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STATUS:
REJECTED
304E MIC-RE26-CM-MDC Medical Campus
General Information
Subcontractor:
Patriot Fire
Subcontractor Project Manager:
christopher Tellez
Phone #:
305-731-7226
Email:
SECTION #1: Job-Site Specific Accident Prevention Plan
Please download the documents you wish to review.
Key personnel
Emergency List
OSHA 300
Appointment Letter
Basic Safety AHA:
7.-
Do you plan to perform work at heights greater than 6 feet at any time using ladders, scaffolds, or any aerial work platform (AWP)?
YES
8.-
Do you plan to perform any excavation work at any point during your project?
NO
9.-
10.-
Do you anticipate performing any electrical or demolition work at any stage of your project?
NO
Attach a copy of your Certificate of Insurance (COI):?
SECTION #3: Equipment Certification (If Applicable)
Do you plan to use any of the following equipment during your activities on the project?
Scissor Lift Use? | Boomlift? | Forklift? | Welder? | Heavy Equipment? |
|---|---|---|---|---|
YES | NO | NO | NO | NO |
If you answered “Yes” to any of the previous questions, please attach the certificate(s) of the operator(s) below.
Person Responsible for Submitting the Information:
Name:
CHRISTOPHER TELLEZ
Position:
PROJECT MANAGER
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
Observations:
- The document submitted as the Safety Plan appears to be a checklist. Please provide the appropriate Safety Plan.
- Please submit the SDS relevant to your activities. Do not resubmit the Safety Plan previously attached under Fall Protection.
- Please provide OSHA 10 certificates for all workers.
- Please submit Fall Protection training certificates for your workers. Attaching the same document previously submitted under the Fall Protection Plan is not acceptable.
- Please note that the only worker authorized to use lifting equipment is Pedro Perez.
03/20/2026 11:52 AM
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