Exhibits.pdf

Exhibit A

Exhibit B Sample Forms

Exhibit C Quality Control Plan Sample

Prior to beginning work, each employee will be trained to perform the task he or she has been hired to perform.

This training will consist of a review and thorough explanation of the contract specifications and requirements, followed by ‘on-the-job’ training to ensure that the contract requirements are understood. All members of a crew will be cross-trained, so that they understand all aspects of a particular type of work. Following training, each employee will be provided with a checklist of work that they are required to perform, which will serve to ensure that all aspects of a particular job are completed on time. The employee will mark each item as it is completed (with completion time), and will sign and date each sheet to ensure accountability for completed work.

Prior to start of the contract, the Contractor will designate a Quality Control Inspector (QCI) in writing. The designated QCI will perform inspections of completed work as soon as possible to ensure that the work meets contract specifications. The inspection schedule will depend on the type of work being completed; items of a routine nature will be inspected based on a random or planned sampling schedule. 100% of unusual items, items which are more important, or highly visible items will be inspected.

Allowable reject levels for all items of work will be zero.

Upon discovery of any deficiency, corrective action will be initiated immediately. The QCI will immediately either correct the deficiency personally, direct another employee to correct the deficiency, or direct the employee who marked the item as ‘complete’ to correct the deficiency. The QCI will meet with the employee who was responsible for initial completion of the work and review contract specifications for the work which was inadequately performed.

The QCI will determine what actions caused the inadequate work and take immediate steps to ensure that the work is correctly performed the next time it is scheduled.

A Quality Control Inspection Report will be completed by the QCI for each day’s work. This report will document what work was completed, what facilities were inspected, the time the inspections were performed, and the results of these inspections. This report will also document any deficiencies noted during inspections and corrective actions taken on deficiencies. This report will be provided to the Corps of Engineers the same day the work is scheduled, or the next morning prior to 9:00 a.m. by e-mail, fax, or in person.

If a Contract Discrepancy Report (CDR) is issued by the government, the Contractor will review the CDR with the QCI within one day of receipt of the CDR, and will meet with the Corps of Engineers representative as soon as possible. Prior to meeting with the Corps representative, the Contractor will meet with the QCI and the individual/crew responsible for completing the work to determine the cause of the contract discrepancy and what actions will be required to prevent any reoccurrence. The Contractor will document these actions on the CDR for submittal to the government.

The contractor will modify these procedures as required to ensure that contract specifications are met.

Exhibit D ENG Form 6293 Accident Prevention Plan

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U.S. Army Corps of Engineers (USACE)

ACCIDENT PREVENTION PLAN (APP) WORKSHEET

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

This form serves as a guide. It does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and

Occupational Health Requirements Manual. The references included in this form correspond to the applicable chapters of EM 385-1-1. No work will begin onsite until the accident prevention plan (APP) is developed according to the EM 385-1-1, reviewed to ensure minimum requirements are met, and approved by the appropriate personnel identified in “Part 1 -Signatures”

PART 1 - SIGNATURES

Plan Preparer - For example: Qualified Person (QP), Competent Person (CP), or project Quality Control (QC).

1. Name: 2. Title:

3. Email Address: 4. Phone Number:

5. Signature

Plan Approver - Corporate Safety Official

1. Name: 2. Title:

3. Email Address: 4. Phone Number:

5. Signature

Plan Concurrence - For example: Industrial hygienist, Project Manager, Superintendent, Site Safety & Health Officer, Quality Control, etc.

1. Name: 2. Title:

3. Email Address: 4. Phone Number:

5. Signature:

PART 2: PROJECT INFORMATION

1. Project Name:

2. Project Address (attach map in Appendix 1):

3. Estimated Project Start Date: 4. Estimated Project Completion Date:

PART 3: PRIME CONTRACTOR INFORMATION

1. Prime Contractor Name:

2. Contract Number:

3. Project Manager Name:

4. Quality Control (QC) Manager Name:

5. Contractor Corporate Safety Official Name:

6. Primary Site Safety & Health Officer (SSHO) Name:

7. Alternate Site Safety & Health Officer (SSHO) Name(s):

PART 4: SOH COMMITMENT AND POLICY

1. Provide a statement of safety and health policy detailing commitment to providing a safe and healthful workplace for all employees on this project.

2. Provide a statement outlining the Contractor's safety program goals and objectives.

5. Project Description / Description of work to be performed:

3. Identify policies and procedure regarding non-compliance with safety requirements.

4. Provide written procedures for holding managers and supervisors accountable for safety.

5. Prime contractor is responsible for the implementation and enforcement of the SOH program for contractor employees, subcontractors, suppliers, and visitors at the site of work?

Yes No

6. Prime contractor will require subcontractors, suppliers, and visitors to comply with the APP and EM 385-1-1? Yes No

7. No work will be performed unless a designated SSHO is present on the site of work. Yes No

8. A list of all known subcontractor(s) and supplier(s) are listed in Appendix 2. Yes No

9. If all subcontractor(s) and supplier(s) are not known at the time of initial APP submittal, Appendix 2 will be updated and resubmitted to the KO/COR for acceptance prior to the start of any work activities.

Yes No

10. All subcontractors will have a copy of the APP, applicable AHAs and will be required to comply with them. Yes No

11. Subcontractors and suppliers at the site of work will abide by the EM 385-1-1, this APP, and all AHAs. Yes No

12. This APP and AHAs will be available to all workers at the site of work. Yes No

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PART 5: TRAINING

1. All employees will be trained according to applicable EM 385-1-1, federal, state, and local requirements prior to the commencement of work.

Yes No

2. The following personnel are identified and designated as personnel responsible for SOH on this project. Add the following documentation to Appendix 3 of this worksheet: 1) SSHO designation letter (ENG Form 6282), 2) instructor signed OSHA 30-hour card (or course completion certificate if within 90 days of having completed the OSHA 30-hour training), and 3) proof of 24 hours of competency of SOH training within the last 3 years for the personnel identified below. (EM 385-1-1, Chapter 2, 2-3 Personnel Qualification/Training):

(Check and list names of personnel being designated)

Primary SSHO Name:

Alternate SSHO Name(s):

3. QP(s) and CP(s) required by EM 385-1-1 (for example, excavation, confined space, scaffolding, fall protection, etc.) for this project will be included in

Appendix 3. Include 1) List of names or designation letters and 2) proof of qualification/competency.

PART 6: SOH INSPECTIONS

1. All applicable inspections required by EM 385-1-1, contract, federal, state, and local requirements will be completed. Yes No

2. The following personnel are assigned to conduct inspections, the type of inspection and frequency for the worksite. At minimum the SSHO must conduct daily site inspections.

Who will conduct inspection? Frequency? What type of inspection?

3. Employees that conduct inspections will have technical proficiency needed to perform inspections. Proof of inspector's training/qualification is included in Appendix 3.

Yes No

4. Deficiencies will be documented and tracked as required by this EM 385-1-1? Yes No

6. Will any external inspections be required (for example, USCG, OSHA, etc.)? Yes No If yes, describe:

PART 7: ACCIDENT REPORTING AND INVESTIGATION

1. Exposure data (man-hours worked) will be reported to KO/COR as required by the contract? Yes No

2. All accidents will be reported as soon as possible according to EM 385-1-1? Yes No

3. All accidents occurring incidentally to an operation, project, or facility for which the EM 385-1-1 is applicable will be thoroughly investigated and analyzed. Corrective actions to prevent reoccurrence will be implemented as soon as reasonably possible. The

KO/COR will be notified when corrective actions are completed.

Yes

No

4. Accident notification will be provided to the KO/COR as stated below: Yes No

ACCIDENT TYPE KO/COR NOTIFICATION TIME

Fatality, permanent and partial disability, or property damage over $600,000 Immediately, no later than (NLT) 8 hours

All other accidents and near misses Immediately, NLT 24 hours

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PART 8: SOH OVERSIGHT

1. A risk management process that meets or exceeds the requirement of the EM 385-1-1 will be implemented on this project site? Yes No

2. Hazardous conditions and unsafe acts will be immediately corrected? Yes No

3. APP and AHAs will be prepared by a QP or CP according to the EM 385-1-1 prior to the start of any work activities on the site of work

(as much as the information can be known at that point in time).

Yes No

4. The plans and AHAs will be updated throughout the life of the project to include changes in personnel, equipment, conditions, etc.

Additional revisions must be incorporated as necessary to reflect changing site conditions, construction methods, personnel roles and responsibilities and construction schedules.

Yes

No

5. No activity/work will be started at the site of work until the APP is reviewed and submitted to the KO/COR for acceptance, with the site-specific plans and procedures required by the EM 385-1-1 to complete the project?

Yes No

6. APP and AHAs will be provided to and reviewed by all workers involved in the activity prior to work? Yes No

7. Workers will sign AHA(s) to concur with identified job steps and controls needed to mitigate hazards? Yes No

PART 9: SEVERE WEATHER PLAN

1. The SSHO or designated onsite personnel is responsible for checking the weather conditions at a minimum of twice a day? Yes No

2. What severe weather forecast will require the SSHO to monitor weather conditions continuously? Describe.

3. What are the training requirements for severe weather precautions and actions?

4. Identify area of retreat or other actions to be taken such as evacuation, shelter in place, etc.

5. Identify procedures to stop outdoor activities if extreme weather conditions to include thunderstorms are in the area.

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PART 10: ACTIVITY HAZARD ANALYSIS (RISK MANAGEMENT)

1. Major phases of work anticipated:

2. Definable Features of Work (DFOW)

Note. An activity-specific AHA will be submitted to the KO/COR for each DFOW prior to any work being performed.

3. List equipment to be used:

4. Anticipated High-Risk Activities: (See examples below, check all that apply):

Electrical and/or Hazardous Energy Confined Space

Working at Heights Excavations & Trenching

Scaffolding Other:

Diving Other:

Load Handling Equipment Other:

Occupational Exposure Other:

5. Detailed project-specific hazards and controls will be provided utilizing AHAs for each activity/DFOW. Yes No

6. No work will begin on an activity/DFOW until the initial AHA addressing the project-specific hazards has been developed, reviewed, and accepted by the KO/COR. (See EM 385-1-1 Chapter 2 section 2-6).

Yes No

7. AHAs are living documents and are intended to be created, utilized in the field, and updated (by the workers) as necessary. Yes No

8. Workers/crews will have accepted AHA(s) that reflects current site conditions, personnel, equipment, control measures, etc. while the work is being performed?

Yes No

9. AHA will be used by the contractor personnel to assure work is being performed consistent with the AHA? Yes No

10. Once the activity has been completed, the AHA will be available and kept onsite for the length of the contract. Yes No

11. AHAs for unknown work activities will be submitted to the KO/COR prior to work and attached to Appendix 4 of this document. Yes No

12. Who has the authority to accept residual risk on AHA(s)? (List below)

Category of Risk Approval Authority (Name and Title)

Extremely High Risk

High Risk

Medium Risk

Low Risk

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PART 11: REQUIRED PROJECT SITE-SPECIFIC PLANS AND PROCEDURES

1. Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the contractor will ensure that all applicable SOH risks and associated compliance plans are in place.

Yes No

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

Yes No

3. These plans and procedures will be coordinated with all project employers and be included in project-specific emergency response and evacuation procedures.

Yes No

4. Address each of the plans in the outline below in the order that they are listed.

Option 1: If a plan is applicable, develop and attach it to Appendix 5. Submit to the KO/COR with this worksheet for acceptance prior to work. Option 2:

If a plan is applicable, but all of the minimum required information for the plan is not yet known, provide justification next to each plan title, and provide an expected date the plan will be created, reviewed, and attached to Appendix 5. Submit to the KO/COR with this worksheet for acceptance prior to work.

Option 3: If a plan is not applicable because of the nature of the work to be performed, provide justification next to each plan title.

Minimum plans required by EM 385-1-1

Reference

EM 385-1-1

paragraph:

Select

Option

Justification for Option 2 and Option 3

Exposure Control Plan 3-7.a

AED Program 3-7.b

Construction Site Plan 4-7.a

Access/Haul Road Plan 4-7.b

Hearing Conservation Program 5-7.a

Respiratory Protection Program 5-7.b

Hazard Communication (HazCom) Program 6-7.a

Process Safety Management (PSM) Program 6-7.b

Lead Compliance Plan 6-7.c

Asbestos Management Plan 6-7.d

Ionizing Radiation Safety Plan 6-7.e

Radiofrequency Plan 6-7.e

Abrasive Blasting Plan 6-7.g

Thermal Stress Management Plan 6-7.h

Mold Remediation Plan 6-7.i

Silica Compliance Plan 6-7.j

Fatigue Management Plan 6-7.k

Night Operations Lighting Plan 7-7

Traffic Control Plan 8-7

Fire Prevention Plan 9-7.a

Wildland Fire Management Plan 9-7.b

Housekeeping Plan 10-7

Electrical Safety Plan 11-7

Assured Equipment Grounding Conductor Program 11-7.b

Energy Control Plan 12-7.a

Hazard Isolation Procedures 12-7.b

Demolition Plan 17-7

Emergency Plan for Marine Activities 19-7.a

Severe Weather Plan for Marine Activities 19-7.b

Float Plans 19-7.c

Tow Plans 19-7.d

Fall Protection and Prevention Plan 21-7.a

Rescue Plan 21-7.b

Scaffold Work Plan 21-7.b

Rope Access Work Plan 23-7

Excavation and Trenching Plan 25-7

Fire Prevention and Protection Plan 26-7 a & f

Compressed Air Work Plan 26-7 a & b

Contingency Response Plan 26-7 a & c

Emergency Rescue Plans and Equipment 26-7 a & d

Ventilation and Dust Control Plan 26-7 a & e

Formwork and Shoring Plan 27-7.a

Masonry Bracing Plan 27-7.b

Steel Erection Plan 28-7.a

Site Layout Plan 28-7.b

Explosive Site Safety Plan 29-7.a

Master Blasting Plan 29-7.b

Vibrations Monitoring Plan 29-7.c

Dive Operations Plan 30-7.a & d

Emergency Management Plan 30-7.a & e

Safe Practices Manual 30-7.b

Snorkeling Plan 30-7.f

Tree Maintenance and Removal Plan 31-7

Construction Safety and Phasing Plan 32-7.a

Safety Plan Compliance Document 32-7.b

Aviation Pre-Accident Plan 33-7

Standard Lift Plan 34-7.b

Confined Space Plan 34-7.b & c

Standard Lift Plan - Floating Plan 34-7.c

Critical Lift Plan 34-7.d

Pile Driving 34-7.e

Housekeeping Plan 35-7.a

Extermination Plan 35-7.b

Site Safety and Health Plan 36-7.a

Comprehensive Work Plan 36-7.b

Emergency Response Plan 36-7.c

E

PART 12: PROJECT SITE COORDINATION

1. Provide procedures for coordinating SOH activities with other employers on the site of work:

PART 13: REQUIRED APPENDICES

Indicate if each of the following items are, or are not, attached to this plan.

Appendix 1. Project Map Yes No

Appendix 2. Subcontractor/Suppliers Yes No

Appendix 3. Personal Qualifications and Designations Yes No

Appendix 4. Activity Hazard Analysis Yes No

Appendix 5. Site-specific plans and procedures Yes No

Appendix 6. Any additional plans, procedures, etc. can be added to this appendix and will be coordinated with the KO/COR. Yes No

Exhibit E

Drawings/pictures