abuse (01.C.02 & Specs)

3. Site Sanitation/Housekeeping Plan (02.B)

4. Medical Support Agreement. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (03.A.01, 03.A.03)

5. Blood-borne Pathogen Program (03.A.05)

6. Exposure Control Plan (03.A.05)

7. Automatic External Defibrillator (AED) Program (03.B.04)

8. Site Layout Plan (04.A)

9. Access/Haul Road Plan (04.B)

10. Hearing Conservation Program (05.C)

11. Respiratory Protection Plan (05.G)

12. Health Hazard Control Program (06.A)

13. Hazard Communication Program (06.B.01)

14. Process Safety Management Plan (06.B.04)

15. Lead Compliance Plan (06.C.02 & Specifications)

16. Asbestos Abatement Plan (06.C.03 & Specifications)

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, programs, procedures (assessments and evaluations), may include but not be limited to:

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures) continued.

17. Radiation Safety Program (06.F)

18. Abrasive Blasting Plan (06.I)

19. Heat Stress Monitoring Plan (HSMP) (06.J.02)

20. Cold Stress Monitoring Plan (CSMP) (06.J.04)

21. Indoor Air Quality Management Plan (06.L)

22. Mold Remediation Plan (06.L.04)

23. Chromium (VI) Exposure Evaluation (06.M)

24. Crystalline Silica Assessment (06.N.02)

25. Lighting Plan for Night Operations (07.A.06)

26. Traffic Control Plan (08.C.05)

27. Fire Prevention Plan (09.A.01)

28. Wild Land Fire Management Plan (09.L)

29. Arc Flash Hazard Analysis (11.B)

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

31. Hazardous Energy Control Program and Procedures (12.A.01)

32. Standard Pre-Lift Plan – LHE (16.A.03)

33. Critical Lift Plan – LHE (16.H)

34. Naval Architectural Analysis – LHE (Floating) (16.L)

35. Floating Plant Inspection and Certification (19.A.01)

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

37. Emergency Plan for Marine Activities (19.A.04)

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

39. Float Plan for Launches, Motorboats, Skiffs (19.F.04)

40. Fall Protection and Prevention Plan (21.D)

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

42. Rope Access Work Plan (24.H)

43. Excavation/Trenching Plan (25.A.01)

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

45. Compressed Air Work Plan for Underground Construction (26.I.01)

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

47. Precast Concrete Plan (27.D)

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, programs, procedures (assessments and evaluations), may include but not be limited to:

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures) continued.

48. Lift-slab Plans (27.E)

49. Masonry Bracing Plan (27.F.01)

50. Steel Erection Plan (28.B)

51. Explosives Safety Site Plan (ESSP) (29.A)

52. Blasting Plan (29.A; 26.J)

53. Dive Operations Plan (30.A.14, 30.A.16)

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

55. Emergency Management Plan for Diving (30.A.18)

56. Tree Felling/Maintenance Program (31.A.01)

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

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

59. Site Safety and Health Plan (HTRW) (33.B)

60. Confined Space Entry Procedures (34.A.05)

61. Confined Space Program (34.A.06)

j. Risk Management Processes (AHAs). Detailed project-specific hazards and controls shall be provided by Activity Hazard Analysis for each activity (DFOW). No work will begin on an activity (DFOW) until the initial AHA has been accepted by the GDA addressing the project-specific hazards. (01.A.14 & 01.A.15) Note: USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process. Contractors and other individual employer’s may use the AHAs or their own version [Job Safety Analyses (JSAs), Job Hazard Analyses (JHAs), or similar Risk Management assessment tools].

These documents are considered equivalent to, and acceptable substitutes for, the USACE’s AHA provided the data collected is the same as that required by the AHA.

Remarks:

Other Remarks:

iWATCH Army Training for Contractors “See Something -- Say Something”

Unclassified

Always Ready. Always Alert.

Because someone is depending on you.

Unclassified date

Always Ready. Always Alert.

Training Objective

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• Contractors and all associated subcontractors performing work on Army contracts must receive this training on the local iWATCH Army program.

• The objective of this training is to inform employees of the types of suspicious activity or behavior to watch for and instruct employees to report suspicious activity or behavior to the Contract Officer Representative (COR), military police, or local law enforcement.

• Training should be completed within 30 calendar days of contract award and within 5 calendar days of new employees’ commencing performance on active contracts (in the case of personnel changes).

• The results of the training shall be reported to the COR.

Training Topics

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• Origin of iWATCH Army

• iWATCH Army Public Service Announcement (PSA)

• Indicators of Suspicious Activity or Behavior

• “See Something Say Something”

• What to Report

• How to Report

• Source for Other Important Information

• Local Point of Contact

Origin of iWATCH Army

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Origin: Headquarters, Department of the Army, ALARACT Message 110/2010, Army Implementation of iWATCH (Terrorist Watch Program), 15 April 2010

• iWATCH Army is a nation-wide modern version of neighborhood watch designed to encourage and enable members of the Army community to help protect their community by identifying and reporting suspicious activity or behavior that may be associated with terrorist activities.

• The Passive element of iWATCH Army is individual situational awareness of the surroundings.

• The Active element of iWATCH Army involves individuals taking action to report suspicious activity or behavior to military police or local law enforcement for investigation.

IWATCH Army PSA

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Place cursor inside black screen area. Control/play will appear at the bottom of the screen. Click (Play/Pause) to view the video.

Indicators of Suspicious Activity or Behavior (What to Report)

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• Individuals drawing pictures or taking notes in an area not normally of interest to a tourist or showing unusual interest in or photographing security cameras, guard locations, or watching security reaction drills and procedures

• Multiple sightings of the same suspicious person, vehicle, or activity, separated by time, distance, or direction

• Individuals who stay at bus or train stops for extended periods while buses and trains come and go

• Individuals who order food at a restaurant and leave before the food arrives or who order without eating

Indicators of Suspicious Activity or Behavior (What to Report)

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• Joggers who stand and stretch for an inordinate amount of time

• Individuals sitting in a parked car for an extended period of time

• Individuals who don't fit into the surrounding environment because they are wearing improper attire for the location or season

• Individuals who exhibit suspicious behavior, such as staring or quickly looking away from individuals or vehicles as they enter or leave facilities or parking area

• People asking questions about security forces, security measures, or sensitive information

Indicators of Suspicious Activity or Behavior (What to Report)

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• Briefcase, backpack, suitcase, or package left unattended

• Vehicle parked in NO PARKING ZONES in front of an important building

• People in restricted areas where they are not supposed to be

• Chemical smells or fumes that worry you

• People purchasing supplies or equipment that can be used to make bombs

• People purchasing weapons or uniforms without proper credentials

“See Something Say Something”

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How to Report:

• Date and time activity occurred

• Where activity occurred

• Physical descriptions of the people involved

• Description of the vehicle(s) involved

• What type of activity

• Describe what you saw or heard

• Provide pictures if you took any

Where to Report:

• Military Police

• Local law enforcement

• Security forces

• Chain of Command

• Army Counterintelligence

• Contracting Officer

Representative

Source for Other Information

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Army OneSource (AOS) Website (select iWATCH Army / Antiterrorism logo on website) http://www.myarmyonesource.com

Examples of Information:

• Antiterrorism Awareness Training

• Individual Protective Measures

• Individual Awareness Tips

• Insider Threats

• Active Shooter

• Cyber Threats

• Risks Associated with Social Media

Local Point of Contact

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Name: instructor complete prior to training

Phone: instructor complete prior to training

Email: instructor complete prior to training

Questions

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