Worker Protection Form-BOP-2201_ (002).pdf
PDF 165 KB Posted
- Attached to
- Bureau of Geological Survey Sonic Drilling
- Solicitation number
- 6100066669
- Issued by
- Dauphin County, Pennsylvania
About this file
This is a Worker Protection Form submitted to the Pennsylvania Department of Conservation and Natural Resources (DCNR), Bureau of Geologic Survey (BGS), in support of a sonic drilling services contract opportunity. The form documents worker protection requirements and safety protocols that the contractor must implement while providing drilling services to extract intact sediment and bedrock core from the shallow subsurface. The form establishes the baseline safety and worker protection standards that bidders must acknowledge and agree to comply with throughout the contract term, ensuring that all personnel involved in the drilling operations maintain appropriate safety measures and protective equipment as required by state regulations and industry standards.
The Worker Protection Form serves as a compliance document that bidders must complete and submit as part of their proposal package. By submitting this form, contractors acknowledge their understanding of and commitment to adhering to all applicable worker protection regulations, safety requirements, and occupational health standards during the execution of the sonic drilling project. This document is a mandatory component of the bid submission process and must be completed in accordance with Pennsylvania state requirements and DCNR specifications.
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Text version
WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM
A. Pursuant to Executive Order 2021-06, Worker Protection and Investment (October 21, 2021), the Commonwealth is responsible for ensuring that every worker in Pennsylvania has a safe and healthy work environment and the protections afforded them through labor laws. To that end, contractors and grantees of the Commonwealth must certify that they are in compliance with Pennsylvania’s Unemployment Compensation Law, Workers’ Compensation Law, and all applicable Pennsylvania state labor and workforce safety laws including, but not limited to:
1. Construction Workplace Misclassification Act
2. Employment of Minors Child Labor Act
3. Minimum Wage Act
4. Prevailing Wage Act
5. Equal Pay Law
6. Employer to Pay Employment Medical Examination Fee Act
7. Seasonal Farm Labor Act
8. Wage Payment and Collection Law
9. Industrial Homework Law
10. Construction Industry Employee Verification Act
11. Act 102: Prohibition on Excessive Overtime in Healthcare
12. Apprenticeship and Training Act
13. Inspection of Employment Records Law
B. Pennsylvania law establishes penalties for providing false certifications, including contract termination; and three-year ineligibility to bid on contracts under 62 Pa. C.S. § 531 (Debarment or suspension).
CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the contractor/grantee identified below, and certify that the contractor/grantee identified below is compliant with applicable Pennsylvania state labor and workplace safety laws, including, but not limited to, those listed in Paragraph A, above. I understand that I must report any change in the contractor/grantee’s compliance status to the Purchasing Agency immediately. I further confirm and understand that this Certification is subject to the provisions and penalties of 18 Pa. C.S. § 4904 (Unsworn falsification to authorities).
Signature Date
Name (Printed)
Title of Certifying Official (Printed)
Contractor/Grantee Name (Printed)
BOP-2201
Published: 02/04/2022
| WORKER PROTECTION AND INVESTMENT CERTIFICATION FORM |
| CERTIFICATION |
| Name Printed: |
| Name PrintedRow1: |
| Title of Certifying Official PrintedRow1: |
| Date1_af_date: |
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