STATUS:
APPROVED
304E MIC-RE26-CM-MDC Medical Campus
General Information
Subcontractor:
Space Solution of florida inc
Subcontractor Project Manager:
Paul Pinzones
Phone #:
7862274774
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)?
NO
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? |
|---|---|---|---|---|
NO | 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:
Paul Pinzones
Position:
PM
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
1.- Please attach the appropriate construction safety plan.
2.- Please use the BASIC SAFETY AHA TEMPLATE provided in the form.
3.- Please provide the General Liability Insurance along with your Workers’ Compensation.
4.- Please confirm by email how many workers you will have on the project.
03/25/2026 10:49 AM
1.- CORRECTED
2.- CORRECTED
3.- CORRECTED
4.- Please confirm by email how many workers you will have on the project. PENDING
04/20/2026 4:34 PM