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STATUS:
APPROVED
305B1 - AC1 Roof Replacement (FIU)
General Information
Subcontractor:
JJAS Door Installation, Inc.
Subcontractor Project Manager:
Jhacson Saavedra
Phone #:
3058872747
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:
Jaime Jimenez
Position:
Integrator
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
Observations:
- Of the OSHA 300A forms submitted, only the 2023 OSHA 300A is properly completed.
- The Certificate of Insurance (COI) provided does not include Workers’ Compensation (WC), and all listed insurance policies, including General Liability (GL), are expired.
- The appropriate Safety Data Sheet (SDS) must be submitted. Resubmitting the AHA is incorrect and does not address this requirement.
01/23/26 11:16 AM
Observations:
- Of the OSHA 300A forms submitted, only the 2023 OSHA 300A is properly completed. NOT CORRECTED
- CORRECTED
- CORRECTED
01/28/2026 3:12 PM
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