AGREEMENT between BROWARD COUNTY and Cummings ...

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Exhibit 2 Page 194 of 379 INCIDENT/ ACCIDENT INVESTIGATION FORM Report # Contractor Name: Contract Number: Employee: Job Title: Social Security #__ __ __ - __ __ - __ __ __ __ Date of Injury:_______________________________________________ Time:__________________am pm Time & Date Reported _____________________________________________________am Location of Incident: to on site Medical: pm Employee Supervisor: Type of Injury: Body Part(s) Affected: Disposition: Employee Not Sent To Dr. Yes No Employee Refused Treatment Sent To: Yes No Project Safety Notified Emergency Room Personal Physician Yes No Project Security Notified Onsite First Aid Station Time: ________ Person Notified:_________________________________________________________ Time: _____________ Person Notified:____________________________________________________ Other_________________ Lost Time Projected Time Out:________________________________________________________ ______________________ Lost Time - Restricted Duty Projected Time Out:________________________________________________________ ____________________ Medical Recordable Name & Address of medical provider:____________________________________________________________________________________________________ Attending Nurse:_____________________________________________________________________________________________________________________ Describe In Detail What Employee Was Doing at the Time of Accident Witnesses: Circle Numbers Identifying Contributing Factors: 1. Absent/Improper Guarding 2. Defective Equipment 3. Weather/Temperature 4. Inappropriate Personal Protective Equipment 5. Inadequate Housekeeping 6. Slippery/Uneven Walking Surface 7. Improper Storage or Placement of Materials 8. Inadequate Ventilation 9. Inadequate Lighting or Noise Control 10. Improper Layout of Area 11. Insect/Animals in Work Area 12. No Unsafe Condition Identified 13. Other:__________________________________________________ Describe Contributing Factors: 14. Operating Without Authority 15. Improper Use of Equipment 16. Inadequate Procedures 17. Use of Defective Equipment/Tools 18. PPE Not Used 19. Inadequate Training 20. Improper Position or Posture 21. Horseplay 22. Altercation 23. No Unsafe Act Identified 24. Other:__________________________________________________________ 25. Other:__________________________________________________________ 26. Other:________________________________________ What actions are being taken to prevent recurrence (Use additional paper if necessary) Was SPA developed for task performed at time of accident Yes No (If yes, attach copy to this form.) Yes No did you speak with the employee regarding this incident Yes No Has employee returned to work Yes No Were statements taken Yes If not, Last Day Worked:___________ Terminated or laid off___________ No Was employee aware of impending layoff/termination Investigation team members: Reviewed by: Supervisor Contractor Safety Representative/Date Project Safety Manager/Date Date of Investigation H
Exhibit 2 Page 195 of 379 WITNESS STATEMENT NAME: DATE: TIME: Project ID# SOCIAL SECURITY NO: - - TEMPORARY ADDRESS: PHONE: PERMANENT ADDRESS: PHONE: LOCATION AT TIME OF ACCIDENT: DESCRIBE, TO THE BEST OF YOUR KNOWLEDGE, HOW THE ACCIDENT HAPPENED: Signature I
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Exhibit 2 Page 1 of 379 AGREEMENT b
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Exhibit 2 Page 3 of 379 Terminal 4
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Terminal 4 Gate Replacement - Weste
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Exhibit 2 Page 99 of 379 Owner Cont
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Exhibit 2 Page 101 of 379 TABLE OF
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Exhibit 2 Page 103 of 379 OVERVIEW
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Exhibit 2 Page 105 of 379 OVERVIEW
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Exhibit 2 Page 107 of 379 OCIP PROG
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Exhibit 2 Page 109 of 379 OCIP INSU
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Exhibit 2 Page 111 of 379 OCIP INSU
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Exhibit 2 Page 113 of 379 CONTRACTO
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Exhibit 2 Page 123 of 379 CLAIM REP
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Exhibit 2 Page 125 of 379 CLAIM REP
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AONWRAP WEB INSTRUCTION Exhibit 2 P
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AONWRAP WEB INSTRUCTION 10. Type yo
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AONWRAP WEB INSTRUCTION Exhibit 2 P
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Exhibit 2 Page 133 of 379 Form-3 En
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Exhibit 2 Page 135 of 379 Enrollmen
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Form-4 On-Site(s) Payroll Report In
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Form-5 Notice of Work Completion In
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Exhibit 1 - Sample Certificate of I
Page 143 and 144: Exhibit 3 - First Report of Injury
Page 145 and 146: Exhibit 2 Page 145 of 379
Page 147 and 148: TABLE OF CONTENT Exhibit 2 Page 147
Page 149 and 150: Exhibit 2 Page 149 of 379 SECURITY
Page 151 and 152: INTRODUCTION Exhibit 2 Page 151 of
Page 153 and 154: DEFINITIONS Exhibit 2 Page 153 of 3
Page 155 and 156: ACRONYMS Exhibit 2 Page 155 of 379
Page 157 and 158: Conduct hazard communication traini
Page 159 and 160: 12. Review and evaluate contractors
Page 161 and 162: or minimize exposures that will or
Page 163 and 164: 2) Positioning device system allows
Page 165 and 166: F. Welding and Cutting Exhibit 2 Pa
Page 167 and 168: 13) Complete and file on site a Loc
Page 169 and 170: M. Job Safety Analysis Exhibit 2 Pa
Page 171 and 172: SAFETY TRAINING Exhibit 2 Page 171
Page 173 and 174: 4. Contractor Safety Audit This Saf
Page 175 and 176: d) The OCIP insurance carrier perso
Page 177 and 178: Exhibit 2 Page 177 of 379 EMERGENCY
Page 179 and 180: Obtain a hurricane tracking and inf
Page 181 and 182: SECURITY Exhibit 2 Page 181 of 379
Page 183 and 184: D. Security - General Project Rules
Page 185 and 186: I. Delivery and Removal of Material
Page 187 and 188: Exhibit 2 Page 187 of 379 FIRST REP
Page 189 and 190: Exhibit 2 Page 189 of 379 CONTRACTO
Page 191 and 192: Exhibit 2 Page 191 of 379 d. Analyz
Page 193: Exhibit 2 Page 193 of 379 4. PPE cu
Page 197 and 198: Exhibit 2 Page 197 of 379 Sequence
Page 199 and 200: Exhibit 2 Page 199 of 379 LOCK-OUT
Page 201 and 202: Exhibit 2 Page 201 of 379 ORIENTATI
Page 203 and 204: Exhibit 2 Page 203 of 379 SAFETY OB
Page 205 and 206: Exhibit 2 Page 205 of 379 CONTRACTO
Page 207 and 208: Exhibit 2 Page 207 of 379 DIVISION
Page 209 and 210: DIVISION 1 SPECIFICATIONS - SECTION
Page 215 and 216: DIVISION 1 SPECIFICATIONS SECTION 0
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DIVISION 1 SPECIFICATIONS SECTION 0
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DIVISION 1 SPECIFICATIONS - SECTION
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Exhibit 2 Page 303 of 379 DIVISION
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Exhibit 2 Page 311 of 379 DIVISION
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Exhibit 2 Page 329 of 379 PART 1 -
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Exhibit 2 Page 331 of 379 Broward C
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Badging Requirements and Ramp Drivi
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Exhibit 2 Page 349 of 379 EXHIBIT 1
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Exhibit 2 Page 351 of 379 NUMBER VE
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TERMINAL 4 GATE REPLACEMENT - WESTE
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Exhibit 2 Page 359 of 379 TERMINAL
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Exhibit 2 Page 361 of 379 TERMINAL
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Exhibit 2 Page 363 of 379 FORM 1: C
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Exhibit 2 Page 365 of 379 FORM 3 FO
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Exhibit 2 Page 367 of 379 FORM 4: F
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Exhibit 2 Page 369 of 379 FORM OF P
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Exhibit 2 Page 371 of 379 FORM OF P
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MONTHLY (CBE) UTILIZATION REPORT Ex
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FINAL (CBE) UTILIZATION REPORT Exhi
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Exhibit 2 Page 377 of 379 CBE UNAVA
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Exhibit 2 Page 379 of 379 CERTIFICA
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AGREEMENT between BROWARD COUNTY and Cummings ...

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