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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 submitted document is not a safety plan.
- Attach the appropriate and company‑specific fall protection plan.
- NOTE: The WC expires in two months and must be updated before expiration.
- Send the SDS appropriate for your project.
- Confirm via email to rq@legocc.com if you will have only one worker on the project.
- Attach the appropriate Fall Protection certification.
- NOTE: Only Javier Garcia is authorized to use the Scissor Lift on this project.
- Use the basic safety AHA template
03/26//2026 12:39 AM
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