3410 Appendix T4

Site Specific Safety Plan Review Checklist

 

 

Written Safety Plan Evaluation

Finding

Project:

Acceptable for Review

Contractor:

Requires Modification

Reviewers/Date:

Missing

Recommendation:

Return to subcontractor for revision

Not Applicable to Contract

 

Submit to ESH for SME review

 

 

Specified  Element

Requirement

Finding

Comment

1.6.C.4.a.

Statement of the subcontractor’s commitment to provide a safe and healthful construction worksite for all employees including subcontractors’ employees and Jefferson Lab personnel

 

 

1.6.C.4.a.(1)

Policy statement concerning substance abuse on the construction site

 

 

1.6.C.4.a.(2)

Signature of a responsible manager of the subcontracting company

 

 

1.6.C.4.b.

Name, title and qualifications of the designated Site Safety and Health Representative and designated alternates

 

 

1.6.C.4.b.(1)

Documented evidence of Off-Site Training for the Site Safety and Health Representative

 

 

1.6.C.4.b.(2)

Description of the inspections performed by this individual (frequency and format for documentation of inspections)

 

 

1.6.C.4.c.

Procedures for coordinating safety and health with lower tier subcontractor's and Jefferson Lab personnel on the construction worksite

 

 

1.6.C.4.d.

Procedures for communicating and coordinating safety and health requirements to non-English speaking subcontractor personnel

 

 

1.6.C.4.e.

The activity hazard analyses required for the project

 

 

1.6.C.4.f.(1)

Description of activity hazard analysis process, including how workers are informed of hazards and protective actions

 

 

1.6.C.4.f.(2)

How workers will acknowledge being provided the information

 

 

1.6.C.f.(3)

A disciplinary process for non-compliance with protective measures identified in the AHA

 

 

1.6.C.4.g.

Identify safety and health training requirements and procedures including but not limited to:

 

 

1.6.C.4.g.(1)

Orientation of new workers prior to beginning work on the construction worksite

 

 

1.6.C.4.g.(2)

Worker acknowledgement of work hazards

 

 

1.6.C.4.g.(3)

Frequency of tool-box safety meetings

 

 

1.6.C.4.g.(4)

Updates or changes on safety practices relevant to the construction worksite, discussions of lessons learned from incidents at the construction worksite and elsewhere.

 

 

1.6.C.4.h.

The Subcontractor’s hazard communication program and the specifics for the construction worksite.

 

 

1.6.C.4.h.

Identification of the activities on the construction worksite that will require employees to be under an occupational medical or exposure-monitoring program.  Upon Jefferson Lab’s request, the Subcontractor shall submit documentation of compliance.

 

 

1.6.C.4.j.

An emergency response plan that sets forth the procedures to be followed upon the occurrence of serious injuries, illnesses, fatalities, fires, structural failures, or other emergencies, including procedures for the administration of first aid and/or other necessary medical treatment. This shall include a list of nearby medical care providers available to the Subcontractor’s employees.

 

 

1.6.C.4.k.

Procedures for recording and reporting safety incidents and maintaining safety and health records in accordance with Occupational Safety and Health Administration (OSHA) requirements and in accordance with Jefferson Lab reporting requirements

 

 

1.6.C.4.k.(1)

Procedures for the investigation of job-related incidents to determine possible cause and corrective action

 

 

1.6.C.4.k.(2)

Specific designation of management persons responsible for review of injury and illness reports

 

 

 

Additional comments to provide subcontractor for subsequent revision:

Recommended Resolution

 

 

 

Form Revision Summary

 

Revision 0.1 – 03/23/19 – Periodic Review; updated TPOC from B.May to B.Rainey

Revision 0.0 – 03/23/16 – New Content

 

 

ISSUING AUTHORITY

FORM TECHNICAL POINT-OF-CONTACT

APPROVAL DATE

REVIEW DATE

REV.

 

 

ES&H Division

Bill Rainey

03/23/19

03/23/22

0.1

 

This document is controlled as an on line file.  It may be printed but the print copy is not a controlled document.  It is the user’s responsibility to ensure that the document is the same revision as the current on line file.  This copy was printed on 3/21/2019.