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STATUS:
APPROVED
267H1 - Ft. Lauderdale Esp renovations
General Information
Subcontractor:
Sleiman construction LLC
Subcontractor Project Manager:
Ravi Chintalakunta
Phone #:
(786) 672-4101
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?
YES
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:
Ravi Chintalakunta
Position:
Assistant Project Manager
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
- Please attach the Safety Plan. Instead of the Safety Plan, you attached the previous Mobilization Checklist.
- Please include the Emergency Contact List. You attached the Key Personnel instead.
- Please review the Appointment Letter you submitted and remove/delete the red text (template instructions).
- Please use the Basic Safety AHA as instructed in the form.
- Please attach the LO/TO Plan.
- In the SDS section, please attach ONLY the SDS.
09/05/2025 1:00 PM
- Please attach the Safety Plan.
- CORRECTED
- CORRECTED
- CORRECTED
- Please attach the LO/TO Plan.
- In the SDS section, please attach ONLY the SDS.
09/12/2025 10:48 am
- CORRECTED
- CORRECTED
- CORRECTED
- CORRECTED
- CORRECTED
- CORRECTED
10/14/25 10:32 AM
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