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STATUS:
APPROVED
273E1 - Village Academy Media Center Renovations
General Information
Subcontractor:
KEY ELECTRIC, INC
Subcontractor Project Manager:
VINNIE SUPPA
Phone #:
954-275-6568
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:
Vincent Suppa
Position:
VICE PRESIDENT
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
- Properly complete the Basic Safety AHA, first page, upper left section.
- Enter the correct description in the COI.
- Submit the OSHA 10 certificates of the workers, or alternatively, email to rq@legocc.com the list of the workers who will be present on this project.
08/27/2025 9:31 AM
- CORRECTED
- CORRECTED
- CORRECTED
09/05/2025 11:25 AM
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