STATUS:
APPROVED
299A1 - Lawton Chiles ES
General Information
Subcontractor:
Southern Acoustic Inc.
Subcontractor Project Manager:
Roger Uphues
Phone #:
407 697-2831
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:
Roger Uphues
Position:
PROJECT MANAGER
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
Observations:
1.- Please use the attached template for the Appointment Letter; the list of Key Personnel is not considered an appointment letter.
2.- Please add the project address, as well as the name and signature of the person responsible for reviewing the AHA.
3.- Please indicate in your Fall Protection Plan who the QUALIFIED person is and attach the corresponding certifications.
4.- Please attach the OSHA 10 certifications of the workers; simply sending the list is not sufficient.
08/19/2025 8:2 PM
MOBILIZATION CHECKLIST APPROVED
08/20/2025 5:58 PM