top of page
STATUS:
APPROVED
196H2 - MDC BLDG 7000
General Information
Subcontractor:
Advanced Roofing
Subcontractor Project Manager:
Julian Olarte
Phone #:
9545226868
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? |
|---|---|---|---|---|
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:
Robert Forte
Position:
Safety Manager
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
Observations:
- Please use the Basic Safety AHA, as previously indicated in your other mobilization forms.
- Correct the description of your Certificate of Insurance (COI).
- Attach the OSHA 10 certificates of your workers.
09/17/2025 10:29 PM
Observations:
- Please use the Basic Safety AHA, as previously indicated in your other mobilization forms.
- CORRECTED
- Attach the OSHA 10 certificates of your workers.
09/19/2025 09:46 AM
bottom of page