Safety Manager

Handbook

Table of Contents I. Executive Summary II. A&A Transfer Safety Manager Profile A. Job Description B. Classified Help Wanted Ad C. Credentials of a Safety Professional III. A&A Transfer Safety Manager Duties A. Daily/Weekly Duties B. Monthly/Quarterly Duties C. Long Term/Annual Duties D. Critical Areas of Focus IV. A&A Transfer Overall Assessment V. Safety Program VI. A&A Transfer Suggestions VII. Appendices A. Activity Hazard Analysis (AHA) B. Safety Inspection C. Rigging Inspection D. Forklift Daily Inspection E. Fall Protection Inspection Form F. Orientation Form G. Discipline Notice H. Incident Investigation Forms (WC, GL, Auto) I. First Reports of Incidents J. Post Accident Management Form (Return to Work) K. Hazard Communication Forms and Quiz L. Recordkeeping M. Confined Space Forms N. District of Columbia Licensing O. Driver History Form and MVR Authorization P. Accountability Program

I. EXECUTIVE SUMMARY

A&A Transfer is dedicated to remaining one of the leading providers in the commercial moving and rigging industry. They are committed to a professional environment for employees, customer service and corporate growth. A&A Transfer recognizes the value and role that a well executed Safety Program provides for marketing and impacting the top line as well as its impact to cost containment and the bottom line. The leadership at A&A Transfer has endeavored to establish a culture of safety. As A&A's insurance and risk management consultant and broker, Rutherfoord has conducted a basic assessment of their current safety program to establish a benchmark to move forward. The purpose of this handbook is to provide the foundation for the development of an effective safety and risk management program for A&A Transfer. This handbook will outline procedures starting with hiring of a safety manager, and provide guidance on implementation of daily, weekly and annual functions.

II. A&A TRANSFER SAFETY MANAGER PROFILE A. Job Description of a Safety Manager

The primary function of a safety professional or safety manager is that of management. Management of the safety program is an essential component to having an effective safety program. The safety manager should bring tools and resources to supervision, but not be tasked with being a “safety cop.” A Safety Manager should be given authority and respect otherwise field personnel will not take the Safety Manager seriously.

The Safety Manager should identify deficiencies and find solutions to safety and loss control issues. Some of these issues and solutions will be the safety manager’s responsibility. However, supervisors should be asked to correct many of the problems. This will be very important in regard to building a “culture” where employees/supervision will be self-sufficient in identifying problems and correcting them without a safety manager.

B. Classified Help Wanted Ad Corporate Safety Director

Commercial Mover and Rigging Company in Northern Virginia seeks full, or possibly part time, Safety Director to coordinate all aspects of the company’s safety and health program. Qualified candidates must have at least 5+ years in safety, environmental health, or related field. Excellent written and oral communication skills, good analytical abilities, and a strong interest in the safety and health field are required. Candidate must have prior experience working in construction related fields and have an understanding of cranes, rigging and fleet operations and related safety regulations and standards. Individual must be capable of writing and updating safety and health manual and training employees. Local residents preferred. Salary commensurate with experience. To apply, please send a cover letter with salary requirements and resume to ________or fax to (703) xxx-xxxx. A&A Transfer, Inc. is an Equal Employment Opportunity/ Affirmative Action Employer. Salary: Full Time: $60K to $75K. W/ Vehicle or allowance

Advertise: There are several Safety Organizations where ads can be placed at no charge:

• NOVA American Society of Safety Engineers (ASSE) has a website where companies post positions. (www.nova.asse.org)

• Washington Area Metro Construction Safety Association (WMACSA). They will send out email postings for free. (www.wmacsa.com)

• ABC and AGC Local Chapters have safety committees to provide notification of available positions. (www.abcva.org) (www.agcva.org)

C. Credentials of a Safety Professional

Certifications/Formal Education

• Certified Safety Professional (CSP) or Associated Safety Professional (ASP) are the highest regarded credentials of a safety professional.

• Construction Health and Safety Technician (CHST) is another certification that is

highly regarded.

• OSHA 500 and 501 certifications would be recommended for candidate. These certifications are necessary to teach OSHA 10 and 30 hour training programs. A 30 hour course would be a mandatory for anyone in the safety role.

• Crane and Rigging Training would be recommended as an awareness basis.

• Educational levels vary in the safety profession. There are numerous recognized

safety degree programs. Bachelors of Science in Safety Management or Master’s of Science are becoming more common within industry. However, non-degreed safety professionals are still common and experience is highly regarded.

• Safety Manager should have a thorough understanding for OSHA 1926 Standards

for the construction industry.

• Safety Manager should have a thorough understanding of OSHA Recordkeeping.

III. A&A TRANSFER SAFETY MANAGER DUTIES A. Daily/Weekly Duties

The Safety Manager should be present in the morning when employees are preparing for their daily work. This will assist with communication and provide a better understanding of whether the crews are prepared for their daily work. This will also allow for the Safety Manager to assess the condition of the crews on a tools, materials, and resource standpoint as well as allow the manger to evaluate their fitness for duty level. This is in reference to personal problems, drugs, alcohol, tension, etc. The above are all things that are critical elements to ensure a safe work environment.

• Daily Worksite Meeting: Ensure that employees are performing daily worksite meeting. This meeting should be conducted prior to any job. Plans should be reviewed such as rigging plans and activity hazard analysis documents (AHAs). See Appendix for example AHA. (Appendix A)

• Activity Hazard Analysis: An activity hazard analysis (AHA) is an important

and very useful tool that can be used to conduct or replace traditional tool box talks, as well as a means to hold daily worksite meetings.

An activity hazard analysis is 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. Ideally, after you identify uncontrolled hazards, you will take steps to eliminate or reduce them to an acceptable risk level.

• Daily Inspections: Inspections should be conducted on a daily basis. Not all

projects can be seen on a daily basis. However, an attempt should be made to visit critical projects. (Appendix B)

• Inspection Documentation: Document site inspections receive signature from

supervisor after inspection. Inspections should be written with corrective actions included. Inspections should be forwarded to management and reviewed. (Appendix B)

A. Daily/Weekly Duties (Continued)

• Rigging Inspection: Ensure that all rigging has been inspected by users and riggers. Inspections shall be documented in the daily safety inspections. Safety Manager will ensure all tags, labels and load ratings are present on rigging equipment. (Appendix C)

• Forklift Inspection: Safety Manager will ensure that operators are completing

daily forklift inspections. Pre and Post Operation Inspections. (Appendix D)

• Fall Protection Inspection: Fall protection inspections are an important task that many companies fail to comply with. Employees will be expected to perform daily inspections of their equipment which will be undocumented. In addition, monthly and annual documented inspections shall be performed. (Appendix E)

• Educate Workers: Safety Manager will be responsible for performing,

documenting and maintaining training records. There will be various training requirements that will be performed and documented. (See Appendix for Documenting Training)

! Daily: There will be daily training performed when the tasks indicate a

need. Also, daily worksite meetings, including AHA’s, should be documented in supervisor’s daily log. This will constitute daily training.

! Weekly: Weekly tool box talks will be performed. Workers will sign the sheet and the talk will be filed.

! OSHA Training: OSHA 10 and 30 hour training courses will be conducted for various levels of the organization depending on employee level (foreman/supervisor/superintendent)

! Specialized Training: Certified Rigger, Crane Operator, Forklift Operator, Aerial Lift Operator.

• New Hire Orientation: It is extremely important that all new employees receive

a new hire orientation. This should be conducted immediately when an employee is hired at A&A. This will be a detailed orientation of the type of work that is going to be conducted, safety requirements and policies of A&A Transfer. A new hire orientation checklist will be completed which provides the trainer/safety manager or supervisor with an outline of the key points to be addressed. Upon completion, the trainer and employee should sign the form to ensure that all points have been discussed. (Appendix F)

A. Daily/Weekly Duties (Continued)

• Enforcement: The Safety Manager will manage and have the responsibility to manage the progressive disciplinary policy that is detailed in the Safety Manual. The Safety Manager will be expected to identify safety violations and hold individuals accountable for their actions. The safety policy for discipline should be consistently applied to eliminate favoritism and provide an effective tool for accountability. (Appendix G)

• Communicate: An open line of communication will be established between the

Safety Manager and upper management via the direct reporting guidelines on a weekly basis. Inspections/findings and training needs will be identified in these weekly meetings.

• Develop Safety Committee: The Safety Manager will develop a safety

committee from employees within the company and from various levels of the organization. These meetings will be conducted on a monthly basis. There are numerous steps to developing a Safety Committee, including having agendas, taking minutes, developing action plans, and creating sub-committees.

• Manage accountability program: The Safety Manager will be responsible for

managing a company accountability program. This will be conducted by measuring jobsite performance on various levels. Some of the measurement tools that will be used will be inspection/violation reports, accident/incident data, documentation of training/tool box talks, etc. (See safety program for more information)

• Incident Investigation: The Safety Manager will be responsible for performing

Accident/Incident and Near Miss Investigations. All incidents shall be reported by supervisor to Safety Manager. Once notified, the Safety Manager will respond and investigate. Depending on the type of incident (Worker’s Compensation, General Liability, Auto, or Near Miss Incident) an investigation will be completed and a report generated. Pictures and diagrams will be part of the investigation process. (Appendix H)

• First Report of Incident Forms: When a Worker’s Compensation claim occurs,

A&A Transfer will be required to fill out and submit a First Report of Incident Form for the state where the accident occurred. Attached are the Virginia, Maryland, and District of Columbia Forms. (Appendix I)

A. Daily/Weekly Duties (Continued)

• Post Accident Management: The Safety Manger will assist in post-accident activities with internal personnel and insurance companies. The Safety Manager may be asked to document and report incidents in a timely manner to the insurance carrier. Also, the Safety Manager should accompany the employee to their initial doctor’s visit. The Safety Manager will be asked to be a liaison with the employee, physician and insurance company to ensure the employee returns to work as soon as possible. (Appendix J)

• Hazard Communication: The Safety Manager, or designated A&A employee,

will manage the company hazard communication program. A complete chemical inventory list will be kept up-to-date and available to all employees. Training will be given to all employees. (Appendix K)

• Recordkeeping: Recordkeeping is a mandatory process that is required per

OSHA. This process will be recorded on the OSHA 200 Log. This will be posted within the organization at the first of the year and will show A&A’s OSHA history of the previous year in regard to “recordable incidents” and “loss time incidents.” (Appendix L)

B. Monthly/Quarterly Duties:

• Monthly All-Hands Meeting: An all-hands meeting with all employees should be held on a monthly basis to discuss hot topics and also as a means to educate employees.

• Monthly Status Reports: The Safety Manager should give monthly status reports

to management with accident data, inspection findings, and progress with goals and targets.

C) Long Term/Annual Duties

TRAINING: In a comprehensive training program, there will be various levels of training that should be conducted depending on the task, piece of equipment, or skill level of employee. Some minor training will be conducted on a weekly or daily basis and some will only need to be conducted on an annual basis.

Task/OSHA Compliance Training: • Employees should be trained on all safety sensitive tasks performed. For instance,

employees using power tools shall be trained on safe working procedures and PPE requirements for the power tools. Employees operating equipment should be trained on that particular piece of equipment.

• Fall Protection: All employees working from heights shall be trained in fall

protection. This training should cover multiple facets of fall protection and requirements of the OSHA standards. The following are items that should be covered during the training:

! A – Anchorage: What are the employees anchoring to ! B – Body Wear: Including Harnesses and dynamics ! C – Connections: What are the employees connected with

Falls are the leading killer in the construction industry and on the rise nationally. This training should be conducted on an annual basis and an ongoing emphasis should be placed the topic.

• Rigging Training: Employees shall be trained to meet ANSI B-30.5 specifications.

See attached rigging inspection report. (Appendix C)

• Crane Awareness: A Crane Awareness Training program will greatly benefit the organization due to the high risk of working with cranes, as well as increase the awareness and knowledge of proper crane operation and set up.

• Confined Space: Employees shall be trained on a site specific basis in regard to

confined spaces. Employees should be presented with the definition, hazards and precautions necessary. (Appendix M)

C) Long Term/Annual Duties (Continued)

• Lockout/Tagout Awareness: This is important due to the equipment that A&A employees work around. The employees should have an awareness program that describes the hazards and procedures that are involved working with power equipment. Employees should be able to identify whether the equipment has been properly shut down, de-energized, and tagged.

• Hand and Power Tools: Use and Inspection of Tools. Depending on type of tool,

additional training and certification may be necessary (i.e. Power Actuated Tools).

• Ladder Safety: Proper use and inspection.

• Forlklift Training: Those who currently drive a forklift (and those who may potentially drive a forklift) should be certified in forklift operation. A certification card shall be present with every A&A Transfer Operator.

• Aerial Lifts: If A&A employees ever use or rent an aerial lift (scissor or articulating

boom lift), they must receive documented training.

• Motorized Equipment: All employees operating motorized equipment over 30 HP shall be trained. All employees working in the District of Columbia must be licensed by the District for that piece of equipment. (See guidelines and training and licensing requirements). (Appendix N)

• Hazard Communication: Employees shall be trained on hazards associated with the

chemicals that they will or could be exposed to. The training should discuss each chemical and the hazards associated with it. The employees should know where to find the Material Safety Data Sheets (MSDS) for each chemical. (Appendix K)

• Supervisor Training: Typically OSHA 10 and 30 hour training certifications are

given to foremen and supervisors. These are given by an OSHA Authorized Trainer. The training does not expire. However, it is a good idea to perform this training every 2 -3 years.

C) Long Term/Annual Duties (Continued)

• First Aid: At least one person per crew will be trained in First Aid/CPR. Training certification expirations vary depending on the governing body or type of certification that is received (i.e. Red Cross, National Safety Council).

• Fleet Requirements: A formal fleet program must be established. This program shall

encompass formal requirements, MVR Checks, and criteria for use. MVR’s should be checked on an annual basis for all drivers who will or may drive a company vehicle or personal vehicle for personal use.

• A formal fleet policy must be established.

D) A&A Transfer, Inc. Safety Manager – Critical Areas of Focus

• Establish, maintain and review A&A Transfer Inc. safety and risk management performance goals annually

Subjective Analysis

! Do the owners and employees of A&A Transfer Inc. embrace a culture of safety?

! Is the safety manual being used effectively? ! Are training programs making a difference? ! Are inspection and record keeping programs having an impact? ! What part of the safety and risk management programs need to be

adjusted? ! What activities and processes can be implemented to impact A&A

Transfer Inc.’s safety culture

D) A&A Transfer, Inc. Safety Manager – Critical Areas of Focus (Continued)

Objective Analysis

! A “Zero Tolerance/Zero Accident” culture must be established within management and in the field. Zero Auto and GL claims should be the goal.

" What is A&A Transfer Inc.’s general liability accident experience in the most recent 12 months—compared to the previous 12 months

" Realistic goals should target 25% decrease in GL and Auto Claims

! Experience Modification -- Performance Goals should target accident rates (Experience Mod and OSHA Incident Rates)

" Experience Modification should target below 1.0: • Current Mod Effective 6/6/2008 = 1.19 • Probable Mod for 6/6/2009 = 1.17 (Due to 05-06 accident

history) • Forecasted Mod for 6/6/2010 = 0.91 (This is forecasting

$18K in losses for 08-09). Goal should of course be below that.

• Safety manager 12 month professional development plan

! Identify professional development course work ! Select organizations that A&A Transfer Inc should be involved with ! Identify individuals within A&A Transfer Inc. that should participate on

internal safety plan evolution moving forward

IV. OVERALL ASSESSMENT Rutherfoord has conducted a preliminary assessment of A&A Transfers safety culture and formal safety and risk management program. This process is ongoing and should continue to evolve as the first steps of the Safety Manager handbook are implemented— a Safety Manager is hired and fully engaged. The following are items that were immediately identified:

• Commitment: There is an acknowledgement from Debi Early and Gassan Kassira of the value of a well planned and executed Risk Management and Safety program. There is also commitment from Debi, Gassan and Jeremy to establish and deploy and all facets of this program. In order for this program to succeed in the long run and ultimately deliver production results and bottom line savings—it needs to be internalized by ALL members of A&A Transfer’s leadership team.

• Dedicated Safety Director/Manager: First and foremost, A&A Transfer needs a

person of authority driving the safety and risk management within the organization. This position will be responsible for the ongoing growth and development of formal effort to establish a culture of safety and risk control.

• Documentation:

! A&A Transfer’s written safety program (provided by a partner of A&A’s

former broker) was too large and not functional. An initial document has been provided. This document along with the Safety Manager Handbook needs to be developed and evolved as A&A begins to formalize and institutionalize the Safety Program. The final document should be applicable to A&A and functional.

! Inspections: Documented safety inspections are needed with the organization.

Not only on overall conditions of jobsites, but also on equipment, tools and Personal Protective Equipment (PPE).

! Training, equipment maintenance, inspection, drug & alcohol testing and

documentation all need to be established or improved.

• Formal Policies and Procedures:

! Employee training – inspection maintenance & training

! Zero tolerance drug & alcohol policy

! Pre-employment, post accident and random drug testing

! Employee training Steps have been taken to start a new safety program that will be used in conjunction with this tool in order to develop a more useable and living document.

•• Training: There is no formal training program currently at A&A Transfer in which

employees are trained on a regular basis. Typically, task training is conducted on an ongoing basis.

! Develop a schedule of monthly and annual.

! Develop and maintain a data base of documented training which will pay

dividends with safety education, culture and the marketing process going forward.

• Continuous and Consistent Communication: A process should be established

where Safety communication from the business owners down to the lowest level laborer on a daily, weekly and monthly basis. Although there is commitment to Safety from the highest level of A&A transfer, this does not appear to be currently happening. Avenues to accomplish will be monthly/quarterly all employee meetings, safety committee meetings, and having a safety manager who will regularly meet with management.

This evaluation will continue going forward, and will be drilled down to more technical and specific deficiencies. The above are immediately identified “Big Picture” items.

V. SAFETY PROGRAM

The following safety program should be considered the foundation for A&A Transfer, Inc.'s safety program. This manual/program should be the focus of the new safety manager's job responsibilities moving forward. There are parts of the manual that will require continuous update and adjustment and parts that will remain static. The evolution of this manual, safety program and culture of A&A Transfer, Inc. will be the Safety Managers’ responsibility from day one.

VI. A&A TRANSFER SUGGESTIONS

Item Where It Can Be Found

1) New hire training and safety orientation In the Handbook (Appendix F) and will eventually be added to Safety Manual.

2) Employee training – inspection maintenance and training

Outlined in the Handbook. Corporate checklist needs to be developed.

3) Zero tolerance drug and alcohol policy In the Safety Manual (Page 5). Needs to be edited

by new Safety Manager and vetted by A&A Attorney.

4) Pre-employment, post accident and random drug testing

Needs to be added to Handbook; already in Safety Manual (Pages 6-7). Needs to be edited by new Safety Manager and vetted by A&A Attorney.

5) Safety incentive program An incentive program is easily implemented,

however, an accountability program is “best practice” and example is included in the Handbook (Appendix P)

6) OSHA – 10 hour training Listed as a Training Target 7) Independent Risk Management Consultant This is provided by Rutherfoord and Van Liner 8) Haz-Com training program Handbook has sign-off sheets, quizzes (Appendix

K). Additional information can be provided. 9) Computer generated lift plans ? 10) Job hazard analysis Appendices A-E 11) C.C.O. Certified union crane operators This should be a contractual requirement for crane

companies 12) Frequent field safety inspections In the Handbook (Section III A.,B; and

Appendices A-E) 13) Third party annual equipment inspection We do not do this, but this would be highly

recommended

VII. APPENDICES

A. Activity Hazard Analysis (AHA) B. Safety Inspection C. Rigging Inspection D. Forklift Daily Inspection E. Fall Protection Inspection Form F. Orientation Form G. Discipline Notice H. Incident Investigation Forms (WC, GL, Auto) I. First Reports of Incidents J. Post Accident Management Form (Return to Work) K. Hazard Communication Forms and Quiz L. Recordkeeping M. Confined Space Forms N. District of Columbia Licensing O. Driver History Form and MVR Authorization P. Accountability Program

Appendix A Activity Hazard Analysis (AHA) A. Policy

Before beginning each work activity involving any type of work presenting hazards not experienced in previous project operations, or where a new work crew or sub-contractor is to perform the work, the crew or supervisor performing that work activity shall prepare an AHA. An activity hazard analysis is 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. Ideally, after you identify uncontrolled hazards, you will take steps to eliminate or reduce them to an acceptable risk level. An AHA can be conducted on many jobs in the workplace or jobsite. Priority should go to the following types of jobs:

• Jobs with the highest injury or illness rates; • Jobs with the potential to cause severe or disabling injuries or illness, even if there

is no history of previous accidents; • Jobs in which one simple human error could lead to a severe accident or injury • Jobs that are new to your operation or have undergone changes in processes and

procedures; and • Jobs complex enough to require written instructions.

B. Procedures

1. AHAs will define the activities being performed and identify the sequences of work, the specific hazards anticipated, site conditions, equipment, materials, and the control measures to be implemented to eliminate or reduce each hazard to an acceptable level of risk.

2. Work will not begin until the AHA for the work activity has been reviewed and accepted by A&A Transfer Inc. site management and other project specific designated personnel.

3. All competent/qualified personnel required for specific activities must be identified and included in the AHA. Proof of their competency/qualification may be requested prior to the start of that work activity.

4. The AHA will be reviewed and modified as necessary to address changing site conditions, operations, or change of competent/qualified person(s).

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Appendix B

SAFETY INSPECTION FORM Location: Project or Job No. Date: Safety Manager: Project Supervisor:

PREPARATORY PHASE (Planning)

Yes No N/A

Activity Hazard Analysis performed and used on the site for each definable feature of work?

Are weekly safety meetings and indoctrination held on site and documented for all workers?

Is the submitted safety plan on site and in use? Is the Activity Hazard Analysis reviewed during the preparatory inspection? Hazardous materials program in place with MSDS sheets on site and maintained?

FIRE PREVENTION

Yes No N/A

Are fire extinguishers available, fully charged, and easily visible within 75 feet for low hazard areas?

Is fuel stored in proper containers? Are hot work permits being obtained? Are fire watches provided? Are gas cylinders stored upright and secured with chain or rope? Is Housekeeping acceptable?

SCAFFOLD SAFETY

Yes No N/A Are daily scaffold inspections performed by designated competent person? Planks overlapped not less than 6" or more than 12" over end supports with toe boards

in place? Tubing pinned properly and all cross bracing in place? If scaffold height is 4X smallest base dimension, is system secured to structure? All guardrails are in place? Full work platform at each working level with no cracks/splits? Safe access provided to each working level? Scaffold and components not overloaded? Is scaffold system plumb and level? Suspended scaffold systems using independent personal fall arrest system?

FALL PROTECTION

Yes No N/A Is a full body harness used where required? Tied off at all times to structural element capable of supporting 5,000 lbs/person? Is protection provided for all personnel working in areas where they could fall 6' or

more? Are employees trained for fall protection systems in use? Does the contractor have a certified competent person? Have standard guardrails been provided where required?

Have horizontal life lines been designed and installed under supervision of a qualified person?

LADDER SAFETY

Yes No N/A Do ladders extend 3' above landing platform and tied to structure? Are ladders used with hand tools only? Are ladder base distances from structure 1/4 height? Are floor openings either covered or surrounded by a guardrail? Electricians not using portable "conductive" ladders? Stairways provided on all structures over 20' during construction and supplied with

guardrail? Portable step ladders over 20' not used on the site? Are ladders properly used?

ELECTRICAL

Yes No N/A Are temporary power panels and receptacles protected from weather? Are GFCI's in use for site tools ? Are temporary lights rigged and secured to supports properly, and with covers? If overhead power lines are in area, are operations maintaining required distance or

isolation? Is lockout/tagout program in effect? Has a sketch of proposed temporary power distribution been submitted/accepted before

installing? CRANES

Yes No N/A Has periodic inspection been performed prior to use on site Are daily start up inspections performed by operator and submitted? Is crane operator qualified and is crane certification posted in cab? Are workers protected from the crane swing radius and prevented from passing under

the load? Are rigging cables and slings in good repair free of kinks and cracks? Is the crane level and on firm ground and outriggers in use with appropriate cribbing? Is crane side loading prohibited? Near electric power sources, are rules followed for clearance/isolation in operating

zone? Is crane equipped with anti two-block device if required?

CONFINED SPACES

Yes No N/A Has entry plan been submitted and accepted? Is atmosphere being monitored? Is space being ventilated? Are entrants, attendants and entry supervisor properly trained? Is rescue/retrieval system in place? Are daily entry permits posted at point of entry and signed by entry supervisor? Is point of entry posted "DANGER CONFINED SPACE"? Has blanking or locking out of systems taken place?

ROOFING

Yes No N/A Has an employee fall protection system been implemented and in proper use? Are skylights and roof penetrations covered or barricaded appropriately? Has the roof been evaluated for its ability to support the intended construction loads? Has the roof been surveyed for deterioration?

EQUIPMENT

Yes No N/A

Are forklift operators qualified through training at the site (certificate included in Safety Plan)?

Does mobile equipment have rollover cages and backup alarms, with moving parts adequately guarded?

Are equipment operations maintaining safe clearance from electrical power lines? Do modifications meet safety rating per manufacturer (i.e., lifting personnel with

forklift)? Are safety lashings provided for high pressure hose connections, i.e., air compressors? Are workers clear of blind spots associated with mobile construction equipment? Do aerial lifts have basket/platform with guardrail? Are workers not extending over guardrail of aerial lifts? Are articulating boom platforms (JLG type) used with Full Body Harness attached to

boom or basket? PERSONAL PROTECTIVE EQUIPMENT

Yes No N/A

Workers wearing leather shoes (not tennis), long pants, sleeved shirts, and steel toes where required?

Are hare hats being worn? Are safety glasses where appropriate? Hearing protection where appropriate? (if you need to yell to converse) Respirators where appropriate? Impalement protection provided where personnel could work above vertical

impalement? Is lighting adequate?

ABATEMENT

Yes No N/A Has abatement plan been submitted and accepted? Is independent air monitoring being performed as required inside and outside barriers? Is containment in place without integrity compromise? Are employees utilizing appropriate PPE? If negative air is used, are fans used continuously and monitored for pressure

differential? Has baseline been performed and necessary final clearance readings taken? Are inspections by independent PQP performed prior to barrier removal? Is waste material properly containerized and stored? Are air monitoring results provided to Safety Office? Are waste shipment records provided to Safety Office?

WATERFRONT AREAS

Yes No N/A Are employees wearing appropriate flotation devices (PFDs)? Is a rescue skiff available? Are emergency life rings available? If diving operations are taking place, has a dive plan been submitted and accepted? Does dive team consist of proper number and qualifications for employees?

Appendix C

RIGGING Contract Name and Number:

Contractor/Subcontractor:

A&A Transfer Inspector

Location:

Date:

Misc. Info:

Equipment name and number: Yes No N/A 1. Has all defective rigging been removed? (15.A.01b) 2. Is rigging stored properly? (15.A.01d) 3. Are running lines within 6 feet 6 inches of the ground or working level guarded? (15.A.03)

4. Are all eye splices made in an approved manner with rope thimbles? (15.A.04) 5. Are positive latching devices used to secure loads? (15.A.05) 6. Are all custom lifting accessories marked to indicate their safe working loads and proof-tested to 125% of their rated load? (15.A.07)

7. Is wire rope removed from service or resocketed when two wires are broken or rust or corrosion is found adjacent to a socket or end fitting? (15.B.01)

8. Is defective wire rope cut up or marked as unusable? (15.B.02) 9. Do wire rope clips attached with U-bolts have the U-bolts on the dead or short end of the rope? (15.B.03)

10. Are protruding ends of strands in splices on slings and bridles covered or blunted? (15.B.05)

11. Except for eye splices in the end of wires and for all endless wire rope slings, do all wire ropes used in hoisting, lowering, or pulling loads consist of one continuous piece, free of knots or splices? (15.B.06)

12. Do all eye splices have at least 5 full tucks? (15.B.06a) 13. When using chain, is only alloyed chain used in rigging? (16.C.01) 14. Do all coupling links or other attachments have rated capacities at least equal to that of the chain? (15.C.03)

15. Are job or shop hooks and links, makeshift fasteners formed from bolts and rods, and other similar attachments restricted from use? (15.C.04)

16. Are all fiber ropes protected from freezing, excessive heat or corrosive materials? (15.D.01)

17. Are all fiber ropes protected from abrasion by padding? (15.D.02)

Yes No N/A 18. Are all splices in rope slings made in accordance with the manufacturer’s recommendations? (15.D.03)

19. Do all eye splices in manila rope contain at least 3 full tucks and do all short splices contain at least 6 full tucks(3 on each side of the centerline of the splice)? (15.D.04a)

20. Do the tails of fiber rope splices extend at least 6 rope diameters (for rope 1” diameter or greater) past the last full tuck? (15.D.05a)

21. Are all eye splices large enough to provide an included angle of not greater than 60° at the splice when the eye is placed over the load or support? (15.D.06)

22. Is protection provided between the sling and sharp surfaces? (15.E.02) 23. Do all wire rope slings have minimum length of clear wire rope equal to 10 times the diameter between each end fitting or eye splice? (15.E.04a)

This checklist is based on EM 385-1-1, dated 3 September 1996. Use of this checklist is optional.

Appendix D

SAMPLE GENERIC CHECKLIST FOR POWERED INDUSTRIAL TRUCKS

##

Overhead Guard Are there broken welds, missing bolts, or damaged areas? Hydraulic Cylinders Is there leakage or damage on the lift, tilt, and attachment

functions of the cylinders? Mast Assembly Are there broken welds, cracked or bent areas, and worn

or missing stops? Lift Chains and rollers

Is there wear or damage or kinks, signs of rust, or any sign that lubrication is required? Is there squeaking?

Forks Are they cracked or bent , worn, or mismatched? Is there excessive oil or water on the forks

Tires What do the tires look like? Are there large cuts that go around the circumference of the tire? Are there large pieces of rubber missing or separated from the rim? Are there missing lugs? Is there bond separation that may cause slippage?

Battery Check Are the cell caps and terminal covers in place? Are the cables missing insulation

Hydraulic Fluid Check level? Gauges Are they all properly working? Steering Is there excessive free play?

If power steering, is the pump working? Brakes If pedal goes all the way to the floor when you apply the

service brake, that is the first indicator that the brakes are bad. Brakes should work in reverse, also. Does the parking brake work? The truck should not be capable of movement when the parking brake is engaged.

Lights If equipped with lights, are they working properly? Horn Does the horn work?

##

Load Handling Attachments Is there hesitation when hoisting or lowering the forks, when using the forward or backward tilt, or the lateral travel on the side shift? Is there excessive oil on the cylinders?

Propane Tank Is the tank guard bracket properly positioned and locked down?

Propane Hose Is it damaged? It should not be frayed, pinched, kinked, or bound in any way. Is the connector threaded on squarely and tightly?

Propane Odor If you detect the presence of propane gas odor, turn off the tank valve and report the problem.

Engine Oil Check levels Engine Coolant Visually check the level. Note: Never remove the

radiator cap to check the coolant level when the engine is running or while the engine is hot. Stand to the side and turn your face away. Always use a glove or rag to protect your hand.

Transmission Fluid Check levels Windshield Wipers Do they work properly? Seat Belts Do they work? Safety Door Is it in place? (Found on stand up rider models) Safety Switch Is it working? (Found on stand up riding tow tractors) Hand Guards Are they in place? (Found on stand up riding tow

tractors, walking pallet trucks, walking transtackers) Tow Hook Does it engage and release smoothly?

Does the safety catch work properly? Control Lever Does the lever operate properly? Safety Interlock If the gate is open, does the vehicle run? (Found on

order pickers) Gripper Jaws Do the jaws open and close quickly and smoothly?

(Found on order pickers) Work Platform Does the platform raise and lower smoothly? (Found

on order pickers)

Appendix E Fall Protection Inspection Fall Protection Inspection is an extremely important part of any safety and fall prevention program. It is recommended that workers receive training through a manufacturer or a trained safety manager within A&A Transfer. Below is an Internet link to Miller’s “Guide to Fall Protection & Inspection”. This document is in a PDF file and too large to include in this handbook. However, the forms can be accessed and printed for internal use. http://www.millerfallprotection.com/smart-solutions/guide-to-fall-protection/guide-to-fall-protection

Appendix F

A&A TRANSFER NEW HIRE ORIENTATION

Employee Safety Orientation Checklist & Acknowledgement Form

v Automobile Safety Program

v Alcohol and Controlled Substances Program

v Hazard Communication Program

v Respirator Protection Program

v Construction Site Safety Orientation

v Emergency Action Plan v Crisis Management Plan v Emergency Information v Accident Reporting v Respirator Protection Program with Medical Evaluation v Review and issue Personal Protection Equipment (PPE) v General Safety and Health Rules and Regulations v Additional Training ________________________________________________ v Current Certifications with dates and expirations (e.g. Forklift, HILTI, Aerial Lift,

OSHA 10 Hour, etc.)________________________________________________ __________________________________________________________________

v Certifications / Training Needed:________________________________________ While employed by A&A Transfer Inc., I will follow the procedures outlined in the Company Safety Plan and/or the Project Safety Plan. Any additional training during the course of employment is also understood to be followed. I understand that failure to follow the safety rules and practices may result in disciplinary action, including termination. I understand that failure to properly report an injury or illness sustained while in the course of employment constitutes a violation of the safety rules and practices, and may result in disciplinary action. I have reviewed the contents of the Company Safety Plan and corresponding Project Safety Plan. Employee (Print Name): _________________________________ Date: ____/____/_______ Employee (Signature): ___________________________________ Witness (Print Name): ____________________________________ Date: ____/____/_______ Witness (Signature): _____________________________________

Appendix G

Disciplinary Notice to Employee From: A&A Transfer Inc. Date: _______________ Employee Name: ________________________________ Days Suspended (if applicable): ____________________ This disciplinary notice is to provide you notice of a violation of company policy and or practice that you were previously trained on. Any future violation for the same offence could result in suspension or termination per the Disciplinary Action Program. Your conduct is not in keeping with A&A Transfer Inc. practices, standards and/or policies for the following reasons: I hereby acknowledge receipt of the above disciplinary notice. Employee: ____________________________________________ Date:_____________ Supervisor: ____________________________________________ Date:_____________ Safety Director: ________________________________________ Date:_____________ Other (__________________):_____________________________ Date:_____________

Written Warning ____ Suspended ____ Terminated ____

Appendix H

Appendix I

Appendix J

Return To Work Form Date: ____________ ______________________________was seen at _____________________on _______ (Patient’s Name) (Urgent Care / Hospital Name) (Date) Social Security # _______________________

Please identify the following restrictions:

____ Patient may return to full work duty on ________________________________.

____ Patient released for light duty on _________________.

(Light Duty is available and all restriction can be me.) ____ No lifting greater than _________lbs.

____ No operation of mechanical equipment (i.e. machinery, motor vehicles, etc.) ____ No pushing / pulling. Limitations: ________________________________

____ No prolonged standing or walking. Limitations: _____________________ ____ Other ________________________________________________________

____ Patient will be unable to return-to-work until _____________________________

____ Patient is free of contagious disease and may return to work on _______________ Additional Comments: _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________________________ Physician’s Name (Print)_________________________ Physician’s Signature Return Appt: __________________ _________________________ (Date) (Time)

Notice of Subcontractor Safety Violation Job: ______________________________________Date: _____________________ Subcontractor: ________________________________Violation#: ______________ Location: ___________________________________________________________ Employee Name(s): __________________________________________________ Foreman’s Name: _____________________________________________________ Description of Violation(s): _______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Subcontractor Print and Sign Violation Received: __________________________________________________ Form Completed By: _____________________________________________________ Date Corrected / Abated: ___________________ Subs Initials: ________ Subcontractor All violations must be corrected immediately. Please date and initial in the spaces provided above when all violations are corrected and return to A&A Transfer Inc.’s on-site construction office.

Toolbox Talk Sign-in Sheet

(For trainings other than what is provided by the safety department)

Topic: ____________________________________ Job Name: ______________________________ Date: ______________ Meeting Attended By:

1. ______________________________________________ 2. ______________________________________________

3. ______________________________________________ 4. ______________________________________________

5. ______________________________________________ 6. ______________________________________________

7. ______________________________________________ 8. ______________________________________________ 9. ______________________________________________

10. ______________________________________________ 11. ______________________________________________

12. ______________________________________________ 13. ______________________________________________

14. ______________________________________________ 15. ______________________________________________

16. ______________________________________________ Translated By: ________________________________________________________ Trainer: ______________________________________________________________ Supervisor’s Signature: _________________________________________________

Appendix K

Hazard Communication Training Acknowledgement I have received information and training on the Hazard Communication Standard 29 CFR 1926.59 and 1910.1200 and understand how to interpret and to use the labeling systems and Material Safety Data Sheets (MSDS) that are in use by A&A Transfer Inc. I agree to observe and follow the safe work practices as presented to me in the training sessions I attended. ____________________________________ Print Name ____________________________________ __________________ Sign Name Date ____________________________________ __________________ Witness Sign Date

Appendix K

Hazard Communication Quiz

Directions: Read the questions and circle the correct letter 1. The OSHA regulation that gives employees the right to know about chemical

hazards and protections is called the:

a. Chemical Act b. Hazard Communication Standard c. Environmental Protection Agency

2. Chemical manufactures identify chemicals hazards and provide the information

on:

a. Container labels and Material Safety Data Sheets (MSDS) b. List of hazardous chemicals c. Letters to customers

3. Employers must have written hazard communication programs:

a. True b. False

4. Chemical health hazards that develop quickly after exposure are called:

a. Acute b. Chronic c. Serious

5. You can be exposed to a chemical by skin or eye contact, inhaling, or swallowing.

a. True b. False

6. If a chemical’s container label is missing or so damaged you can’t read it, you

should: a. Try to remember what was in the container. b. Treat the container cautiously. c. Not use the chemical.

7. To find all the details on a chemical’s hazards and precautions, you should

check:

a. Your hazard communication plan b. Its MSDS c. Its label d. All of the above

8. When employees complete hazard communication training, they should:

a. Know and understand how to identify chemical hazards and protections b. Know how chemical manufactures identify chemical hazards c. Know where to buy PPE

9. Before starting any job with a chemical, you should:

a. Receive a manufacture’s booklet on the chemical b. Read the chemical’s label and MSDS c. Put on a respirator and protective suit

_____________________________________________ Print Name _____________________________________________ ______________ Sign Name Date

Appendix L

Appendix M

Confined Space Entry Sign-In / Sign-Out Sheet Work Location: _______________________________________ Date: ____________ NOTE: All persons entering and exiting the confined space must sign in and out

every time.

Print Name Signature Time In Time Out

Confined Space Entry Permit

This permit is valid for one shift only. It must be updated or renewed for each

shift. This permit must be posted and remain at the entry location. Job Name: ___________________________________________ Date: ______________ Confined Space Work Site Location: _______________________________________________ Reason for permit: _____________________________________________________ Shift Time Start: _____________________ Time Completed: _________________ Description of Work: _________________________________________________ Entry Supervisor: ____________________________________________________ Entrants: Attendants(s): _____________________________________ ______________________________ _____________________________________ ______________________________

_____________________________________ ______________________________ List of Potential Hazards of the Space: List of Safety Equipment Required: _____________________________________ ______________________________

_____________________________________ ______________________________ _____________________________________ ______________________________

In the event of emergency Call 911

Confined Space Air Monitoring Log

Air monitoring should be performed continuously during confined space entry, when possible.

Oxygen Lower Explosive Limits

Carbon Monoxide

Hydrogen Sulfide Gases

(O2) (LEL) (CO) (H2S) Typical Readings 20.9 0 0 0

Alarm Points 19.5 10 35 10

Date: begin shift time -

after break time -

after lunch time - Date: begin shift time -

after break time -

after lunch time - Date: begin shift time -

after break time -

after lunch time - Date: begin shift time -

after break time -

after lunch time -

Date: begin shift time -

after break time -

after lunch time -

Date:

begin shift time -

after break time -

after lunch time -

Appendix N

District of Columbia Operators of Motorized Equipment URGENT - All current operator licenses will expire on SEPTEMBER 30 2008.... 90 days prior to expiration of the operator’s license, the license holder should have received a renewal letter from Pearson VUE. If the license holder has not received this letter, THEY MUST follow these steps to attain a renewed license: STEP 1 – Operator/license holder can complete the forms sent by Pearson VUE for renewal or complete the online renewal. Instructions to complete online renewal: 1. Click on: https://www.asisvcs.com/services/licensing/DCOPLA/LicRenewals/LrIndex.asp?CBCAT=09STST%20www.asisvcs.com/services/licensing/DCOPLA/LicRenewals/LrIndex.asp?CBCAT=09STST <https://www.asisvcs.com/services/licensing/DCOPLA/LicRenewals/LrIndex.asp?CBCAT=09STST%20www.asisvcs.com/services/licensing/DCOPLA/LicRenewals/LrIndex.asp?CBCAT=09STST> 2. Log In and Complete the Requested Information NOTE: To Log In to the website you must have the following information: 1. Your Last Name 2. License Prefix and License Number (Can be found on your current license) 3. Personal Identification Number (Can be found on your Renewal Notice that was sent in the mail or you can obtain this by calling Pearson VUE at 1-877-543-5217)

STEP 2 – To complete the License Renewal, the license holder will need to submit the following: 1. A color copy of the license holder’s current DRIVERS LICENSE. 2. 2 passport style photos 2” X 2”. STEP 3 – Renewal paperwork MUST be received before 9-30-08 (allow 10 business days to send in submittals listed in STEP 2) or the license holder will be charged an additional fee of $50.00. If the renewal is not received by 11-30-08, the license holder will need to submit for a new license. ** Renewal Fee - $110.00 ** If you have any questions please contact Pearson VUE at 1-877-543-5217 or Jeremy Hawkins at 703.489.9805

Appendix O

Driver History Form

Driver’s Name (Print): _______________________________________________

Home Address: ____________________________________________________

City:__________________________ State:_______ Zip Code: ______________

1. Do you have a valid Driver’s License? Yes _____ No _____

2. In which State are you a Licensed Driver? ______________________________

3. If you have held a license in any other state during the past 36 months, please provide

the following information:

Dates States

From_______ To _______ ____________________________

Form_______ To _______ ____________________________

From_______ To _______ ____________________________

4. Have you been convicted of driving while impaired or under the influence of alcohol

and/or drugs within the past 36 months? Yes ( ) No ( ). If yes, give explanation(s)

and dates(s).

___________________________________________________________________

___________________________________________________________________

5. Have you refused to submit to a Blood Alcohol Content (BAC) test within the past 36

months? Yes ( ) No ( ). If yes, give explanation(s) and date(s).

_____________________________________________________________________

_____________________________________________________________________

6. Have you been convicted of reckless driving, leaving the scene of an accident, or

committing a felony involving a vehicle within the past 36 months?

Yes ( ) No ( ). If Yes, give explanation(s) and Date(s):

____________________________________________________________

_____________________________________________________________

7. Have you had your operator’s license suspended, revoked or administratively

restricted within the past 36 months? Yes ( ) No ( ). If Yes, give explanation(s)

and date(s):

___________________________________________________________________

___________________________________________________________________

8. Have you been convicted or found at fault for any non-fatal accident involving a

motor vehicle within the past 36 months? Yes ( ) No ( ). If Yes, list the date(s):

___________________________________________________________________

____________________________________________________________________

9. Have you been convicted or found at fault for any fatal accidents involving a motor

vehicle within the past 36 months? Yes ( ) No ( ). If Yes, List the date(s):

_____________________________________________________________________

_____________________________________________________________________

10. Have you been convicted of any other moving vehicle violations during the past 36

months? Yes ( ) No ( ). If Yes, list types and date(s):

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Appendix O

I certify that the answers provided to the questions on this form are true to the best of my

knowledge. I authorize A&A Transfer Inc. or its designated representative(s) to obtain

information regarding my driving record in any state at any time while I am employed by

(or seeking employment with) this company. I understand that any misstatement of the

facts on this form may be grounds for termination of employment. In the event that my

MVR indicates that I am a “High Risk Driver” as defined in the glossary of the Motor

Vehicle Safety Program, I understand that I may be subject to probation or dismissal.

________________________ ____________________ _______________________ (First) (Middle) (Last) Driver’s Name (Print)

____________________________________ _________________

Driver’s Name (Signature) Date

________ - _______ - ________ Male_____ Female_____ ___________

Social Security Number Date of Birth

__________________________ __________________ __________

Driver’s License Number Expiration Date State

_____________________________________

Risk Manager’s Name (Sign)

Appendix P

Steps for Implementing an Accountability Program follows