HomeMy WebLinkAbout8224RESOLUTION NO 8224
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF REDLANDS
ADOPTING A CONTRACTOR SAFETY PROGRAM AND RESCINDING
RESOLUTION NO 7766
WHEREAS, California Labor Code sections 6400, 6401, and 6401 7, and 6402 through 6404,
and Title 8, California Code of Regulations, sections 336 10 and 336 11, require employers to
develop, implement, and maintain a comprehensive safety program, and
WHEREAS, City staff has reviewed the proposed City of Redlands Contractor Safety
Program ("Program"), and has determined that the Program is in compliance with current Cal/OSHA
standards, and
WHEREAS, the Program establishes policies and procedures in accordance with the
California Labor Code that will be applicable to contractors performing work on City -owned property
and City -owned facilities, and
WHEREAS, in accordance with California Public Contract Code section 20101, the Program
also establishes a safety prequalification process for prospective bidders for City pubhc work projects,
and
WHEREAS, if approved, Program reviews will be conducted annually by City staff, with any
recommended changes to the Program being brought to the City Council for consideration,
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
REDLANDS AS FOLLOWS
Sectionl The City Council hereby adopts the City of Redlands Contractor Safety
program, in the form attached hereto as Exhibit "A "
Section 2 Resolution No 7766 is hereby rescinded
ADOPTED, SIGNED AND APPROVED this 15t day of Jung. 2021
Paul T Banch, Mayor
ATTEST
Donaldson, City Clerk
1
I \Resolutions\Res 8200 8299\8224 Contractor Safety Program Rescindmg 7766 docx I \Resolutions\Res 8200-8299\8224 Contractor Safety Program
Rescinding 7766.docx
I, Jeanne Donaldson, City Clerk of the City of Redlands, hereby certify that the foregoing resolution
was duly adopted by the City Council at a regular meeting thereof held on the 15th day of June,
2021
AYES Councilmembers Tejeda, Davis, Guzman -Lowry, Mayor Banch
NOES None
ABSENT Councilmember Foster
ABSTAINED None
Donaldson, City Clerk
2
I \Resolutions\Res 8200-8299\8224 Contractor Safety Program Rescinding 7766.docx I \Resolutions\Res 8200 8299\8224 Contractor Safety Program
Rescinding 7766.docx
THE CITY OF REDLANDS
CONTRACTOR SAFETY
PROGRAM
Rev June 15, 2021
TABLE OF CONTENTS
I POLICY
II AUTHORITY
III SCOPE
IV DEFINITIONS
V RESPONSIBILITIES
RISK MANAGEMENT
PROJECT MANAGER (CITY)
INSPECTOR (CITY)
EMPLOYEES (CITY)
CONTRACTOR.
PROJECT SAFETY OFFICIAL.
VI PROGRAM
.3
.3
.3
.3
.4
4
5
5
5
5
6
.6
SAFETY PREQUALIFICATION QUESTIONNAIRE. 6
APPEAL PROCESS. 7
CONSTRUCTION PROJECTS (TIER I AND TIER II) .8
INSPECTIONS. 9
TRAINING/DOCUMENTATION 9
NON-COMPLIANCE 9
CITY PERSONNEL. 9
VII RECORDKEEPING 10
VIII ADDITIONAL REFERENCES 10
ACKNOWLEDGMENT OF RECEIPT (A) 11
SAFETY PREQUALIFICATION QUESTIONNAIRE (B) 12
NOTICE OF NONCOMPLIANCE (C) 13
JOB HAZARD ANALYSIS (D) 14
INCIDENT INVESTIGATION FORM (E) 15
at Zia}
CONTRACTOR SAFETY PROGRAM
I Policy
The purpose of this Contractor Safety Program ("CSP") is to ensure, as best as reasonably possible, the
protection and safety of all persons and property during construction activities undertaken by private
contractors on behalf of the City of Redlands ("City") The City has a comprehensive and structured
approach in outsourcing services performed on City facilities by third -party persons and entities
("Contractor(s)") The first phase of this comprehensive approach includes actively screening Contractors
based on safety records, safety performance, and safety compliance After the qualified Contractor is
awarded a contract, the Contractor must then ensure compliance with all local, state, federal and
Cal/OSHA regulations applicable to the contracted scope of work, and requirements set forth within this
CSP The Contractor, its agents, and personnel must adhere to the policies and procedures set forth by
this CSP and all applicable laws and regulations
II Authority
California Code of Regulations, Title 8, Section 336.10 "Determination of Citable Employer"
California Code of Regulations, Title 8
"Greenbook" Standard Specifications for Public Works Construction
Redlands Municipal Code
California Building Code
III Scope
This CSP applies to all Contractors who provide or render construction or improvement services for City -
owned property and facilities.
The Contractor services covered under this CSP include, but are not limited to, the following:
A. New construction,
B. Remodeling;
C. Facility maintenance or repair;
D Equipment installation or maintenance, and
E. Services (i e janitorial, fleet operations, landscaping, etc.)
Consultants/ Professional service providers are exempt from having to submit a Safety Prequalification
Questionnaire ("SPQ"), prior to the beginning of work, but they are expected to be compliant with industry
best practices with regards to maintaining a safe work environment for their employees and others
IV Definitions
A. Contract — any written agreement between the City of Redlands and a Contractor, to perform a
specified scope of work on City facilities. With respect to this policy, a contract includes, but is not
limited to awarded purchase orders, bids, and/ or project contracts.
B. Construction Work — construction, alteration, and/or repair, including painting and decorating.
C. Contractor— a person or entity (including all personnel) awarded a contract to perform work on
City property or facilities.
D D.A.R.T Rate — Injuries and illnesses severe enough to warrant Days Away, Restrictions and
Transfers. The DART rate is calculated using the following formula Number of OSHA
Recordable injuries and illnesses that resulted in DaysAwayx200,000/divided by total hours
worked by all employees during the year covered.
3
E Designated Work Area — an area where it is necessary to restrict or limit entry or access of
nonessential personnel or the public. Examples include work areas involving remediation
abatement, demolition, excavation, and overhead lifting.
F Facilities — any building or property owned by the City of Redlands.
G Hazard — source or situation with a potential for harm in terms of injury or health, damage to
property, damage to workplace environment, or a combination ofthese
H Job Hazard Analysis ("JHA") — a technique that focuses on job tasks as a way to identify hazards
before they occur It focuses on the relationship between the worker, the task, the tools, and the
work environment. The objective is to eliminate the risk or to utilize control measures to reduce
the risk.
I North American Industry Classification System ("NAICS") — is the standard used by Federal
statistical agencies in classifying business establishments for the purpose of collecting, analyzing,
and publishing statistical data related to the U.S. business economy
J Non-compliance — any deviation from standards, practices, processes, procedures, regulations etc.
that could either directly or indirectly lead to injury or illness, property damage, damage to the
workplace environment, or any combination of these criteria
I<. Notice of non-compliance — form provided to the Contractor by the City alerting the contractor
of non-compliance with City specifications, Cal/OSHA regulations, or any other generally accepted
safe work practice.
L. Non -compliant hazardous work condition — any hazard that is considered to be non -compliant
with State or Federal safety and health regulations, City specifications, or any inconsistency with
generally accepted work practices
M Personnel — all Contractor employees, contractors, sub -contractors and agents providedaccess to
City property or facilities.
N Recordable Incident — any injury or illness resulting in death, days away from work, restricted
work or transfer to another job, medical treatment beyond first aid, or loss of consciousness per
OSHA Section 1904 7(a)
0 Safety Tailgate — informal safety meeting generally conducted at the job site prior to the
commencement of a job or work shift.
P Services — any and all, labor, duties, functions and activities required to be performed by the
Contractor under the contract and any subsequent addenda
V Responsibilities
RISK MANAGEMENT
A. Update, maintain, and administer this CSP,
B. Maintain centralized records of training, site visit data, written programs, tailgate meetings, permits, and
all other necessary contractor related documentation,
C. Provide technical assistance to Engineering personnel,
D Attend Pre -construction meetings and progress meetings as needed,
E Provide assistance on safety inspections as needed,
F Review safety submittals,
G Provide guidance on pre -qualification determination, and
H Provide training to affected city personnel with responsibilities under this program
4
PROJECT MANAGER (CITY)
The Project Manager has the authority to delegate any or all portions of this CSP to subordinates, but the Project
Manager will be held accountable for their compliance. The Project Manager shall contact Risk Management, as
necessary, for assistance in relation to this CSP
A. Ensure safety hazards are addressed in a timely manner;
B Communicate safety concerns during pre -construction meetings and progress meetings,
C. Inform impacted employees of construction activities scheduled in their workarea,
D Enforce pre -qualification procedures in bidding process, and
E. Ensure this CSP is properly executed
INSPECTOR (CITY)
The City of Redlands construction inspector is not a safety professional and will only provide "Notice of Non -
Compliance" for obvious and serious non -compliant conditions.
A. To the best of their abilities, inspect work sites for safety hazards,
B. Communicate safety concerns to Contractor;
C. Provide Contractor with "Notice of Non -Compliance" when serious conditions occur or repeatviolations,
D Collect documentation needed for construction worksites,
E Submit documentation to Risk Management forrecordkeeping;
F Maintain photo documentation of safety hazards,
G Never enter situations that can harm or endanger himself/ herself;
H Never use personal protective equipment (PPE) or enter situations, which they are not trainedfor;
I Contact Emergency Medical Services (911) and Risk Management in case of emergency,and
J Attend and communicate safety concerns in progress meetings
EMPLOYEES (CITY)
A. Immediately notify the Project Manager, inspector, or Risk Management of any safety related concerns
at a Contractor job site, and
B. Contact Emergency Medical Services (911) and Risk Management in case ofemergency
CONTRACTOR
Where relevant and applicable, the Contractor's responsibilities shall include
A. Compliance with requirements and responsibilities detailed within the Contractor Safety Program,
B Ensure all local regulatory requirements are met and all necessary permits are obtained before conducting
work on behalf of the City;
C. Designate a Project Safety Official by name who shall be available at all times to abate safety hazards,
D Ensure all personnel have the appropriate qualifications and training to perform the contracted work
(Copies of current training documentation and certifications must be on file with theCity),
E Inform City Project Manager or inspector of any job site safety hazards orconcerns,
F Inform City Project Manager if any suspected asbestos -containing material is located,
G Conduct and submit Job Hazard Analysis (JHA) before work and as required by change of tasks,
H Conduct and submit Safety Tailgates on a bi-weekly basis,
I Provide all required PPE necessary to conduct work safely and in accordance with required local
regulations,
J The safety of all individuals who enter work site,
K. Spill cleanup,
L. Immediately report any incidents, accidents, near misses, unsafe conditions, or unsafe acts involving any
jobsite personnel,
5
M Arrange for the proper storage and removal of waste generated prior to the completion of job, and provide
confirmation that the materials have been removed or disposed of in a manner compliant with all
applicable environmental regulations,
N Removing all equipment used during work activities and ensuring proper housekeeping of designated
work area at the end of each workday and upon completion of the job;
O Contact Emergency Services (911) and Project Manager in the event of an emergency; and
P For the actions of their subcontractors, as they may pertain to this CSP, including their adherence to its
contents and review of this document.
PROJECT SAFETY OFFICIAL (CONTRACTOR)
A. Shall be at the work site at all times,
B Must be thoroughly familiar with the Contractor's Injury and Illness Prevention Program (IIPP) and Code of
Safe Practices,
C. Shall be available at all times to abate any potential safety hazards, and
D Shall have the authority and responsibility to shut down an unsafe operation, ifnecessary
VI Program
SAFETY PREQUALIFICATION PROCESS
A. The safety prequalification process is intended to
• Provide the City with knowledge of past and current safety performance of Contractors working on
City construction projects,
• Improve Contractor compliance with City safety rules, including safe work practices required by
applicable regulations and laws, and
• Improve safety during Contractor activities.
B. A copy of the SPQ shall be provided to each person or entity bidding on a project, as part of the bidding
process.
C. The completed questionnaire shall be returned and reviewed prior to awarding contract work, with
supporting information provided as indicated by responses on questionnaire
D The SPQ shall be submitted to 35 Cajon St., Suite 4
Redlands Ca, 92373
Attention Project Name -Contractor Name-SPQ
E The following criteria and information relating to the Contractor will be reviewed prior to awarding
contract.
• Contractor License,
• Incident Rates,
• OSHA Citations,
• Safety Policies,
• Safety Programs and Procedures,
• Compliance History on City Projects, and
• Certification Statement.
F Contractor must qualify in each section to be approved for award of a contract.
G If a Contractor fails to pass prequalification procedure, the City has the right to disqualify the Contractor's
proposal.
H All costs associated with compliance with City of Redlands prequalification requirements shall be at the
sole expense of the Contractor
I If a Contractor provides information that is later determined to be false, or improperly withholds
information, the Contractor will be immediately disqualified.
J Any questions or information relating to filing this questionnaire may be answered by reaching:
• Engineering (909) 798-7698, or
• Risk Management• (909) 798-7514
DISQUALIFICATION APPEAL PROCESS
This provision is established pursuant to Public Contract Code section 20101(d) which requires every public agency
that requires prospective bidders to prequalify pursuant to the law to establish "a process that will allow prospective
bidders to dispute their proposed prequalification rating prior to selection of an alternate bidder " lithe City intends
to disqualify a bidder based upon the bidder's safety record, the City will notify the bidder in writing and provide
the bidder with any supporting evidence that has been received from others or adduced as a result of an
investigation by the City The notice of intention shall be sent by certified mail with return receipt requested or by
overnight mail via a delivery service that provides online tracking which identifies the date of the prospective
bidder's receipt of the notice, and shall include notice that the bidder has the right to, and may request a hearing
to rebut any evidence used as a basis for disqualification and to present evidence to the City as to why the
prospective bidder should be found qualified Requests for a hearing must be made by written request to the City
within ten calendar days of the date of the prospective bidder's receipt of the City's notice of intention If the bidder
does not request a hearing within the time allowed, the City's determination shall stand unchallenged and become
final
Within seven calendar days of receiving the bidder's request for a hearing, the City shall notify the bidder in writing
of the date, time and place of the hearing. The hearing shall be held no sooner than ten (10) calendar days and no
later than fifteen (15) calendar days after the notice is given The notice shall inform the bidder of its right to present
testimony and documents in support of its position
The hearing shall be conducted before the Redlands City Manager, which may be continued from time to time as
reasonably determined by the City Manager, but shall not exceed forty five (45) days. At the conclusion of the
hearing, and after considering all testimony and documentation presented, the City Manager shall issue a written
decision no later than five calendar days following the hearing. The City Manager's decision shall be final and is not
subject to further appeal to the City
The bidder shall not be entitled to bid on any contracts with the City until it has met the safety pre -qualification
standards If the City Manager approves an appeal, the contractor will have been deemed to meet the qualification
standards and it will be valid for one year The bidder shall have the right to withdraw its application for
prequalification or its appeal at any time before the City Manager's decision becomes final Such withdrawal will
not preclude the bidder from re -applying for prequalification
CONSTRUCTION PROJECTS
A. After a contract is awarded, the Contractor shall maintain, throughout the duration of the project, safety
measures as necessary to protect the public and workers within, or in the vicinity of, the designated work
zone This includes an evaluation of the work to be performed and the hazards likely to be encountered.
Contractors are expected to follow, at a minimum, all pertinent laws, rules and regulations for the location
in which they will be working. Where applicable, Contractor Safety Programs will meet or exceed City
programs/ procedures and are subject to review and approval by the City prior to contract execution
7
B Job Hazard Analysis ("JHA")
1. Prior to a notice to proceed a JHA must be completed utilizing the City's form, or equivalent, to
assess the hazards present in the designated work area Any information requested on the City's
form, but not stated on the equivalent form utilized, shall be provided separately with the original
submission
2. All members of the construction unit must sign the JHA to acknowledge hazard abatement
procedures.
3 JHA must be kept at job site accessible to all impacted personnel.
4 Failure to follow JHA procedures may lead to termination of the contract.
C. Personal Protective Equipment ("PPE")
1. All required PPE must be worn at all times during work activities.
2 All mandatory PPE must be highlighted in theJHA.
3 PPE shall be provided by the Contractor
4 Failure to follow PPE guidelines may lead to termination of the contract.
D Safety Tailgates
1. Safety Tailgate Meetings must be held on a biweekly basis for all construction projects.
2. The first meeting shall take place on Day 1, Week 1 and every other weekthereafter
3 Tailgates shall be signed by all personnel and submitted to Construction Inspector for
recordkeeping.
4 Tailgate topics should be specific to the scope of work of the project.
E Injury Reporting
1. Contractors shall immediately report injuries or accidents to the Project Manager (regardless of
severity) Additionally, contractors are responsible for and must also conduct accident
investigations of any injuries that occur on site and provide results to the Project Manager
2. Use the City Incident Investigation Form (Attachment E), or equivalent, to meetthis requirement.
F Spill Prevention
1. The Contractor is responsible for any spill within the confines of the project and those outside of
the construction limits caused by the Contractor's defective equipment, containers, or personnel.
2. Secondary spill containment systems shall be used to prevent contamination of theenvironment.
G Construction in Occupied Buildings
1. When building occupants are present during construction projects additional safeguards must be
implemented to eliminate exposures and complaints. Dust/ particulates from demolition, sanding
and other construction activities must be controlled by adequate ventilation, or containment and
negative air ventilation systems based upon the specific type of activity and particle Similar controls
must be utilized for odorous activities including, but not limited to, carpet adhesive, painting,
welding, and coatings.
2. The Contractor shall ensure that the HVAC system is protected in order to prevent contamination.
If an HVAC system is unprotected and contaminated by any construction/demolition materials, the
Contractor shall be held responsible for the cost of cleaning the system and any subsequent repairs
therein
3 Negative air ventilation systems shall have appropriate filtration and be exhausted outside of the
building.
INSPECTIONS
A. Follow up inspections will be executed to enforce compliance with safety and health requirements.
B Follow up inspections will be conducted as part of routine site inspections by construction inspector and
Risk Management employees.
C.
The SPQ aims to provide the City with knowledge of Contractor safety history and safety practices This
minimizes the need for increased frequency of inspections. In addition, the City will take the following
guidelines into consideration when determining frequency of inspections.
1. Scale of project,
2. The frequency with which the number and types of hazards change as the work progresses,
3 More frequent inspections will be implemented in the beginning of the project; and
4 When the Contractor has never worked for the City
TRAINING/DOCUMENTATION
A. Contractor will ensure that all personnel are properly trained for the scope of work they are assigned, as
well as the equipment they will be utilizing.
B. Documentation shall be on file with the City prior to projectstart.
C. Personnel missing training documentation shall not be permitted to work on awarded City projects.
D Training requirements are mandated by Federal and State Regulations. This may include, but is not
limited, to the programs listed in the SPQ.
NON-COMPLIANCE
A. Contractor compliance issues shall be documented on the "Notice of Non -Compliance" form A copy of
this form shall be provided to Contractor for completion
B. Upon receipt of the completed "Notice of Non -Compliance" form, the Project Manager and Risk
Management will evaluate, based on the incident, and identify, as appropriate, any additional corrective
and/or preventive actions for completion
C. If immediate correction is not feasible, the project will be temporarily stopped until the issue is adequately
resolved
D City staff with authority to stop work are
1. Construction Inspector;
2. City Project Manager;
3 City Manager; and
4 Risk Management staff
E. Any violation or deviation from safety rules, procedures, or regulations, based on evaluation, may be
subject to any and all disciplinary actions listed asfollows
1. Verbal warning
2. Written warning -Notice of Non -Compliance (work may not continue until approved corrections are
implemented),
3 Dismissal of non -complying personnel, and/or
4 Termination of Contract.
The City of Redlands maintains the right to terminate any contract for the violation of safety
issues without liability to the City
CITY PERSONNEL
A. All affected City employees will be informed in advance of any construction related work or other contract
work which has the potential for impacting their workplace Notifications will be made to all affected
employees via e-mail or written memo by the Project Manager or designee Notifications must include the
following information
1. Start and end dates of the work to be completed,
2. Work areas to be affected,
3 Description of work to be completed, �� .,... ,.w_......,.> . _w...��
4 Name and phone number of Project Manager;
5 Name and phone number of Construction Inspector; and
6. Name and phone number of Risk Management.
B Employees should be instructed to notify Project Manager regarding logistical issues or other concerns.
Safety and Health concerns should be directed to either the Project Manager, Inspector, or Safety
Specialist.
VII Recordkeeping
The City's Human Resources / Risk Management Department will maintain all records prepared in
association with this CSP, with copies also place on file with the office of the City Clerk.
VIII Additional References
https.//www.dir.ca.gov/title8/336 10. htm l
Attachment A
City of Redlands
Acknowledgment of Receipt Statement
I acknowledge by signing this document, that I have received and reviewed the City of Redlands'
Contractor Safety Program and understand that it contains important information on the City's policies
and procedures regarding employee safety as it pertains to Contractor activities Furthermore,
acknowledge that failure to comply with any of these procedures may lead to termination of the
contract with the City
Contractor Signature Contractor Title
Contractor Name (Print) Date Signed
If you have any questions regarding this document, please contact the
Risk Management Division at (909) 798-7514
11
Attachment B
CITY OF REDLANDS
SAFETY PREQUALIFICATION QUESTIONNAIRE
Omitting or reporting false information on this questionnaire may result in disqualification of bid.
The City of Redlands reserves the right to conduct random or for -cause audits of information stated
in this questionnaire If deemed necessary, additional documentation may be requested by the City
to verify responses on this questionnaire
SECTION 1- GENERAL INFORMATION
Company Name
Contractor License #
Expiration Date
Address
City
State
Zip Code
Name of Person Submitting Application
Title
Telephone #
Email Address
Identify the highest ranking Safety/Health Professional in your Company
Name
Title
Telephone #
12
SECTION 2 — INCIDENT RATES & WORKER'S COMPENSATION INFORMATION
INCIDENT RATES
Provide your actual injury and illness data below•
Provide the NAICS Code Number that best represents
your Firm
Provide any additional numbers here
(Provide three tull years of data)
Last Calendar
2 Years Ago
3 Years Ago
Number of hours worked by all employees
Total Recordable Incident Rate*
DART Rate*
Total Number of Fatalities
Incident Rate = [(Total Recordable Cases X 200,000 hours)/ Number of hours worked by all employees]
D.A R T Rate = [(Total Number of entries for Days Away, Restricted and Job Transfer X 200,000 hours)/ Number of
hours worked by all employees]
If your latest incident rates and DART rates are greater than 100% of the industry average for all your NAICS code
Numbers Listed, your bid may be disqualified
The industry average can be found at www bls gov
WORKERS' COMPENSATION INFORMATION
1 Provide your Workers' Compensation Experience Modification Rate (EMR) Data.
Policy Year
EMR
* If your current EMR is greater than 1 25, initialing here certifies that you will provide a
competent, full time person or representative responsible for safety for all City
projects.
Current EMR*
* Initialing here certifies that your firm does not have an EMR.
1 Year Ago
(Submit a copy of your firms Loss Run Reports for the last three years if your firm does
not have an EMR )
Name of your firm s Workers Compensation carrier
Phone Number of Workers Compensation carrier
2 Years Ago
3 Years Ago
2 Is your firm self -insured for Workers' Compensation claims?
Yes ❑
No ❑
(If yes, please attach a copy of the latest Annual Report to the State of California Department of Industrial Relations
and/or State of California Certificate of Self -Insurance )
SECTION 3— CITATION HISTORY
1 Has your firm received any regulatory citations in the last three years?
Yes ❑
No ❑
If yes, please answer the question below
13
2 Were any of the confirmed (Closed) citations classified as Serious, Willful, Repeat, or Failure to
abate?
Yes ❑
No ❑
3 If yes, please explain
4 Have you abated all of the citations issued to you in the last threeyears
Yes ❑
No ❑
If no, please explain abatement action plan
SECTION 4 - SAFETY POLICIES
Questions (Please check YES or NO)
YES
NO*
1
Does your company provide and adhere to a written Illness Prevention Program (IIPP) (CCR Title 8
§3203(a))? If yes, a copy of the program will be required on hand at the job site throughout the duration of
the contract Please attach a copy to your bid proposal
❑
❑
2
Does your company provide and conduct Tailgate Meetings, or equivalent with employees at least every 10
working days (CCR Title 8 §1509(e))
❑
❑
3
Does your company have a policy for disciplinary action for unsafe behavior ensuring employee compliance
with safe and healthy work practices? (CCR Title 8 §3203(a)(2))
❑
❑
4
Does your company provide and abide by a written Code of Safe Practices that relates to your firm's
operations (CCR Title 8 §1509(b)) If yes, a copy of the Code of Safe Practices will be required on -hand at
the job site throughout the duration of the contract Please attach a copy with your bid proposal
❑
❑
5
Does your company perform JHAs? (CCR Title 8 §1511(b)
❑
❑
6
Does your company provide training and retraining programs for ensuring employee compliance with safe
and healthy work practices? (CCR Title 8 §3203 (a)(2), (a)(7)
❑
❑
7
Does your company provide training and retraining programs for ensuring employee compliance
❑
❑
*Please provide reason(s) for NO answer in the box below or on a separate sheet of paper
Failure to provide the above referenced documents will result in the contractor's bid being disqualified
SECTION 5 - SAFETY PROGRAMS AND PROCEDURES
PLEASE ANSWER ALL QUESTIONS BY CHECKING YES OR NO, AND ATTACHING
APPROPRIATE DOCUMENTS THAT MAY APPLY OR AS REQUESTED
14
YES
NO
1
Is Confined Space work anticipated in the scope of the work awarded? (If no, please proceed to
Question 2)
❑
❑
If yes, please attach the following
Attached?
Copy of written Confined Space Entry Procedure
❑
❑
List of personnel authorized on jobsite to work in confined space(s)
❑
❑
List of personnel authorized on jobsite to serve as Rescue Team
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
2
Is work requiring Lockout/Tagout protocols anticipated in the scope of the work awarded? (If no,
please proceed to Question 3)
❑
❑
If yes, please attach the following
Attached?
Copy of written Lockout/Tagout (LOTO) Procedure
❑
❑
List of personnel authorized on jobsite to perform LOTO
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
3
Is work requiring a personal lift anticipated in the scope of the work awarded? (If no, please proceed
to Question 4)
❑
❑
If yes, please attach the following
Attached?
List of personnel authorized on jobsite to use lifts
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
4
Is work requiring a forklift anticipated in the scope of the work awarded? (If no, please proceed to
Question 5)
❑
❑
If yes, please attach the following
Attached?
List of personnel authorized on jobsite to use a forklift
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
5
Is work requiring a crane anticipated in the scope of the work awarded? (If no, please proceed to
Question 6)
❑
❑
If yes, please attach the following
Attached?
Copy of written Crane Program
❑
❑
Copy of all expected Crane operators' Certifications
❑
❑
List of personnel designated as Competent under Crane program
❑
❑
Verification of personnel training (copies of certs cards, etc )
❑
❑
NOTE If awarded bid, more documentation may be required
15
6.
Is Hot Work (as defined by OSHA) anticipated in the scope of the work awarded?
(If no, please proceed to Question 7)
❑
❑
If yes, please attach the following:
Attached?
Copy of written Hot Work Procedure
List of personnel authorized on jobsite to perform Hot Work
Verification of personnel training (copies of certs, cards, etc.)
7
Is Trenching/ Excavation work anticipated in the scope of the work awarded? (If no, proceed to
Question 8)
Is a plan in place for the disposal of all material that cannot be returned to the trench/ excavation?
Are appropriate materials for barricading or securing work area at jobsite?
❑
Has a permit from the Department of Industrial Relations for excavations deeper than 5 feet been
obtained?
If yes, please attach the following:
Attached?
Copy of written Trenching/ Excavation Procedure
❑
Copy of Permit if trench is to exceed depth of 5 feet
List of personnel designated as Competent under Trenching/ Excavation Program
Verification of personnel training (copies of certs, cards, etc.)
NOTE If awarded bid, more documentation may be required
8.
Is electrical work anticipated in the scope of the work awarded? (If no, proceed to Question 9)
If yes, please attach the following:
Attached?
Copy of written Electrical Safety Program
®
❑
List of personnel designated as Competent under Electrical Safety Program
❑
❑
Verification of personnel training (copies of certs, cards, etc.)
❑
9.
Is work that may have an arc flash potential anticipated in the scope of the work awarded? (If no,
proceed to Question 10)
❑
Are all materials required to safely perform arc flash present?
If yes, please attach the following:
Attached?
Copy of Arc Flash Procedure
List of personnel designated as Competent under Arc Flash Program
Verification of personnel training (copies of certs, cards, etc.)
16
10
Is work involving chemicals anticipated in the scope of the work awarded? (If no, proceed to
Question 11)?
❑
If yes, please attach the following
Attached?
Copy of written Hearing Conservation Program
❑
❑
List of personnel working in high noise areas
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
11
Is work involving chemicals anticipated in the scope of the work awarded? (If no, proceed to
Question 12)?
❑
❑
* Copies of SDS for Chemicals used must be kept at jobsite
Please attach the following
Attached?
Copy of written Hazard Communication Program
❑
❑
List of personnel performing work with chemicals
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
List trade names of all hazardous materials which you will be using on site
12
Is work on or adjacent to public roadways anticipated in the scope of the work awarded (If no,
proceed to Question 13)
❑
❑
Do you have the appropriate provisions (signs, devices, barricades/)
❑
❑
Please attach the following
Attached?
Please provide a list of personnel working in traffic areas
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
NOTE If awarded bid, more documentation may be required
13.
Is it anticipated in the scope of the work awarded that exposure to asbestos is possible? (If no,
proceed to Question 14)
❑
❑
Please attach the following
Attached?
Copy of written procedure(s)
❑
❑
List of personnel working with potential exposure to asbestos
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
17
14
Is it anticipated in the scope of the work awarded that exposure to silica is possible? (i e
sandblasting, concrete demolition, concrete saw cutting, surface grinding, etc ) (If no, proceed to
Question 15)
❑
❑
Please attach the following
Attached?
Copy of Silica Control Plan
❑
❑
List of personnel working with potential exposure to silica
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
15
Is work at heights anticipated in the scope of the work awarded? (If no, proceed to Question 16)
❑
❑
Please attach the following
Attached?
Copy of written Fall Protection Program
❑
❑
List of personnel designated as Competent under Fall Protection Program
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
16
Is work requiring the use of respirators anticipated in the scope of the work awarded? (If no,
proceed to Question 17)
❑
❑
Please attach the following
Attached?
Copy of written Respiratory Protection Program
❑
❑
List of personnel using respirators
❑
❑
Verification of personnel training (copies of certs, cards, etc )
❑
❑
17
If the scope of work to be performed is not adequately represented by questions (1 16), please list any additional Health
& Safety concerns below
SECTION 6 - COMPLIANCE HISTORY ON CITY PROJECTS
In addition to the previous sections, Contractors that have previously been awarded work by the City, will be
equally evaluated on their compliance history in relation to City projects
18
SECTION 7 - CERTIFICATION STATEMENT
I Certify under penalty of perjury that
a the information contained herein is true and correct to the best of my knowledge,and
b no attempt has been made to give false or misleading information or to withhold any information
Signature of Authorized Representative
Title of Authorized Representative
Printed Name of Authorized Representative
Date Signed
19
Attachment C
NOTICE OF NON-COMPLIANCE
Project
Contractor•
Notice of Non -Compliance was issued to Contractor's representative,
Name
on at
The following unsafe behaviors were observed at the Contractor's job site
If the unsafe condition is not immediately corrected, the City of Redlands may take disciplinary action
in accordance with the Contractor Safety Program guidelines.
To be completed by Contractor
Corrective action plan to abate hazards
Unsafe Condition Resolved Date Time
Remarks
20
1144
Job Hazard Analysis
Attachment D
Project
Company•
Project Safety Official
Project Manager (City)
Scope of Work
Location
Date
Tasks
Potential Safety
Risks/Hazards
Safety
Controls/Mitigat
Required PPE
❑ Hard Hat
❑ Safety Vest
❑ Safety Glasses/Goggles
❑ Safety Boots
❑ Respirator
❑ Safety Gloves
❑ Face Shield
❑ Fall Protection
❑ Other•
Signatures of Employees On -Site this JHA is applicable to
Employee Signature
Print Name
Date
21
INCIDENT INVESTIGATION FORM
Attachment E
Date of Incident:
Time of Incident
Date Reported
Lead Investigator•
Contact Information
Contractor•
Employee Name
Witness 1 Name
Telephone
Witness 2 Name
Telephone
Incident Site/ Location
Incident Summary•
Near Miss Yes
No
Incident Severity•
Minor Significant Major
Critical
Root Cause(s)
Corrective Actions
22