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STATUS:
APPROVED
299A1 - Lawton Chiles ES
General Information
Subcontractor:
Titan Fire Protection
Subcontractor Project Manager:
Nathan Dretzka
Phone #:
3215015479
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:
Marguerite Garner
Position:
Safety Coordinator
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
- The safety plan you submitted is not adequate. The safety plan must comply with the appropriate procedures for your scope of work. Please complete and submit a proper safety plan that includes policies, procedures, and clearly identifies subparts such as PPE requirements, Fall Protection, Electrical Hazards, Hazard Communication, etc.
- Please use the attached Appointment Letter Template as a reference. The document you submitted is not an Appointment Letter.
- Use the Basic Safety AHA as indicated in the form. Please use the provided template as a reference.
- Submit the Certificate of Insurance (COI) that includes Workers’ Compensation coverage.
- The First Aid/CPR certificates you submitted will expire in 3 days. Please provide valid certificates that will remain current at the time of your mobilization and throughout the duration of the project.
- Please attach the certificate of the Competent Person in Fall Protection.
08/25/2025 11:59 AM
NEW NOTES//////////
- CORRECTED
- CORRECTED
- Use the Basic Safety AHA as indicated in the form. Please use the provided template as a reference. NOT CORRECTED
- CORRECTED
- CORRECTED
- Please attach the certificate of the Competent Person in Fall Protection. NOT CORRECTED
08/26/2025 3:05 PM
NEW NOTES//////////
- CORRECTED
- CORRECTED
- Use the Basic Safety AHA as indicated in the form. Please use the provided template as a reference. NOT CORRECTED
- CORRECTED
- CORRECTED
- Please attach the certificate of the Competent Person in Fall Protection. NOT CORRECTED
08/27/2025 9:12 AM
- CORRECTED
- CORRECTED
- CORRECTED
- CORRECTED
- CORRECTED
08/27/2025 2:01 PM
Mobilization Approved
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