siemens - Public Service Commission

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Progress Energy
Contractor's Safety In~~Pmatiorl/ChecI~l~st Form
PURPOSE: Please supply the following safety tnformation foi your company. Safety IS important to Progress Energy arid
will be used as criteria in selecting contractois NOTE: 1NCOMPLE'PE FORMS CANNOT BE PROCESSED.
IC%ON 1; TO BE COMPLETED 8Y THE CONTRACTOR 1
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Please provide your cirrrent written safety inanual (diskette or CD-ROM, if possible) (Nota:
Unless there are changes to the manual, resvbmission is not neccssary foi annual reviews).
Does your company have a high level CorpOratQ officer responsible for safety compliance?
Title. Director, Ettvivoiirnental Wealth aitd SaFety
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- your company have a formal safety program to assure compliance yth.safety regiilatiorts?
Does program ii'CWe: .
e Job hazard ___--I__.__. analvsis and coiitrol .
. 0 Medical management of work related injuries and illnesses
* On-site supervision to ensirre con,pliance with safety regctlations and Progress Energy
s?!etY..P.o!icles
Pre-qualification and management of subcontractors to ensure conipliance with safety
regulations -. and Progress Energy Safety policies
Does your company hold periodic crewlteam safety meetings? -
0 How Often? Site Safoty Meetings are helrf wookly.
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Does your company provide and docuineut requited initial and roftcshor training to prepare
employees to perform duties if) compliance with safety regiilations? NOTE: If a contract is
awarded, the DR will need this documentation prior to commonceinent of work for Progress
Enerov.
CDmpliance History
Has a serioiis. willful or repeat OSHA citation been issued to your company within the last thiee
yeais? (Please check the OSHA web site at http://www osha.aov/pls/iiiiis/establishnient, htnil )
If yes, please provide a copy of the citation and 8 certification of abatement.
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Has your company andlor aiiy of its officers beei
any vlolation of any federal or
state occupational health and safety laws?
ff yes, please attach a description of this case, including its resolution.
Line & Service Contractors: Is your Federal Motor Carrier Safety Rating Satisfadory? (Can be
louncl at h t t j , ~ ~ . ~ ~ ) If ~ not, ~ ~ state ~ ~ what ~ : the ~ rating is (Unsatisfactory or
Conditloital).
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FKM-%US 00478
Apph to: Pragrea Energy Carolinas, I N , Pmgresr Energy Fiorlda, inc ; Piwresr Cwigy Mice Company, 11c: Rev 5 74%
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