CONTRACTOR SAFETY PROGRAM

Transcription

1 CONTRACTOR SAFETY PROGRAM Program Designed to Cover All Locations in the United States 30 January 2014 TE Connectivity Date 1/30/14 Revision

2 Table of Contents Page INTRODUCTION... 3 Implementation Steps... 4 CONTRACTOR SAFETY PROGRAM Background Policy Scope Definitions Responsibilities Plant Manager Contractor Safety Program Manager Building Contractor Safety Program Coordinator Project/Service Manager Contractor Designated Site Safety Representative Contractor Employees Contractor Safety Requirements General Requirements Pre-Qualification Qualifications for Projects Pre-Performance Meeting and Site Planning Coordination of Safety Programs Project Coordination Reporting and Record keeping Requirements Reporting and Correcting Safety Violations Reporting Job-Related Accidents Reporting for Maintenance and Construction Contracts Record Keeping References Attachments 1. Pre-Qualification Review General Services Contractor A. Pre-Qualification Review Checklist General Services Contractor Hazard Analysis For Contractor work Contractor Checklist / Self Audit Contractor Preliminary Report of Accident Example Narrative of a Lost Time Accident Contractor Acknowledgment Letter...23 TE Connectivity Date 1/30/14 Revision

3 7. Sample Site Specific Contractor Safety Guide...24 TE Connectivity Date 1/30/14 Revision

4 INTRODUCTION To obtain services important to our business we are dependent on many contractors. It is critical that these contractors and TE Connectivity personnel are working in a safe and healthful environment. Implementing a program to help manage contractor safety can also mean better value for the construction or service dollar, lower insurance costs and may result in fewer litigation problems. The Occupational Safety and Health Administration (OSHA) does not have a single comprehensive regulatory reference that outlines a specific process to assist facilities on managing contractor safety. The OSHA General Industry and Construction Standards do present specific standards for employers to follow to ensure the safety of their personnel. In addition, specific standards contain elements that require coordination by contractors and facility owners to ensure the safety of personnel. Some of the OSHA standards that specify contractor / facility responsibilities include the: Hazard Communication Standard (29 CFR ); Permit-Required Confined Space Standard (29 CFR ); and Control of Hazardous Energy Standard (29 CFR ). OSHA s approach to enforcement on a jobsite with many employers, a multi-employer worksite, is to issue citations to the employer whose employees are exposed, the employer who generated the hazard, the employer responsible for correcting the hazard and the employer who controls the worksite. This approach requires that all employers understand and follow through on their responsibilities for managing health and safety programs. Most, if not all, site locations where contractors are working will be considered multi-employer work sites. TE Connectivity Corporation has developed this written program to protect TE Connectivity and contractor personnel (whether employees, agents or representatives of contractor or its subcontractors) from unsafe conditions and unsafe actions that may occur during contractor activities. Elements in the program include: Pre-Qualifying Contractors; Qualifications for Projects; Pre-Award Meeting; Training; Project Coordination; Contractor Safety Guide; Reporting Safety Violations; Post-Project Review; and Record keeping. TE Connectivity Date 1/30/14 Revision

5 Implementing this program will advance the health and safety program of each facility. The process of qualifying the contractors and subcontractors, assuring the TE Connectivity Date 1/30/14 Revision

6 effectiveness of their health and safety program, and ensuring the coordination with the facility will provide benefits to TE Connectivity and to the personnel contracted to work in TE Connectivity facilities.

7 Implementation Steps Follow these steps to meet the regulatory requirements of a building specific Contractor Safety Program. TE Connectivity Plant Manager should assign an individual to serve as that Building Contractor Safety Program Coordinator. 1. All contractors and subcontractors must pre-qualify prior to working for TE Connectivity. To show the implementation of their health and safety program, each contractor and subcontractor will identify their corporate safety representative and will submit the documentation listed in Attachment 1, Pre-Qualification Review,. 2. When selected to bid on a project, the contractor will submit, written documentation with the bid to support their understanding of the OSHA regulations that apply to the project. Other information that will be submitted includes: The name of the proposed on-site company representative and the designated site safety representative. Documents showing past experience by the company on a similar job and past experience or competency of key personnel (for example, the supervisor) on a similar job. Records of training, licenses, and certificates of qualifications (as appropriate for that project or tasking) for personnel working on the project (e.g., Hazardous Waste Operations and Emergency Response (HAZWOPER), fittesting, asbestos licenses). NOTE: A letter, signed by an officer of the company, stating that all personnel who will perform work on a given project / program have received appropriate training that meets or exceeds regulatory requirements will be accepted as proof of training. Confirmation that contractors understand the prohibition against using alcohol or illegal substances on the job site, and that personnel will be expelled from the site if they are observed to be under the influence of alcohol or drugs. 3. Individual buildings may have additional documentation requirements for acknowledgement of the contractor s personnel s receipt and review of the safety information and rules review for that structure and organization. They may require employees that work in their environment to sign a policy document or acknowledgment. They may have specialized forms to support coordination in their building and require step-by-step documentation and initials. 4. For certain, larger projects: After being awarded a project, the Building Contractor Safety Program Coordinator, Project/Service Manager and contractor shall conduct a pre-performance meeting. At this meeting the contractor must provide a written project/contract safety plan and the following items will be reviewed:

8 The performance schedule. The key personnel and their responsibilities for managing safety and coordinating safety issues. The procedures for effective communication. The requirement for the contractors and subcontractors to ensure that activities are completed in accordance with applicable regulations; the responsibilities of the contractors and subcontractors to ensure safety on the jobsite; and the responsibilities of contractors and subcontractors to provide the required equipment and safety supplies to complete the identified activities. 5. During site activities all potential safety and health hazards will be immediately reported to TE Connectivity. If hazards are not corrected, TE Connectivity and the contractor have the authority to suspend activities until the corrective action is complete. 6. During site activities, all accidents will be documented appropriately using the forms provided in Attachments 4 and When the contract work is completed, or at least annually, the Building Contractor Safety Program Coordinator and Project/Service Manager will conduct a post project review that focuses on the safety program effectiveness and identifies program strengths and deficiencies. As part of this review, the Building Contractor Safety Program Coordinator will review statistics that indicate the number of hours worked, the number of injuries, and the incidence rate for contractors. 8. The Project Manager will maintain appropriate safety and health records generated during construction projects. Building Contractor Safety Program Coordinator will be responsible for maintaining any Environmental Health and Safety records associated with service contracts. Examples of records which must be maintained include: Employee exposure monitoring results (30-year retention) MSDSs associated with the project (30-year retention) These records will be turned over to the Building Contractor Safety Program Coordinator at the completion of the project or at each annual review for inclusion in that building s records. Portions of this document following this line are to be distributed to and used by the contractors. CONTRACTOR SAFETY PROGRAM Background

9 TE Connectivity Corporation has outsourced accomplishment of many of the Construction, Building Operations and Maintenance Services. The Project Managers and/or Building Contractor Safety Program Coordinator will coordinate with the contractor s designated safety representative and the TE Connectivity Contractor Safety Program Coordinator to maximize adherence to safety regulations and the policies outlined in this program. 1.0 Policy It is the policy of TE Connectivity to provide contractor personnel and TE Connectivity employees with a safe and healthful working environment in accordance with the OSHA General Industry Standards (29 CFR1910). This process focuses on coordinating the activities of both groups and begins with pre-qualifying the contractors that support facility operations. 2.0 Scope This program applies to TE Connectivity personnel and their contractors at all TE Connectivity buildings. The coordination of safety and health programs with the contractor working at the site is critical to ensure that building personnel are protected from hazards introduced by the contractor, and to ensure that contractor personnel are aware of hazards present in the facility. The scope includes facilities maintenance, construction operations, building decommissioning operations, as well as building services such as landscaping/lawn mowing, janitorial, pest control, mail delivery, etc. 3.0 Definitions Construction / Renovations Employees: Personnel retained to work on a project for a specific period of time to complete a specified scope of work. Because their work is independent of the operations performed by TE Connectivity personnel and not directed by TE Connectivity, these individuals are not considered to be TE Connectivity employees. Contractors: Companies and personnel retained by TE Connectivity to provide specific services and/or complete specific project-related activities. Experience Modification Rate (EMR): The system for rating a contractor s safety record, which considers the average workers compensation losses for a given firm s type of work and amount of payroll, and which predicts the dollar amount of expected losses to be paid by that employer in a designated rating period, usually three years.

10 Multi-Employer Work Site: This situation occurs when contractors are working in a facility. OSHA defines four categories of employers and assigns the following responsibilities: Exposing Employer: An employer whose employees are exposed to the hazards. Creating Employer: The employer who creates the hazard. Controlling Employer: The employer who, by contract or through actual practice, has the authority for ensuring that the hazardous condition is corrected. Correcting Employer: The employer who has the responsibility for actually correcting the hazard. Operations and Maintenance Employees: (e.g., building maintenance, janitorial services, landscape services, etc.): These are contract personnel who work in or around the facility on a regular basis. They perform building maintenance, for example, working on facility electrical systems, plumbing and HVAC; also includes janitorial, landscaping and other service contractors. 4.0 Responsibilities TE Connectivity and its contractors are responsible for the safety of their respective personnel. In general, the employer who creates a hazardous working condition is responsible for correcting it. Furthermore, on multi-employer worksites, each party has a responsibility to maintain a safe work environment for itself as well as for others. The responsibility of coordinating facility and contractor activities begins prior to the contractor s commencing work on-site and does not end until the work is completed and the contractor s performance is evaluated. 4.1 Plant Manager The Plant Manager has overall responsibility for: Implementing and overseeing the building-specific portions of this program. Ensuring that the Facility Health and Safety Coordinator, the Building Contractor Safety Program Coordinator, Facility Services Program Manager and Project Managers, Employees, and contractors meet their obligations under this program. Providing adequate resources to carry out the provisions of this program. 4.2 Contractor Safety Program Manager

11 The Contractor Safety Program Manager resides within Facilities Services and serves as the champion of this program. The Contractor Safety Program Manager will work in concert with the Project Managers, Building Contractor Safety Program Coordinators, Facility Managers, TE Connectivity plant/building personnel and the contractors to implement and maintain this program. The Program Manager will serve as liaison to enhance communication among all the parties involved. Specifically, the Program Manager will: Implement and oversee the overall Program; coordinate with all associated groups/personnel to ensure everyone understands the requirements of this program and that the requirements of the program are executed. Ensure that the responsible Plant Manager lead annual Contractor Orientation which will review the overall program with contractors representatives and relay TE Connectivity expectations. Provide technical support to project management, building service personnel and TE Connectivity plant/building personnel; assist personnel in meeting the objectives of this Program. 4.3 Building Contractor Safety Program Coordinator This individual is the on-site coordinator for this program. The Building Contractor Safety Program Coordinator: Provides a copy of the facility s written Hazard Communication Program to the Contractor and/or ensures all relevant hazard communication information is relayed to the Contractor; also, ensures that any potential hazards/concerns which may be created by the contractor are communicated to affected TE Connectivity employees. Attends any pre-performance meetings with the contractor and Project/Service Manager to discuss hazard communication information and any other unique safety concerns specific to a project. Provides contractor access to MSDS Sheets for hazardous substances within the work environment. Provides contractors information on chemicals used or stored in areas where they will be working. Provides contractor information on the facility s chemical labeling system. Receives and appropriately manages MSDS sheets provided by the contractor for hazardous substances introduced by the contractor. Performs periodic reviews of this program to ensure the appropriate actions in this program are completed and documents are maintained. Informs the Project/Service Manager of observed safety performances of the contractor.

12 Communicates with the Project/Service Manager and the Contractor Designated Site Safety Representative any changes in the work environment, the work activity, or the behaviors of any participants that may affect the safe occupancy and effective accomplishment of assigned tasks in the shared work site. Tracks receipt and review required submittals (e.g., safety programs, training records, OSHA logs, etc.) received from contractors and subcontractors. Informs Contractor Safety Program Manager of Project Activity. 4.4 Project/Service Manager The Project/Service Manager is responsible for completion of the specified work and is responsible for managing the activities of the contractor. The Project/Service Manager: In coordination with the Building Contractor Safety Program Coordinator, prepares a scope of work that clearly identifies the specific health and safety concerns for the project. In coordination with the Building Contractor Safety Program Coordinator, reviews with the contractor the relevant facility safety and health information concerning the nature of operations to be performed by the contractor. Ensures a safety evaluation has been completed for all contract bidders (prequalification) before a contract is awarded. Meets with the contractor during the project to discuss the contractor s overall safety performance. Determines with plant management whether any contractor health and safety performance deficiencies require partial or complete cessation of work pending correction of identified hazards. It should be noted that the responsibility to identify risk, notify contractor of this risk, and the authority to stop work (in the event of imminent danger) resides with everyone. Confirms that the Contractor is following the contractor s safety program and implements any necessary corrective measures to ensure that TE Connectivity personnel are protected. Notifies the appropriate organization personnel, using the Contractor Preliminary Report of Accident (Attachment 4), in the event of an accident. Ensures an accident investigation form is prepared; provides copy of this form to the Safety Program Manager, Building Safety Coordinator and Plant Manager. Note: Only TE Connectivity employee recordable accidents should be recorded on a TE Connectivity OSHA 300 Log. Communicates with the Building Contractor Safety Program Coordinator and the Contractor Designated Site Safety Representative any changes in the work

13 environment, the work activity, or the behaviors of any participants that may affect the safe occupancy and effective accomplishment of assigned tasks in the shared work site. 4.5 Contractor Designated Site Safety Representative Contractor Designated Site Safety Representatives are responsible for: Ensuring that the scope of activities is correctly identified and the requirements for performing the work in accordance with applicable health and safety regulations are incorporated, as necessary, into appropriate project documents (e.g., project proposal, project health and safety plan, etc.) Ensuring that contractor personnel are trained in the applicable health and safety standards and regulations that apply to the tasks that they will perform. Ensuring that contractor personnel are provided with the equipment and resources needed to safely and effectively complete the work. The facility will not provide the contractor with personal protective equipment and/or monitoring equipment associated with the work activities. Providing MSDS sheets to Building Contractor Safety Program Coordinator for approval of hazardous chemicals before taking chemicals into the building. If permitted to use TE Connectivity scissor-lifts, forklifts, etc., the Contractor must be certified to operate this equipment and have a safety program in place that addresses use of this type of equipment. Where TE Connectivity is providing this equipment for Contractor use, the Contractor is responsible for inspection before each use ensuring that this equipment is safe and used properly. Submitting Contractor Preliminary Report of Accident Form (Attachment 4) and an Accident Investigation form to Project/Service Manager and Building Contractor Safety Program Coordinator if there is an accident. Communicating with the Building Contractor Safety Program Coordinator and the Project/Service Manager any changes in the work environment, the work activity, or the behaviors of any personnel or other participants that may affect the safe occupancy and effective accomplishment of assigned tasks in the shared work site. 4.6 Contractor Personnel (Employees, Agents and Representatives of Contractors and Subcontractors) Contractor personnel are responsible for: Using all tools and equipment properly and according to manufacturer s guidelines. Performing work in accordance with applicable OSHA standards. Reporting all injuries and/or incidents, and unsafe practices and/or conditions immediately to their supervisor. If the supervisor is not on-site, contractor

14 personnel must notify a TE Connectivity representative prior to leaving the site after an incident. Cooperating in the investigation of any accident. Understanding, based on the scope of work, the potential hazards inherent to the work and taking the necessary precautions to reduce/eliminate these hazards. Following all posted signage and the plant/facility specific behavior/safety rules. 5.0 Contractor Safety Requirements 5.1 General Requirements Effective management of contractor activities involves coordinating operations and programs with the contractor prior to commencement of on-site work. Elements include: Prepare a clear proposal and scope of work; utilizing pre-qualified contractors. In coordination with the Building Safety Coordinator, review contractor operations during the on-site effort to ensure that facility personnel understand the conditions and how the changing work environment impacts their performance of tasks. Review the performance of work and debrief contractor at the completion of work to provide facility managers with a more complete understanding of the requirements for the task and the nature of conditions encountered which can facilitate the planning for subsequent projects. In the process of managing the relationships with contractors, it is important to realize there are two categories of contractor personnel: Operations and Maintenance Employees (includes service contracts), and Construction/Renovation Employees. When several contractors work in a facility, the requirements for a multi-employer work site, as defined by OSHA, apply to the site operations. At these worksites, the contractor shall be responsible for managing the project and the work tasks, and shall be the employer, as defined by OSHA. If the site includes a construction project, then responsibilities are designated as in the contract documents. If work is to be completed through a General Contractor, the project contract team is treated as one entity and the General Contractor is responsible for all the included subcontractors. 5.2 Pre-Qualification Contractors shall be pre-qualified prior to working for TE Connectivity. To pre-qualify, the contractor shall submit documentation to TE Connectivity that substantiates implementation and execution of their company health and safety program.

15 Attachment 1 describes these requirements and presents a pre-qualification checklist (Attachment 1A) that can be used to verify that the contractor has submitted all necessary documents. If deficiencies are identified in the program, TE Connectivity shall send a statement to the contractor indicating the need for additional documentation and/or the reason(s) for refusal. If the contractor is determined to be qualified, the company shall be placed on the approved bidder s list. Contractors are responsible for updating their programs and ensuring the programs conform to the latest requirements of current standards. Contractors are responsible for informing TE Connectivity of a change in their eligibility status. If incidents occur on non-te Connectivity jobsites that reflect on the contractor s safety program (e.g., accidents which change their EMR), the contractor shall notify TE Connectivity of these incidents. 5.3 Qualifications for Projects When the Project/Service Manager requests a bid, only qualified contractors shall be contacted. The Project/Service Manager shall prepare a scope of work that identifies the tasks to be performed and the general health and safety concerns for the project. If, based on the project scope, any specific or unique safety concerns are anticipated, these will also be identified at this time. The contractor must also be aware that any violations of safety and health standards or policies relevant to the project, observed or identified by TE Connectivity, may result in a review of the contractor s health and safety performance, work stoppage and/or possibly termination of contract activities. Any delays in the project due to a contractor violating a safety and health standard or policy shall be at the expense of the contractor. 5.4 Pre-Performance Meeting and Site Planning A pre-performance meeting may be held with the Contractor for some smaller projects (as appropriate) and most, if not all, larger projects. As part of the pre-performance meeting (if convened) or prior to project start-up, the Contractor shall ensure that they are aware of TE Connectivity site-specific safety rules and any potential hazards present in the area where the work is to be performed. Means to accomplish the above include meeting with the Project/Service Manager and Building Contractor Safety Program Coordinator and review/completion of Attachment 2, Hazard Analysis for Contractor Work. This attachment provides contractors with a checklist of various work issues that may be encountered on a project. This checklist may be used as a tool in the first step of a hazard analysis for the project and may be reviewed during the pre-performance/construction conference. Any participant has the option of requesting a pre-performance meeting if one has not been scheduled.

16 One of the primary goals of the pre-performance meeting is to identify/discuss potential hazards associated with the work and how implementation of the contractor s health and safety program, on a project-specific basis, can control these hazards. Items to identify in the contractor s project safety and health program include: How the contractor will comply with applicable TE Connectivity safety and health requirements and local, state, and federal regulations. The contractor employee who is responsible for carrying out the contractor s plan (i.e., contractor s designated safety representative) and providing daily site implementation of the health and safety plan. Qualifications of equipment and machinery operators. The contractor s programs for training its personnel and maintaining records of training. Procedures for coordinating contractor operations with TE Connectivity as required by specific regulations, for example, the Hazard Communication Program. Requirements for the contractor to comply with any local signage or expected behaviors in the TE Connectivity environment. Management of safety and health issues including, but not limited to, building evacuation, fire protection and prevention, hearing conservation, housekeeping, the use of personal protective equipment, fall protection, scaffold work, confined spaces, and lockout/tag-out. Procedures for reporting to TE Connectivity and government agencies any accidents and injuries, and inspections by government agencies. 5.5 Coordination of Safety Programs Prior to the start of work, the Project/Services Manager, Building Contractor Safety Program Coordinator, or a designated alternate shall review with the contractor s Designated Safety Representative the relevant facility safety and health information concerning the nature of operations to be performed by the contractor. This information shall be reviewed with TE Connectivity personnel working in the area where the contractor will be located. This information shall include but not be limited to hazard communication and the types of chemicals used by the Contractor, the warning signs that Contractor will use, and a review of how the Contractor s procedures will impact on egress in the work area. Additional coordination of TE Connectivity and contractor resources shall be required when TE Connectivity personnel work with contractor personnel. These requirements include coordination of lockout/tag-out procedures when working on systems that contain

17 hazardous energy, and coordination of entry procedures if the work involves confined space entry. 5.6 Project Coordination The contractor shall have the primary responsibility for ensuring that safe performance is followed on the job site each day. Attachment 3, Contractor Checklist/Self- Audit, shall be utilized by the Contractor to aid in their self-evaluation of safety performance. The contractor s implementation of the safety and health program and the contractor s response to the safety concerns identified by TE Connectivity shall be recorded. The contractor s oversight shall include a review of how changes in the project impact on the safety and health of TE Connectivity personnel. Any significant changes shall be communicated to responsible TE Connectivity Project/Service Managers and/or the Building Contractor Safety Program Coordinator, who will notify their personnel. When TE Connectivity personnel work in the same area or on the same task as the contractor, coordination concerning project specific health and safety requirements shall be addressed prior to the start of activities to ensure the safe and effective completion of work. 6.0 Reporting and Record keeping Requirements Safety violations, job-related accidents and certain contractor activity require specific reporting and record keeping procedures as outlined below. 6.1 Reporting and Correcting Safety Violations In the event that TE Connectivity identifies a potential safety and health hazard, the condition shall be immediately reported to the responsible contractor supervisor and to the TE Connectivity Project/Service Manager. The contractor shall be responsible for correcting the condition. The Project/Service Manager, building management and the Building Contractor Safety Program Coordinator shall determine whether the deficiencies require partial or complete cessation of work pending correction of the hazards. If the identified deficiency presents a hazard to contractor personnel only, the contractor shall correct the situation and provide formal written notification of the correction to the Project/Service Manager. If TE Connectivity personnel are potentially impacted by the safety hazard, the Project/Service Manager shall review the corrective measures to ensure that TE Connectivity personnel are protected. If a corrective action is not taken immediately, the contractor shall identify to the Project/Service Manager the interim measures to be implemented and the anticipated completion time. If the contractor does not correct violations within the specified time frame to the satisfaction of Building Contractor Safety Program Coordinator and/or the Project/Service Manager, the lack of action to correct deficiencies may result in suspension of activities until the corrective action is complete.

18 The contractor shall ensure that each employee/personnel of the contractor or subcontractor understands that an individual who violates safety and health rules and regulations can be removed from TE Connectivity property. 6.2 Reporting Job-Related Accidents In the event of an accident on the job that results in injury to personnel or damage to property, the contractor shall notify the Project/Service Manager and prepare a Contractor Preliminary Report of Accident (Attachment 4) or a workers compensation Employer s Report of Injury/Illness. This documentation shall be faxed to the Project/Service Manager by the close of business on the day of the accident.

19 The Project/Service Manager, together with the Building Contractor Safety Program Coordinator, shall perform an accident investigation and prepare a written narrative (see Attachment 5 for example) regarding the events of the accident in the following instances: An accident involving TE Connectivity personnel or property An accident involving Contractor personnel if the accident could result in lost time or restricted duty of personnel An accident involving a fatality This information shall be reviewed with the Contractor Safety Program Manager within 24 hours. 6.3 Reporting for Maintenance and Construction Contracts The Project/Service Manager, as part of the project completion, can initiate steps to review the implementation of the health and safety program for the project. This review is particularly important for projects of longer duration and scope. Steps in this process include: Requesting that the contractor prepare a report that identifies the hours worked, the number of injuries, and the injury and illness incidence rate for the contractor personnel on the project. Copies of the report should be sent to the Project/Service Manager and the Facility Health and Safety Coordinator who will review the report with the contractor, if necessary. Reviewing the implementation of the project health and safety plan with the contractor. The review should focus on the program effectiveness, identified program strengths and deficiencies, and any records of unsatisfactory performance. The information collected during the review of the contractor s performance can be evaluated to determine the contractor s attitudes and practices relating to safety and to determine whether to retain the contractor on the bidder s list. 6.4 Record Keeping All safety and health records generated during the project (e.g., the records of meetings, records of training, and copies of submittals forwarded by the contractor) shall be maintained by the Project/Services Manager. Upon completion of the project, or at the annual review of services, contract program documentation is to be provided to the Building Contractor Safety Program Coordinator for required record keeping. 7.0 References

20 Title 29, Code of Federal Regulations (CFR), Part 1910 General Industry Standards. Title 29, CFR, Part 1926 Construction Standards. Title 29, CFR, Part Permit-Required Confined Spaces Title 29, CFR, Part The Control of Hazardous Energy (Lockout/Tagout) Title 29, CFR, Part Hazard Communication

21 ATTACHMENT 1 PRE-QUALIFICATION REVIEW GENERAL SERVICES CONTRACTOR A Contractor who would like to perform work for TE Connectivity Corporation must review this information (see Attachment 1A Checklist for summary) and submit the following: A copy of the contractor s written corporate health and safety program and a sample job-specific safety plan. Specific details concerning the submissions presented to TE Connectivity shall depend on the nature of the project and the type of work performed by the contractor. The identification of the company safety representative. Certification or other demonstration, such as a letter signed by a company officer, indicating that any employees utilized on TE Connectivity projects will have current training and certification (as required) in the Contractor s health and safety program and other safety topics specific to project activities (e.g., respiratory protection, hearing conservation, Hazard Communication, HAZWOPER, confined spaces, asbestos, etc.). Contractor personnel must be familiar with the safety and health rules and regulations that TE Connectivity established for the work site, along with applicable rules and regulations mandated by all other federal, state, and local governments. Summary of OSHA 300 log information for the past three years, and the following information for the past year: Number of injuries and occupational illnesses. Number of lost workday cases. Number of restricted workday cases. Number of medical cases with medical attention only. Number of fatalities. Note: Employee personal and private information should be removed from any documentation before submission. Worker Compensation Records, including experience modification rates (EMR) for workers compensation insurance for the three most recent years. Employee personal and private information should be removed from any documentation. A list of any OSHA citations received over the past year. A list of actions taken to mitigate and avoid the same and similar violations. Certificates of insurance, as appropriate, for the services to be performed. Total employee hours worked in the last year.

22 Confirmation that the contractor understands the prohibition against using alcohol or illegal substances on the job site and that personnel will be expelled from the site if they are observed to be under the influence of alcohol or drugs. Review attachments - reproduce earlier reviews ATTACHMENT 1-A PRE-QUALIFICATION REVIEW CHECKLIST GENERAL SERVICES CONTRACTOR Company Name: Date of Submittal: Requirement Received Not Received Comments Corporate Safety Health Program Sample of a Job Specific Safety Plan Site Safety Plan for Project (as appropriate) Identified Safety Representative Identified Site Representative Letter of personnel training verification Copies of PPE Programs as related to project (e.g. Respiratory Protection) Medical Surveillance Program (as appropriate)

23 Fire Safety Plan Emergency Response/Evacuation Plan Written HAZCOM Program Personnel Access to Exposure Records Procedure Incident/Accident Reporting Procedures Drug/Alcohol Policy Review Certificates of Insurance OSHA 200 / 300 Log Information List of OSHA Citations and mitigations Worker Compensation Records Experience Modification Rates (EMR) for 3 most recent years Total personnel hours worked in last year Additional Comments: Reviewed By: Date: Project / Services Manager: Contractor Safety Program Manager: ATTACHMENT 2 HAZARD ANALYSIS FOR CONTRACTOR WORK Work Issues Applicable to Project Yes No Air Resources

24 Asbestos Awareness Blood borne Pathogens Exposure Control Plan Chemical Safety and Handling Confined Space Program (Permit-Required) Electrical Safety Electrical Enclosed Spaces Excavation and Trenching Fire Protection and Prevention Gas Enclosed Spaces Hazard Communication Program Hearing Conservation Insulation Materials (Non-Asbestos) Lead Management Program Management of Change Materials Handling Mechanical Equipment Mercury Management Program Noise Oil and Dielectric Fluid PCB Management Personal Protective Equipment Pesticide Use, Storage, and Disposal Respiratory Protection Program Sampling Vehicle Management Waste Management Water Resources Welding and Burning

25 Name Date Name Date Work Area Protection Working at Elevations Facility Orientation Contractor Safety Orientation Reviewed by: Project / Services Manager: Building Contractor Safety Program Coordinator Contractor Designated Site Safety Representative: Name ATTACHMENT 3 CONTRACTOR CHECKLIST/SELF AUDIT Date DATE: LOCATION: FIRE PREVENTION Extinguishers

26 Housekeeping HAND TOOLS Proper tool being used Damaged tools repaired or replaced POWER TOOLS Tools and Cords in good condition CONTRACTOR: P.O. NO.: INSPECTOR: FIRST AID Kit on hand OK UNACCEPTABLE N/A POWER ACTUATED TOOLS Operators qualified/certified All Tools used on recommended surfaces LADDERS Ladders inspected mechanical safeguards in place

27 Emergency phone numbers posted Ground fault circuit interrupters landing Side rails extend above Ladders secured SCAFFOLDS Proper footing provided Proper ladder for application Proper footing provided Guardrails in place Toe boards in place Ropes and cables in good condition Safety lines in use ATTACHMENT 3 (CONTINUED) CONTRACTOR CHECKLIST CRANES AND DERRICKS OK UNACCEPTABLE N/A Guards

28 HEAVY EQUIPMENT Lights, brakes, warning signals Rollover protection EXCAVATIONS Barricades in place Outriggers used Adequate clearance PERSONAL PROTECTIVE EQUIPMENT Hard hats Shoring/sheeting Ladders where required Spoil distance maintained Hearing protection Eye and face protection Respiratory protection Proper clothing Safety shoes Gloves ELECTRICAL Temporary Electrical Supply LOCK OUT Electrical Stored Energy Compressed Air Hydraulics REMARKS:

29 ATTACHMENT 4 CONTRACTOR PRELIMINARY REPORT OF ACCIDENT (Typical) CONTRACTOR EMPLOYEE VEHICLE CONTRACTOR NAME: EMPLOYEE NAME: LOCATION: LOCATION/PROJECT DESCRIPTION: DATE/APPROX. TIME: CONTRACTOR PERSONAL INJURIES: PUBLIC PERSONAL INJURIES: VEHICLE NO./TYPE: DESCRIPTION OF ACCIDENT: TELEPHONE: MEDICAL ACTION TAKEN: IMMEDIATE CORRECTIVE ACTION TAKEN:

30 SIGNATURE OF PERSON RECORDING ACCIDENT VIA TELEPHONE ATTACHMENT 5 SIGNATURE OF PERSON REPORTING ACCIDENT EXAMPLE NARRATIVE OF LOST TIME ACCIDENT Date: Tuesday, 15 June :48 a.m. To: Graves, J.; Tracer M.; O Brien V. From: Carroll C. Subject: Contractor Accident On Monday, May 14, 1999, at approximately 11:00 a.m., Mr. James Dyers, 29, an employee of Gibson, Inc., was injured at Harrisburg TE Connectivity Bldg #XXX. Mr. Dyers was injured when he fell approximately 10 feet from a ladder from which he was working. The ladder had been secured with stainless steel wire, which broke and caused the ladder to move. When he fell, he struck his left rib cage on a pipe and his left shoulder on the concrete floor. He was transported by ambulance to Harrisburg General Hospital where he was treated for fractured ribs and a dislocated shoulder and admitted.

31 ATTACHMENT 6 CONTRACTOR LETTERHEAD Enter the Date Here TE Connectivity Corporation P.O. Box 3608, Mail Stop Harrisburg, PA Attn: Contract Safety Program Administrator Reference: Safety Compliance Dear Mrs. Witters, This letter acknowledges receipt of TE Connectivity Corporation s Contractor Safety Program dated. Our Company has reviewed and understands the Program details and agrees to comply with the Contractor Safety Program, including but not limited to the responsibilities and requirements expressly outlined in Paragraphs 4.5, 4.6, 5 and 6. As requested, enclosed you will find a copy of our current proof of insurance certificate and a summary of our OSHA 300 log for the last three years. Our Company acknowledges that our agreement to comply with the Program does not obligate TE Connectivity to make any purchase of services from us. TE Connectivity and our Company understand that nothing in the Program materials is intended to or will be construed to create any

32 partnership, joint venture or joint enterprise, nor shall either party be deemed to be the employee, agent or legal representative of the other for any purpose whatsoever. Our Safety Representative is, xxx-xxx-xxxx, ext. xxx. address - xxxxx@xxxxxx.xxx Please contact me if you have further questions. Sincerely, Company Name Senior Mgmt. Name w/signature above Title ATTACHMENT 7 Sample Site Specific Contractor Safety Guide

33 TE Connectivity Revision Date 1/30/14