top of page
STATUS:
APPROVED
299A1 - Lawton Chiles ES
General Information
Subcontractor:
Lotti Services & Construction
Subcontractor Project Manager:
Janitza Gutierrez
Phone #:
3214241470
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?
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:
Janitza Gutierrez
Position:
President
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
- Attach the company’s OSHA 300A. You mistakenly attached the OSHA 30.
- Complete the information on the Basic Safety AHA (top left of the first page).
- In the COI, include the appropriate project description.
08/26/2025 2:57 PM
- Attach the company’s OSHA 300A. You mistakenly attached the OSHA 30. NOT RECUIRED (CORRECTED)
- CCORRECTED
- CORRECTED
08/26/2025 2:57 PM
bottom of page