A21 - Enclosure 2 - LHE Form16-1 Certificate of Compliance.pdf

Form 16-1

FORM 16-1

Certificate of Compliance for LHE and Rigging

This form is applicable to all Contractor Load Handling Equipment (LHE) and Rigging Gear being brought onto the project site and applies to all cranes, derricks and any other hoisting equipment used to lift suspended loads.

This certificate shall be signed by an official of the company that provides LHE/cranes and rigging gear for any application under this contract.

Contracting Officer’s Point of Contact:

(Government Designated Representative)

Phone #:

Prime Contractor/Phone #: Contract Number:

SSHO/QC: Phone #:

LHE Manufacturer/Type/Capacity:

LHE Operator(s) Name(s):

I certify that:

1. The above noted LHE and all rigging gear conform to the EM 385-1-1, applicable OSHA regulations (host country regulations in foreign countries) and applicable ASME standards.

2. The operator(s) noted above has been trained, qualified and designated in accordance with the requirements in Section 16, EM 385-1-1 for the operation of the above noted LHE.

3. The operator(s) noted above has been trained not to bypass safety devices during LHE operations.

4. The operator(s), rigger(s) and company official (staff) are aware that immediate notification to the GDA of any incident or accident involving this equipment is required.

Company Official Signature: Date:

Company Official Name/Title:

Post on Crane/LHE (In Cab and Contractor’s Office for each piece of LHE brought onto USACE Project/Property)