TABLE OF CONTENTS

PART 1 GENERAL SAFETY AND HEALTH MANUAL 1

Goal and Purpose 2

Objectives 2

Responsibilities 3

Management 3

Safety Department 3

Project Managers 4

Project Managers / Superintendents 4

Superintendents 4

Drivers 5

Operators 5

Employees 5

Safety and Health Procedures 6

Accountability 6

Enforcement-Progressive Discipline Procedures 7

Pre-Planning 7

Employee Participation 7

Site Safety Inspections 7

Accident Investigation and Prevention 8

Personal Protective Equipment 8

New and Re-Hired Employee Orientation 8

Training 8

Technical Support 9

Emergency and First Aid 10

Emergency Procedures 10

Fire 10

First Aid 10

Accident Reports / Record Keeping---------------------------------------------------------------------------------- 11

Documentation 11

Sub-Contractor Selection 11

Safety and Health Manual Revision 12

Safety Library / Safety Board 12

Distribution of Safety and Health Manual 12

PART 2 JOB SPECIFIC WORK RULES 13

Abrasive Grinding 14

Access / Egress 14

Aerial Lift 14

Air tools 14

Compressed Air 14

Compressed Gas Cylinders 15

Concrete and Masonry Construction 15

Confined Spaces 15

Cranes------------------------------------------------------------------------------------------------------------- 15

Drinking Water 16

Electrical – General 16

Employee / Subcontractor Conduct 16

Excavation and Trenching 17

Eye and Face Protection 17

Fall Protection 17

Fire Protection 18

Flag Personnel 18

Flammable and Combustible Liquids 18

Foot Protection 19

Gases, Vapors, Fumes, Dusts, and Mists 19

Hand Tools 19

Hard Hats 19

Hearing Protection 19

Heating Devices, Temporary 20

Housekeeping 20

Lasers 20

Ladders 21

Lighting 21

Liquefied Petroleum Gas 21

Motor Vehicles and Construction Equipment 22

Personal Protective Equipment 22

Powder - Actuated Tools 22

Power Transmission, Mechanical 22

Protection of the Public 23

Rollover Protective Structures (ROPS) 23

Respiratory Protection 23

Rules for Drivers of All Vehicles 23

Rules for Operators 24

Saws 24

Scaffolds 25

Signs 25

Storage 26

Toilets 26

Washing Facilities 26

Welding, Cutting and Heating 26

Wire-Ropes, Chains, Ropes and Other Rigging Equipment 27

Working/Walking Under Suspended Loads 27

PART 3 SPECIFIC SAFETY AND HEALTH POLICIES AND PROGRAMS 28

Substance Abuse Program 29

Hazard Communication Program 33

Automobile Safety Policy 35

Demolition Safety Policy 41

PART 4 EMPLOYEE ORIENTATION PACKAGE 42

PART 5 COMPANY FORMS

All management and supervisory personnel are charged with the responsibility for planning safety into each work task and for preventing the occurrence of incidents and/or controlling conditions/actions that could lead to occupational injuries or illness. The ultimate success of a safety program depends upon the full cooperation of each individual employee. Management at CDM Atlanta, Inc., d.b.a.: Georgia Blind Company® assumes the responsibility and is prepared to take the necessary actions to see that safety rules and practices are enforced.

Our goal is the total elimination of accidents from our operations.

Sincerely,

Michael J. Lennon

President

To reflect management’s commitment to provide a safe and healthy working environment for all employees, subcontractors and vendors.

To establish a set of policies and requirements that management and employees can use as guidelines in their efforts to ensure a safe and healthy working environment.

To be in compliance with all federal, state and local safety and health regulations.

To be in compliance with all of our clients’ safety and health rules and regulations.

Achieve our goals of …zero injuries

Management, Project Managers, Superintendents, sub-contractors, vendors, visitors and all employees are responsible for the compliance with this Safety and Health Manual. A summary of each party’s responsibilities is outlined below.

It is the responsibility of management to establish rules and programs designed to promote safety and health;

to make known to all employees the established rules and programs and to impress upon all employees the responsibility and accountability of each individual to maintain a safe and healthful workplace.

Management will ensure that appropriate safety and health training is provided, that inspections are performed, and that accident investigations are conducted and reviewed.

Management will designate a person to administer the Safety and Health Program, which includes the general Safety and Health Manual and Specific Safety and Health Manuals. This person has the following duties:

Answer questions concerning the Safety and Health Manual.

Keep all copies of the Safety and Health Manual up-to-date.

Keep all documentation concerning the Safety and Health Manual up-to-date.

 

 

Name: Michael J. Lennon

Phone: 770-487-6041

Cell: 404-557-5221

 

Project Managers are responsible for maintaining safe and healthful working conditions under their supervision.

Project Managers and Superintendents are responsible for coordinating their safety efforts with each other.

Superintendents are responsible for maintaining safe and healthful working conditions on the jobsite(s) under their supervision.

Superintendents are responsible for carrying out the planning of the Project Managers and making the Project Managers aware of any new conditions or hazards that may arise.

Superintendents will continually conduct (at least daily) inspections of jobsite(s) material or equipment. The Superintendent conducting these inspections must be capable of identifying existing and predictable hazards in the work environment, of identifying working conditions, which are unsanitary, hazardous, or dangerous to employees, and of identifying unsafe behavior. In addition, Superintendents must have the authority to take prompt corrective measures to eliminate or control hazards and correct unsafe behavior. Hazards and corrective actions will be documented for each inspection.

Superintendents will ensure that prompt medical attention for any injured employee is available, and will report in writing all accidents and injuries to Project Managers and/or the Safety and Health Coordinator.

Superintendents make sure personal protective equipment (PPE) is available and is being used correctly. Training on PPE is provided, on site, by the Superintendents.

Superintendents are responsible for filling out the Accident Report within 24 hours of the Accident.

Superintendents are responsible for having the appropriate up-to-date Material Safety and Data Sheets (MSDS) on their jobsite.

Superintendents are responsible for all weekly safety meetings, both company and sub-contractors. All safety meetings shall be documented & maintained at each job site.

Superintendents are responsible for ensuring all safety rules & regulations are followed on the jobsite, by ALL employees, workers, visitors, sub-contractors, etc.

Superintendents are responsible for submitting accident/incident reports and reviewing all

Accidents with the Safety and Health Coordinator.

Drivers are expected to drive safely at all times. Drivers will abide by all federal and state laws regarding the safe operation of vehicles on public roads.

Drivers must meet the requirements outlined in Part 2 Job Specific Work Rules under the section "Rules for Drivers".

Operators are expected to operate their equipment safely at ALL times.

Operators of heavy equipment must meet the requirements outlined in Part 2 Job Specific Work Rules under the Section "Rules for Operators".

It is the responsibility of all employees to work safely to ensure their own safety as well as the safety of co-workers and others. Employees are encouraged to ask for assistance when unsure about how to safely perform any task.

The safety and health goal and objectives will be realized by implementation of policies outlined under the following headings:

Accountability

Enforcement / Progressive Discipline Policy

Pre-Planning

Employee Participation

Site Safety Inspections

Accident Investigations and Prevention

Personal Protection Equipment

New & Re-Hired Employee Orientation

Training

Technical Support

Documentation

 

Project Managers and Superintendents are accountable for improving the safety performance of personnel under their supervision.

A Safety Committee will be established. The Safety Committee shall perform the following:

Establish safety and health goals.

Feed back on safety performance on a regular basis.

Recommend rewards and promotions based on safety excellence.

If any employee has knowledge of any existing safety hazard, and they have brought it to their supervisor’s attention without results, please respond to Safety and Health Coordinator, and the situation will be promptly investigated.

First Violation: A written warning, followed by an explanation

and/or training.

Second Violation: A written warning, management review of written

warning; followed by one of the following actions:

Subject to Suspension, without pay

Subject to Re-Training

Subject to Termination

Third Violation: Mandatory Re-Training

Subject to Termination

Exceptions:

The progressive discipline policy will be suspended, if an employee commits a gross violation of these Safety and Health Manuals or participates in an unsafe act that poses an immediate danger to the life and health of themselves or other employees. The employee will be immediately suspended without pay or terminated.

If an employee commits a substance abuse violation (as described in the Substance Abuse Program) that employee is subject to the disciplinary measures outlined under the Substance Abuse Program.

The pre-planning of jobs will include attention to the elimination or control of safety and health hazards, and all items in the company Safety and Health Manual.

Employees are encouraged to make the Safety and Health Coordinator aware of any safety and health issues.

Employees are encouraged to make recommendations for the elimination or control of safety and health hazards.

All safety and health issues brought up by the employees will be reviewed and responded to by management in a timely manner.

Site safety inspections will be conducted on a regular basis to determine jobsite hazards, methods to eliminate or control the hazards and ensure that safe work practices are being implemented.

Accidents will be investigated to prevent future mishaps.

All Accidents must be reported to the Safety and Health Coordinator.

An Accident Investigation Report must be filled out for each Accident by the Supervisor of the employee involved in the Accident.

All Accidents will be reviewed by the Safety and Health Coordinator to determine future prevention measures.

Definitions:

Accident: An "accident" is one in which 1) a fatality occurs, or 2) an individual in the accident immediately receives medical treatment away from the accident scene, 3) a driver of a commercial motor vehicle receives a citation for a moving traffic violation arising from an accident or 4) there is damage to company property, the property of others or public property.

 

All employees will be trained on the proper use and maintenance of personal protective equipment (PPE).

The Safety and Health Manual will be reviewed with all new hired and/or re-hired employees prior to beginning work. New hired and/or re-hired employees will be required, prior to beginning work, to sign a statement of employee understanding regarding the Safety and Health Manual.

All training will be documented and entered into employee’s personnel files and safety records.

Project Managers and Superintendents meetings will be conducted on a regularly scheduled basis. Some of the topics for these meetings will focus on their responsibility as outlined in the Safety and Health Manual.

They will be trained to identify hazards, hazard control and the training of other employees, subcontractors and vendors on safe work practices and procedures.

On-site training will cover such topics as:

a) Safety rules and/or regulations.

b) Site specific hazards.

c) Safe work practices.

Procedures being used to eliminate specific hazards.

Training on personal protective equipment.

Other topics the Superintendents or the Safety and Health Coordinator deem necessary.

The Superintendents are responsible for weekly toolbox safety meetings on site-specific safety and health hazards.

The Superintendents document each session topic and attendance is recorded.

The Superintendent, with the aid of the Safety and Health Coordinator, will determine the emergency phone numbers for each jobsite. The Superintendent will post the emergency numbers in such a manner that every employee of a jobsite will be aware of the location of the emergency phone numbers.

All sites / departments, etc. of this company should have at least 1 (one) person trained in emergency first aid and CPR.

First aid for minor injuries will be administered on the jobsite. If the injury requires immediate medical treatment beyond first aid, the Superintendent will call the appropriate emergency number to receive immediate medical treatment.

If the injury does not require immediate medical treatment, but does require medical treatment beyond first aid, the Superintendent shall arrange transportation for the employee to the appropriate emergency medical facility.

If the injury is minor, and first aid treatment is required by the Superintendents appropriate action should be taken to prevent exposure to blood borne pathogens and the exchange of body fluids.

All employees must notify their supervisor and/or the Safety and Health Coordinator of any first aid uses or occurrences.

Refusal of first aid by any employee should be noted in writing on the Medical Treatment Refusal Form and turned in to the office.

Each recordable event will be entered no later than 5 (five) working days after receiving the information.

The current and previous year OSHA 200 summary shall be posted by February 1, and shall remain in place all year.

The OSHA 200, (log and summary), the OSHA 101, (supplementary record), shall be retained for five years following the end of the year to which it relates.

All documentation relating to the Safety and Health Manual will be kept up-to-date and filed in such a manner that it will be readily accessible. Project Managers and Superintendents are required to file all appropriate documentation in a timely manner with the Safety and Health Coordinator.

Safety and health performance will be one of the criteria used to select subcontractors. The safety and health guidelines outlined below will be used to evaluate subcontractors. Copies of the following must be submitted to Safety and Health Coordinator prior to starting work.

3 year EMR "Mod-Rate"

Safety and Health Manual

Substance Abuse Program

The Safety and Health Manual is a working document and will be revised and updated as necessary.

At a minimum, the Safety and Health Manual will be reviewed and updated on an annual basis.

A "Safety Library" and "Safety Bulletin Board" will be established with an up-to-date, current copy of the

A current copy of the OSHA standards will be in the "Safety Library " also.

Many other safety related items will be available on the "Safety Library" & "Safety Bulletin Board".

Up-to-date copies of the Safety and Health Manual will be available to all employees, subcontractors and vendors through the Safety and Health Coordinator.

In addition, Project Managers and Superintendents will have up-to-date copies of the Safety and Health Manual, which is to be kept in their vehicles at all times, or in the field office, where applicable.

Abrasive wheel bench or stand grinders must have safety guards strong enough to withstand bursting wheels. [1926.303(b) & (c)(1)]

Adjust work rest on grinders to a clearance not to exceed 1/8 inch between rest and wheel surface. [1926.303(c)(2)]

Inspect and ring-test abrasive wheels before mounting. [1926.303(c)(7)]

Always leave wheel in working condition for next user. Properly dress wheel before and after use.

Do not jump on or off equipment and/or vehicles.

Use only safe means of access/egress to and from work areas. Jumping from or to work areas is not allowed, nor is sliding down cables, ropes or guys.

Keep all equipment, vehicles, footwear, access areas, etc. clean at all times.

Employees shall have adequate training and proper authorization prior to operating any Aerial Lift. [1926.453(b)(2)(ii)]

All modifications to any aerial lift, must have written approval from the manufacturer. [1926.453(a)(2)]

Secure pneumatic tools to hose in a positive manner to prevent accidental disconnection. [1926.302(b)(1)]

Install and maintain safety clips or retainers on pneumatic impact tools to prevent attachments from being accidentally expelled. [1926.302(b)(2)]

The manufacturer’s safe operating pressure for all fittings shall not be exceeded. [1926.302(b)(5)]

All hoses exceeding ½ inch inside diameter require safety devices at the source of supply to reduce pressure in case of hose failure. [1926.302(b)(7)]

Compressed air used for cleaning purposes may not exceed 30 psi, and then only in conjunction with effective chip guarding and personal protective equipment. [1926.302(b)(4)]

Exceptions to 30 psi are allowed only for concrete form, mill scale, and similar cleaning operations. [1926.302(b)(4)]

The use of compressed air to clean off yourself or other workers is not allowed.

Put valve protection caps in place before compressed gas cylinders are transported, moved or stored. [1926.350(a)(1)]

Cylinder valves will be closed when work is finished and when cylinders are empty or being moved. [1926.350(a)(8)]

Compressed gas cylinders shall be secured by a cart, chain, etc. at all times. [1926.350(a)(7)]

Keep cylinders at a safe distance, or shield from welding or cutting operations and place where they cannot become part of an electrical circuit. [1926.350(b)(1)&(b)(2)]

Oxygen and fuel gas cylinders (in storage), shall be separated by a five-foot high non-combustible wall. The wall must have a fire-resistance rating of at least one-half hour or a 20-foot separation. [1926.350(a)(10)]

Oxygen and fuel gas regulators must be in proper working order while in use. [1926.350(h)]

No construction loads shall be placed on the structure until the structure is capable of supporting the load. [1926.701(a)]

No employee shall work under concrete bucket while the bucket is being elevated or lowered into position. [1926.701(e)(1)]

Only authorized employees shall be allowed in the "limited access zone" of masonry walls construction. [1926.706(a)(1)-(5)]

All protruding reinforced steel onto and into which employees could fall shall be guarded to eliminate the hazard of impalement. [1926.701(b)]

All manufacturer specifications and limitations must be followed. [1926.550(a)(1)]

All Equipment shall be inspected, by a competent person, prior to use. [1926.550(a)(5)]

Accessible areas of the "swing radius" shall be barricaded to prevent employees from being struck or crushed by the crane. [1926.550(a)(9)]

The use of a crane to hoist employees is prohibited. [1926.550(g)(2)]

An adequate supply of potable drinking water shall be provided in all places of employment. [1926.51(a)(1)]

Potable drinking water containers shall be capable of being tightly closed and be equipped with a tap. [1926.51(a)(2)]

The common drinking cup is prohibited. Cup dispensers and disposable cups shall be provided. [1926.51(a)(4)]

A sanitary container for unused cups and a receptacle for used cups shall be provided. [1926.51(a)(5)]

All 120-volt, single phase, 15- and 20- ampere receptacles must be protected by G.F.C.I.s. [1926.404(b)(1)(ii)]

All extension cords shall be inspected daily, prior to use, for damage or defects. [1926.404(b)(1)(iii)(c)]

Continuity test shall be conducted on all extension cords, generally every three months [1926.404(b)(1)(iii)(D)&(E)]

Temporary lights shall not be suspended by their cords. [1926.405(a)(2)(ii)(F)]

Workspaces, walkways and similar locations shall be kept clear of cords. [1926.416(b)(2)]

All extension cords must be 3-wire type, protected from damage, and not fastened with staples, hung from nails or suspended from wires. [1926.416(e)(2)] & [1926.405(a)(2)(ii)(J)]

No cord or tool with a damaged ground plug shall be used. [1926.404(b)(iii)(c)]

Splices must be soldered wire connections with insulation equal to the cable. [1926.403(e)]

Worn or frayed cables may not be used. [1926.416(e)(1)]

Cables passing through work areas will be covered or elevated to protect from damage. Boxes with covers for the purpose of disconnecting must be securely and rigidly fastened to mounting surface.

No employee may work in proximity to any electric power circuit that may be contacted during the course of work, unless protected against electric shock by de-energizing circuit and grounding it or by guarding with effective insulation. [1926.416(a)(1)]

In work areas where exact location of underground electric power lines is unknown, workers using bars or other hand tools, which may contact lines must wear insulated protective gloves. [1926.416(a)(2)]

No "cat-calling" and/or any form of sexual harassment will be tolerated.

Willful destruction of company property, (i.e., cutting back-up alarm wires or seatbelts) may result in immediate dismissal.

Any employee caught stealing anything, will be terminated.

Eye and face protection must be worn when machines or operations present potential eye or face injury. [1926.102(a)(1)]

Employees involved in welding operations must wear filter lenses or plates of the proper shade number. [1926.102(b)(1)]

Employees exposed to laser beams, by DIRECT and/or EXTENDED amounts of time, shall be furnished suitable laser safety goggles, which will protect for the specific wavelength of the laser and be optical density (O.D.) adequate for the energy involved. [1926.102(b)(2)]

Eye and face protective equipment shall meet all requirements of ANSI Z 87.1-1968, "Practice of Occupational and Educational Eye and Face Protection". [1926.102(a)(2)]

Goggles will be worn over any employee owned prescription glasses that do not meet industrial safety standards. [1926.102(a)(3)]

Where employees are exposed to falling 6 feet or more from an unprotected side or edge, other than when on a scaffold, the employer must select and use a guardrail system, safety net system, or a personal fall arrest system to protect the worker from falls. [1926.501(b)(1)]

A personal fall arrest system consists of an anchorage, connectors, a body harness and may include a lanyard, a deceleration device, lifeline or a suitable combination of these. [1926.500 (b)] & [1926.502(d)]

Each employee in a hoist area shall be protected from falling 6 feet or more by guardrail systems or personal fall arrest systems. If guardrail systems (or chain gate or guardrail) or portions thereof must be removed to facilitate hoisting operations, as during the landing of materials, and a worker must lean through the access opening or out over the edge of the access opening to receive or guide equipment and materials, that employee must be protected by a personal fall arrest system. [1926.501(b)(3)]

Personal fall arrest systems, covers, or guardrail systems must be erected around holes (including skylights) that are more than 6 feet above lower levels. [1926.501(b)(4)]

Each employee using ramps, runways, and other walkways shall be protected from falling 6 feet or more by guardrail systems. [1926.501(b)(6)]

Each employee engaged in roofing activities on low-slope roofs with unprotected sides and edges shall be protected from falling by guardrail, safety net, or personal fall arrest systems or a combination of a

Warning line system and guardrail system.

Warning line system and safety net system.

Warning line system and personal fall arrest system, or

Warning line system and safety monitoring system. [1926.501(b)(10)]

 

A fire protection program is to be followed throughout phases of the construction and demolition work involved. It shall provide for effective fire fighting equipment to be available without delay, and designed to effectively meet all fire hazards as they occur. [1926.150(a)(1)]

Fire fighting equipment shall be conspicuously located and readily accessible at all times, and periodically inspected and maintained in operating condition. [1926.150(a)(2) through (a)(4)] Report any inoperative or missing equipment to your superintendent/foremen.

Fire extinguishers, rated not less than 2A, will be provided for each 3,000 square feet of building area (or major fraction). Travel distance from any point to the nearest fire extinguisher may not exceed 100 feet. [1926.150(c)(1)(i)]

Fire extinguishers should be mounted 48" to 60" off the floor.

When signs, signals, and barricades do not provide necessary protection on or adjacent to a highway or street, flag personnel or other appropriate traffic controls shall be provided. [1926.201(a)(1)

Flag personnel shall wear a red or orange warning garment while flagging. Warning garments worn at night will be reflectorized material. [1926.201(a)(4)] & [1926.651(d)]

Only approved containers and portable tanks shall be used for storage and handling of flammable and combustible liquids. [1926.152(a)(1)]

All containers must be labeled with appropriate hazardous warnings. Keep flammable liquids in closed containers when not in use.

Post conspicuous and legible signs prohibiting smoking in service and refueling areas. [1926.152(g)(9)]

No smoking within 25’ of any fuel storage and/or fueling operations.

Employees shall wear shoes or boots that give ankle support and that have a hard sole.

No sneakers, tennis shoes or open toed shoes are permitted.

Exposure to toxic gases, vapors, fumes, dusts, and mists at a concentration above those specified in the "Threshold Limit Values of Airborne Contaminants for 1970" of the ACGIH, shall be avoided. (American Conference of Government Industrial Hygienists) [1926.55(a)]

When engineering and administrative controls are not feasible to achieve full compliance, protective equipment or other protective measures shall be used to keep the exposure of employees to air contaminants within the limits prescribed. Any equipment and technical measures used for this purpose must first be approved for each particular use by a competent industrial hygienist or other technically qualified person. [1926.55(b)]

Employers shall not issue or permit the use of unsafe hand tools. [1926.301(a)]

Wrenches shall not be used when jaws are sprung to the point slippage occurs. Keep impact tools free of mushroomed heads. Keep wooden tool handles free of splinters or cracks and assure a tight connection between the tool head and the handle. [1926.301(b),(c) & (d)]

Electric-power operated tools shall either be approved double insulated or be properly grounded, and used with ground fault circuit interrupters. [1926.302(a) & 1926.404(b)(1)]

Employees working in areas where there is a possible danger of head injury from impact, or from falling or flying objects, or from electrical shock or burns, shall be protected by protective helmets. [1926.100]

Hard Hats will be worn when required.

Hard Hats shall be worn correctly.

When engineering or administrative controls fail to reduce sound levels within the limits of Table D-2, ear protective devices shall be provided and used. [1926.52(b) & 1926.101(a)]

In all cases where sound levels exceed the values shown in Table D-2 of the Safety and Health Standards, a continuing, effective hearing conservation program shall be administered. [1926.52(d)(1)]

Plain cotton is not an acceptable protective device. [1926.101(c)]

When heating devices are used, fresh air shall be supplied to maintain the safety and health of employees. [1926.154(a)(1)]

Solid fuel salamanders are prohibited. [1926.154(d)]

Clean up everyday all areas, including but not limited to, jobsite, vehicles, shop, office, equipment, tools, etc.

Scrap lumber and other debris will be kept clear from work areas at all times. [1926.25(a)]

Remove combustible scrap and debris at regular intervals. [1926.25(b)]

Containers will be provided for collection and separation of all refuse. Covers are required on containers used for flammable or harmful substances. [1926.25(c)]

At the end of each phase of work, return all tools and excess material to proper storage. Clean up all debris before moving on to the next phase. Each employee, is responsible for keeping their work areas clean.

All vehicles and/or equipment must be free of loose debris, dirt, mud, etc., before operation on public roads.

Whenever materials and/or trash are dropped more than 20 feet, an enclosed chute shall be used. [1926.252(a)]

Nails shall be withdrawn from used lumber. [1926.250(b)(8)(i)]

Only qualified and trained employees shall be assigned to install, adjust and operate laser equipment. [1926.54(a)]

"Laser in Use" signs shall be posted at all times lasers are in operation. [1926.54 (d)]

Portable and fixed ladders with broken or missing rungs or steps, broken or split side rails, or with other faulty or defective construction are prohibited. When ladders with such defects are discovered, withdraw them from service immediately. [1926.1053(b)(16)]

Place portable ladders on a substantial base at a 4-1 pitch, have clear access at top and bottom, extend a minimum of 36 inches above landing or, where not practical, provide grab rails. Secure against movement while in use. [1926.1053(b)(1) thru (b)(7)]

Portable metal ladders may not be used for electrical work or where they may contact electrical conductors. [1926.1053(b)(12)]

Job-made ladders will be constructed for their intended use. Rungs and/or cleats will be uniformly spaced, no more than 12 inches, apart. [1926.1053(a)(3)(i)]

No ladders shall be used in a horizontal position as platforms, runways, or scaffolds. Extension ladders must be retracted before transporting.

All ladders must be secured top and bottom. Always face ladders when going up or down.

Materials and tools should be hoisted up or down ladders with a rope, cable or other safe hoisting methods.

Never use the top or the top step of a stepladder.

Construction area, ramps, walkways, corridors, offices, shops, sheds and storage areas shall be adequately lighted. [1926.56(a)]

Additional lighting and maintenance of lighting shall be provided at all stairways, aisle ways, and entry / exit areas.

Each system shall have containers, valves, connectors, manifold valve assemblies, and regulators of an approved type. [1926.153(a)(1)]

All cylinders shall meet DOT specifications. [1926.153(a)(2)]

Containers shall be place upright on firm foundations or otherwise firmly secured. [1926.153(g) & (h)(11)]

Portable heaters shall be equipped with an approved automatic device to shut off the flow of gas in the event of flame failure. [1926.153(h)(8)]

Cylinders shall be equipped with an excess flow valve to minimize the flow of gas in the event the fuel line becomes ruptured. [1926.153(i)(2)]

Storage of LPG within buildings is prohibited. [1926.153(j)]

Storage locations shall have at least one approved portable fire extinguisher, rated not less than 20-b:c. [1926.153(L)]

Check all vehicles in use at the beginning of each workday to assure all parts, equipment and accessories affecting safe operation are in proper operating condition and free from defects. All defects shall be corrected before placing vehicle in service. [1926.601(b)(14)]

No employee shall use any motor vehicle, earthmoving, or compacting equipment having an obstructed view to the rear unless:

Vehicle has a reverse signal alarm distinguishable from the surrounding noise level,

Or

Vehicle is backed up only when an observer signals it is safe to do so. [1926.601(b)(4)]

Heavy machinery, equipment, or parts thereof, which are suspended or held aloft will be substantially blocked to prevent falling or shifting work under or between them. [1926.600(a)(3)(i)]

The employer is responsible for requiring the wearing of appropriate personal protective equipment in all operations where there is an exposure to hazardous conditions, or where the need is indicated for using such equipment to reduce the hazards to the employees. [1926.28(a)] & [1926.95(a) thru (c)]

Only trained employees shall operate powder – actuated tools. [1926.302(e)(1)]

Belts, gears, shafts, pulleys, sprockets, spindles, drums, flywheels, chains or other reciprocating , rotating, or moving parts of equipment must be guarded if such parts are exposed to contact by employees or otherwise constitute a hazard. No equipment may be used without guards in place. [1926.300(b)(2)]

Guarding shall meet the requirement of ANSI B 15.1-1953 (r 1958), "Safety Code for Mechanical Power Transmission Apparatus". [1926.300(b)(2)]

Always give the public the "right of way".

Rollover protective structures (ROPS) applies to the following types of materials handling equipment:

Respiratory protective devices, shall be approved by the National Institute for Occupational Safety and Health or acceptable to the U.S. Department of Labor for the specific contaminant to which the employee is exposed. [1926.103] & [1910.134]

Respiratory protective devices shall be appropriate for the hazardous material involved and the extent and nature of the work requirements and conditions. [1926.103] & [1910.134]

Employees required to use respiratory protective devices, shall be thoroughly trained in their use. [1926.103] & [1910.134]

Respiratory protective equipment shall be inspected regularly and maintained in good condition. [1926.103] & [1910.134]

No employee shall operate vehicles, without adequate training and proper authorization.

Do not talk on the telephone/radio while driving. Pull over/off the road for safety.

Drivers must not take chances. To arrive safely is more important than to arrive on time.

At all times be cautious of other drivers on the road.

Display a positive company image while driving any vehicle.

Positively no tailgating. Maintain a proper distance between you and all other drivers.

Obey all speed limits and observe extreme caution in school zones.

Drivers should also refer to Part 2 "Specific Work Rules," in the section titled "Motor Vehicles and Construction Equipment."

When pulling a trailer, compressor, tack wagon, or other unit, always hook up safety chains and put a pin through the hitch.

Anyone pulling a trailer or piece of equipment is responsible for checking for proper tags, tires, lights, signals, mirrors, fuel, etc.

All accidents must be reported to the Safety and Health Coordinator or office management within 1 hour.

If an accident occurs, the driver must follow the procedures as outlined in the Substance Abuse Program.

No unauthorized "Riders" in company and/or pick-up trucks.

No employee shall operate equipment without adequate training & proper authorization.

Operators shall not operate any heavy equipment that is not in safe working order.

Operators shall inspect their equipment prior to beginning work to ensure the equipment is in safe working order.

Operators will refer to Part 2 "Specific Work Rules," in the section titled "Motor Vehicles and Construction Equipment".

All accidents must be reported to the Safety Coordinator or office management within 1 hour.

If an accident occurs, the operator must follow the procedures as outlined in the Substance Abuse Program.

No "Riders" on equipment.

All portions of band saw blades will be enclosed or guarded, except for working portion of blades between bottom of guide rolls and table. [1926.304(d)]

Portable, power-driven circular saws will be equipped with guards above and below the base plate or shoe. The lower guard will cover the saw to depth of teeth, except for minimum arc required to allow proper retraction and contact with the work, and will automatically return to covering position when blade is removed from the work. [1926.304(d)]

Radial saws will have an upper guard, which completely encloses upper half of saw blade. The sides of the lower exposed portion of blade will be guarded by a device, that will automatically adjust to the thickness of and remain in contact with material being cut. Radial saws used for ripping must have non-kickback fingers or dogs. Radial saws will be installed so the cutting head will return to starting position when released by operator. [1926.304(g)]

Scaffold means any temporary elevated platform (supported or suspended) and its supporting structure (including points of anchorage) used for supporting employees or materials or both. [1926.450(b)]

Fall protection - such as guardrail and/or personal arrest systems - must be provided for each employee working on a scaffold more than 10 feet above a lower level. [1926.451(g)(1)]

Each scaffold and scaffold component shall support, without failure, its own weight and at least 4 times the maximum intended load applied or transmitted to it. Scaffolds shall be designed by a qualified person and constructed and loaded in accordance with such design. Scaffolds and scaffold components shall not be loaded in excess of their maximum intended loads or rated capacities, whichever is less. [1926.451(a)(1)]

The scaffold platform shall be planked or decked as fully as possible with the space between the platform and uprights not more than 1 inch wide. When side brackets or odd shaped structures result in a wider opening between the platform and the uprights, the space shall not exceed 9.5 inches. The platform shall not deflect more than 1/60 of the span when loaded. [1926.451(b)(1) & (f)(16)]

The work area for each scaffold platform and the walkway shall be at least 18 inches wide. [1926.451(b)(2)]

Access must be provided when the scaffold platforms are more than 2 feet above or below a point of access. Cross-braces shall not be used as a means of access. [1926.451(e)(1) & (e)(8)]

A competent person shall inspect scaffolds, scaffold components, and ropes on suspended scaffolds before each work shift and after any occurrence that could affect the structural integrity. The competent person also must ensure that prompt corrective action is taken. [1926.451(f)(3) & (d)(10)]

Stilts may be used on a large area scaffold. (A large area scaffold is a pole, tube and coupler, systems or fabricated frame scaffold erected over substantially the entire work area.) [1926.452(y)]

When a guardrail system is used, the guardrail height shall be equal to the height of the stilts and any alterations to the stilts shall be approved by the manufacturer. [1926.452(y)]

For the protection of all, signs such as "No Smoking", "Laser in Use", "Keep Out", "Eye Protection Required", "Out of Order – Do Not Use", and "Authorized Personnel" will be posted. All employees will obey these directions.

All materials stored in tiers will be secured to prevent sliding, falling or collapse. [1926.250(a)(1)]

Aisles and passageways will be kept clear and in good repair. [1926.250(a)(3)]

Stored materials will not obstruct exits. [1926.151(d)(1)]

Materials will be stored with due regard to fire characteristics. [1926.151(d)(2)]

Weeds and grass in outside storage areas shall be kept under control. [1926.151(c)(3)]

Flammable liquids must be kept in approved containers. [1926.152(a)(1)]

20 or fewer persons – one facility

20 or more persons – one toilet seat and one urinal per 40 persons

200 or more persons – one toilet seat and one urinal per 50 persons [1926.51(c)(1)]

Washing facilities shall be in near proximity to the worksite and shall be so equipped as to enable employees to remove all harmful substances. [1926.51(f)]

When practical, objects to be welded, cut, or heated shall be moved to a designated safe location or, of the objects to be welded, cut or heated cannot be readily moved, all movable fire hazards in the vicinity shall be taken to a safe place, or otherwise protected. [1926.352(a)]

Proper precautions (isolating welding and cutting, removing fire hazards from the vicinity, providing a fire watch, etc.) for fire prevention shall be taken in areas where welding or other "hot work" is being done. No welding, cutting or heating will be done where application of flammable paints, or presence of other flammable compounds, or heavy dust concentrations, creates a fire hazard. Equip torches with anti-flashback devices.

All arc welding and cutting cables shall be completely insulated and be capable of handling the maximum current requirements for the job. There shall be no repairs or splices within 10 feet of the electrode holder, except where splices are insulated, equal to the insulation of the cable. Defective cable shall be repaired or replaced [1926.351(b)(1) & (b)(2)]

Fuel gas and oxygen hose shall be easily distinguishable and shall not be interchangeable. Hoses shall be inspected at the beginning of each shift and shall be repaired or replaced if defective. [1926.350(f)(1) & (f)(3)]

General mechanical or local exhaust ventilation or air line respirators shall be provided, as required, when welding, cutting or heating:

zinc, lead, cadmium, mercury, or beryllium bearing, based or coated material in encloses spaces

stainless steel with inert-gas equipment

in confined spaces

or

where an unusual condition can cause an unsafe accumulation of contaminants [1926.353(b)(1),(c)(1) through (c)(2) & (d)(1)(iv)]

Arc welding and cutting operations will be shielded by non-combustible or flameproof shields to protect employees from direct arc rays. When electrode holders are left unattended, electrodes will be removed and holder will be placed or protected so they cannot make electrical contact. All arc welding and cutting cables will be completely insulated. Defective cable will be repaired or replaced. [1926.351]

Remove electrodes from unattended electrode holders. [1926.351(d)(1)]

Welding electrode stubs shall be collected in metal containers and not dropped on the floor or other walking / working surface.

Torches shall be lighted ONLY by friction lighters or other approved devices. [1926.350(g)(3)]

Cigarette lighters and/or matches are NOT approved lighting devices!

Wire ropes, chains, ropes and other rigging equipment will be inspected prior to use and as necessary during use to assure their safety. Remove defective rigging equipment from service immediately. [1926.251(a)(1)]

Job or shop hooks and links, or makeshift fasteners, formed from bolts, rods or other such attachments will not be used in rigging "systems". [1926.251(b)(3)]

When U-bolts are used for eye splices, the U-bolt will be applied so the "U" section is in contact with dead end of rope. [1926.251(c)(5)(i)]

Hook "safety latches" shall be maintain in a safe, operable condition.

Employees shall NOT work / walk under any suspended load. [1926.701(e) (1) & (2)]

Plan your work and train your crew prior to performing activities with cranes and rigging.

An employee reporting to work visibly impaired will be deemed unable to properly perform required duties and will not be allowed to work. If possible, the employee's supervisor will first seek another supervisor's opinion to confirm the employee's status. Next, the supervisor will consult privately with the employee to determine the cause of the observation, including whether substance abuse has occurred. If, in the opinion of the supervisor, the employee is considered impaired, the employee will be sent home or to a medical facility by taxi or other safe transportation alternative - depending on the determination of the observed impairment - and accompanied by the supervisor or another employee, if necessary. A drug test may be in order. An impaired employee will not be allowed to drive.

The confidentiality of any information received by the employer through a substance abuse testing program shall be maintained, except as otherwise provided by law.

If the physician, official, or lab personnel has reasonable suspicion to believe that the job-applicant has tampered with the specimen, the applicant will not be considered for employment.

Employees with a confirmed positive test result may, at their option and expense, have a second confirmation test made on the same specimen. An employee will not be allowed to submit another specimen for testing.

If the physician, official, or lab personnel has reasonable suspicion to believe that the employee has tampered with the specimen, the employee is subject to disciplinary action up to and including termination.

An employee shall be determined to be under the influence of alcohol if the employee's normal faculties are impaired due to the consumption of alcohol, or if the employee has a blood alcohol level of .05 or higher.

Failure to submit to a substance abuse test also is misconduct and also shall be subject to discipline up to and including termination.

Any questions or comments regarding the Hazardous Communication (HAZCOM) Program should be directed to the Safety and Health Coordinator.

All chemicals on-site are used from an original container or a temporary container, only in small quantities for immediate use. Any chemical left after work is completed must be returned to the original container, if it is not returned to the original container it must be labeled. No unmarked containers of any size are to be left in the work area unattended.

The name of the chemical.

The physical hazards.

The health hazards.

The primary route of entry.

The OSHA permissible exposure limit.

Any general precautions for safe handling.

The date of preparation or the date of the last change to the MSDS.

The name, address and telephone number of the chemical manufacturer.

MSDS are kept at the office and are accessible to all employees. Job specific MSDS will be readily available to the employees working on specific job-sites. If an employee cannot locate an MSDS sheet contact the Safety and Health Coordinator.

The Safety and Health Coordinator is responsible for distribution of the appropriate up-to-date MSDS sheet to the job sites. Superintendents are responsible for having the appropriate up-to-date MSDS sheets on their job sites.

Employees are trained to work safely with hazardous chemicals. Employee training will include:

Methods that may be used to detect a release of hazardous chemicals in the workplace.

Physical and health hazards associated with chemicals.

Protective measure to be taken.

Safe work practices, emergency response and use of personnel protective equipment.

Information on the Hazardous Communication Standard.

Labeling and warning systems.

The employees Right to Know.

And an understanding of the Material Safety Data Sheet (MSDS).

Superintendents are responsible for site specific hazardous chemical training. Training includes:

Types of chemicals on the job site.

Hazards created by chemicals on the job site.

First aid and emergency procedures, when exposed to specific chemicals.

Using appropriate personnel protective equipment for hazardous chemical handling.

 

Superintendents inform employees of any special tasks that may arise which would involve possible exposure to hazardous chemicals.

Review of safe work procedures and use of required PPE is conducted prior to the start of such tasks. Where necessary areas are posted to indicate the nature of the hazard involved.

Other on-site employers are required to adhere to the provisions of the Hazard Communication Standard.

________________________________________

Signature of Driver Date

_______________________________________________________________________________________ Approved Title Date

Use this form to record critical information at the scene of the accident or as soon afterwards as possible.

Determine the extent of injuries or damage.

File an accident report and obtain medical assistance if needed.

A police report may be required by state or local law.

Talk only with the police or your insurance agent or Claim Representative.

Don’t admit liability or fault at the scene of the accident.

Write down the names, addresses, phone numbers and insurance companies of the individuals involved in the accident and any witnesses.

Record the license plate numbers of cars involved. Also, record the extent of injuries is any were sustained.

Report the accident even if it’s minor, wasn’t your fault or you don’t yet have all the facts.

Date Time am/pm City State

My Vehicle Other Vehicle

Driving on what street |

At what speed |

In what direction |

Signal given? |

Lights on? |

Street condition Dry Wet Icy Snowy Muddy

Driver Passenger Pedestrian

Name Phone

Address City State

Insured with Policy No

Insurance Agent Phone

Vehicle (year / model / type)

License plate number State

Name Phone

Address City State

Insured with Policy No

Insurance Agent Phone

Exterior

Interior

Exterior

Interior

Driver Passenger Pedestrian

Name Phone

Address City State

Hospital

Driver Passenger Pedestrian

Name Phone

Address City State

Hospital

Name Phone

Address City State

Name Phone

Address City State

Notified Police? Yes No If no, reason

If yes, department

Name

Badge Number

Arrests or citations You Other driver

Name

Address Phone

Vehicle towed to

Draw the auto accident here. Include as much detail as possible, including addresses and street names.

Give a detailed description of the accident here

The purpose of this Demolition Safety Policy is to eliminate accidents and/or injuries during demolition activities.

All employees working in demolition areas need to be specifically trained to the hazards related to demolition.

Fire protection plans and/or fire extinguishers shall be in place prior to and during demolition operations.

Emergency plans must be implemented and communicated to all workers in demolition areas.

No Smoking in demolition areas.

No radios or music headsets allowed at any time, not just during demolition.

All Personal Protective Equipment (PPE) needs to be reviewed before start of demolition. Hard hats and eye protection shall be worn by all employees in demolition areas, at all times. Hearing protection shall be used by all employees, when required, during demolition operations. Long pants and shirt sleeves are required.

Barriers shall be installed AND maintained to segregate demolition workers from all other workers and…to segregate construction workers from the public and/or client employees. All entrances to demolition areas shall be controlled and monitored during demolition activities. The "public" always has the right-of-way.

Special considerations shall be implemented whenever asbestos, lead or other hazardous materials are encountered during demolition activities.

Dust and debris control shall be used at all times during demolition activities.

Whenever gas-powered units of any type are used for demolition operations, adequate ventilation and air quality monitoring shall be implemented and maintained at all times until demolition operations are completed.

Adequate lighting shall be provided at all demolition areas.

Lock-out / Tag-out of existing and new mechanical / electrical / plumbing systems shall be implemented PRIOR to the start of demolition activities.

Any structure removal shall be coordinated with a registered engineer.

Shoring and/or re-shoring shall be in place and maintained during demolition activities, where required.

All management and supervisory personnel are charged with the responsibility for planning safety into each work task and for preventing the occurrence of incidents and/or controlling conditions/actions that could lead to occupational injuries or illness. The ultimate success of a safety program depends upon the full cooperation of each individual employee. Management at CDM Atlanta, Inc., d.b.a.: Georgia Blind Company® assumes the responsibility and is prepared to take the necessary actions to see that safety rules and practices are enforced.

Our goal is the total elimination of accidents from our operations.

Sincerely,

Michael J. Lennon

President

My signature below certifies that I have this day reviewed the

sheet. The Safety Manual and Company Safety Rules were either read by me or read to me by an

by the safety

instructions issued by my supervisors and will report to him all unsafe conditions or practices observed on

the work site.

I understand that any violation of the safety rules or refusal to comply with an OSHA "Safety and

Health Regulation" is grounds for dismissal.

Except under emergency conditions, I will obtain first aid treatment at the site for all injuries and will

report to the foreman or the superintendent before leaving to obtain additional medical attention. A list of

physicians and medical facilities for the company are available onsite and I understand that I must

choose one of the named physicians or medical facilities for an on the job injury. I further understand that

if I seek medical treatment elsewhere other than the listed physicians or medical facilities for an on the job

injury, I shall be responsible for my own medical bills.

_______________________________________ __________________________________

Signature Date

Four things needed to maintain a fire:

Fuel

Heat

Oxygen

Chain reaction

Take away any one of the first three and the fire will be out.

Stay upwind of a fire when using a fire extinguisher.

Stay back 8 to 10 feet from a grease fire because the force of the pressure/powder from the fire extinguisher may cause the grease to splatter.

Three classes of fire extinguisher ratings:

Wood, paper, plastic

Flammable liquids

Electrical

PASS is the word used to train people properly to use a fire extinguisher.

Pull the pin.

Aim the extinguisher at base of fire.

Squeeze the handle.

Sweep extinguisher from side to side from outside towards center of fire.

A 10lb. B.C. rated extinguisher should be within 50’-0" of any 5 gallons of fuel.

A 20 lb. B.C. rated extinguisher should be within 25’-0" maximum 75’-0" of any Liquefied Petroleum Gas tanks or any other fuel tanks greater than 5 gallons capacity.

All fires no matter how small must be reported immediately to supervisor.

Mount fire extinguisher:

Minimum of 4" from the floor

No more than 5’0" off the floor

 

The distance one should stand from the base of the fire is written on the fire extinguisher. For example: (2 ½ lb.) Minimum distance is 6’ (20 lb.) minimum distance is 12’.

Everyone should check the fire extinguisher in work area daily to make sure it has adequate pressure and that the pin is still in the proper place.

A fire extinguisher should be serviced once a year.

Every six years a fire extinguisher should be discharged and recharged.

At each testing, a maintenance tag will be placed on the extinguisher to show the inspection date.

 

 

_____________________________________ _______________________________

Signature Date

Most hazards will fall into five broad categories:

Flammables and combustibles

Compressed gases

Systemic poisons

Corrosives

Irritants

A hazardous substance can endanger our well being in four ways:

Inhaled

Ingested

Absorption

Injection

MSDS’s (Material Safety Data Sheets) contain the following information:

How to properly handle and store

Outline spill clean-up procedures

The medical and first aid procedures

I know where the MSDS’s, emergency supplies, and emergency phone numbers are located.

I understand how to interpret and use the MSDS’s.

I will, when working with hazardous products in containers, follow the guidelines outlined on labels which explain the dangers of the product and the proper way to use this product.

_____________________________________ __________________________________

Signature Date

An emergency plan is a set of rules or procedures to be followed by all personnel in the event of an emergency.

 

The emergency plan is maintained by the company and is implemented by the Superintendent. The emergency plan determines the proper access/egress of emergency equipment and/or personnel into or out of the area, in case of emergency.

 

Supervisors will be directed to key locations, to assist in an emergency situation.

 

Each employee is expected to follow directions of supervisors and cooperate in any emergency action effort.

 

Personnel should evacuate the area in an orderly fashion, when instructed to do so by the supervisor.

 

If you become aware of an emergency situation or any injury, notify a supervisor immediately.

 

Notify supervisor of the location of emergency so that 911 can be called.

 

All personnel shall evacuate the area in an orderly manner and reassemble in the designated location.

 

All supervisors are responsible for knowing the location and number of employees at all times.

 

All personnel will be accounted for to ensure that everyone has evacuated the area.

 

Personnel are strictly forbidden to discuss project conditions, incidents or emergencies with the owner, media, press or any person not associated with the emergency. Refer all questions and/or interviews to senior company management.

 

______________________________________ ___________________________________

Signature Date

 

General requirements – the use of ladders with broken or missing rungs, broken or split side rails, or other faulty or defective construction is prohibited.

Portable ladder feet shall be placed on a substantial base, on a 4 : 1 pitch and the area around the top and bottom of the ladder should be kept clear and clean at all times.

Ladders shall not be used in a horizontal position as platforms, runways, or scaffolds.

Portable ladders shall be tied, blocked or otherwise secured to prevent movement.

All ladders shall extend 36 inches above the landing.

Avoid the use of metal ladders when the possibility of contact with electrical power exists.

Always clean mud or greasy substances from shoes before climbing up ladder.

Always face the ladder and hold on with both hands, whether climbing up or down.

It is dangerous to reach out too far from a ladder in any direction, keep your "center of gravity" as close to the ladder as possible. Move the ladder, as the work requires.

Never use the top or the top step of a step ladder.

Never use a step ladder as a straight ladder.

_______________________________________ _________________________________

Signature Date

No one should create hazards for other workers and employees by leaving objects like pipes, carts, boxes, barrels and other trash/debris in the access path and work areas.

Housekeeping is an important part of our daily work. With the cooperation of everyone we can keep all areas clean, neat, organized and free from tripping hazards.

A clean workplace reduces fire hazards.

Housekeeping should be part of your DAILY routine.

Follow these steps to help keep your work areas clean:

________________________________ __________________________

Signature Date

I, (name-print)______________________________________________________________,

__________________________________________ _________________________________

Signature Date

If an employee has 3 accidents or injuries, which are caused by the employee, or if the employee causes two accidents or injuries to another employee within any twelve-month period, he/she will receive a written warning from the Safety Coordinator. The written warning will state that if another accident occurs due to the actions or inaction of the employee within six months from the date of the warning, the employee will be terminated.

__________________________________________ _________________________________

Signature Date

These items include:

"Big Ten" Company Safety Rules

Safety Certificate

Fire Extinguisher

Hazard Communication/MSDS

Emergency Plan

Ladder Safety

Housekeeping / Clean-up

Substance Abuse Policy

Accident Reporting

Safety Violation Citation System

Accident Termination Policy

Safety Incentive Plan

Questions/Comments:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

________________________________________ __________________________________

Signature Date

________________________________________ __________________________________

Supervisor Date

Job Name / Location:___________________________________________________________________

Superintendent:_______________________________________________________________________

I have not received nor witnessed any accident or injury during the course of this pay period’s work.

I am signing this form voluntarily, for accident tracking purposes.

Name:_______________________________________________________

Signature:____________________________________________________

Date:________________________________________________________

All Incentive Plans start January 1, 2001

All employees start at "0" as of January 1, 2001

All new hires start at "0" (month of hire date)

All accidents (bodily or property) start back at "0" (first aid does not count)

Hourly Foremen / Laborers / Carpenters / Mechanics / Employees

Incentive awards of cash or gift certificates will be awarded values based on the number of months without accidents.

**These schedules and amounts may change in accordance with overall company performance.

Date:

Employee: SS#

Address: Phone#:

Who to contact in a emergency:

Phone#: Relation to employee:

New Hire Re-Hire Date Salary Hourly

Rate: Hour Year Payday

Married / Single FWH SWH Offered Insurance

Approval: Date:

Received Physical ? Received Lab Results ? verbal

written

Processed thru ADP By

SEND COPY OF W-4 to : Ga. Employee New Hire reporting, PO Box 38480, Atlanta, Ga. 30334

Termination Date: Reason:

Processed D.O.L. Notice Processed thru ADP

Returned __________________________________________ items:

Comments

I agree that a company-specified clinic or physician’s office may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the Company for analysis.

I further agree to and hereby authorize the release of the results of said tests to the Company.

I understand that it is the current use of illegal drugs that prohibits me from being employed at this Company.

I further agree to hold harmless the Company and its agents (including the above named physician or clinic) from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the Company's consideration of my application of employment.

I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

APPLICANT:

Print Name: S.S.#:

Signature: Date:

WITNESS:

Print Name:

Signature:

_____________________________________ _________________________________

Signature Date