STATUS:
REJECTED
267F1 - Corrections for Rohde Office Towers Restrooms (Phase 1 of 8)
General Information
Subcontractor:
Turnkey Mechanical
Subcontractor Project Manager:
Emmanuel Flores
Phone #:
3055910261
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 | YES | YES | YES | 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:
Emmanuel Flores
Position:
Project Manager
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
1.- Please complete the information properly in the BASIC SAFETY AHA TEMPLATE; placing an “Approved” stamp is not sufficient.
2.- Confirm by email whether there will be only one worker on the project. This is because only one worker’s OSHA 10 was submitted.
3.- Submit an updated Forklift certification, as yours expires in 30 days.
4.- Submit the proper Boomlift and Scissor Lift certifications. The Train the Trainer certificate of your instructor will be requested — make sure the person providing the training holds the proper trainer credentials.
04/07/2026 2:02 PM