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STATUS:
REJECTED
306A1 - Memphis Cemetary
General Information
Subcontractor:
Down To Earth Landscape & Irrigation
Subcontractor Project Manager:
Larry Lentz
Phone #:
813.767.0573
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:
Tony Gomez
Position:
Regional Landscape Construction Manager 813.924.1507
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
Observations:
- The “Key Personnel List” must be a list with contact information that includes name, phone number, email, and position.
- Complete the Appointment Letter properly.
- Properly complete the general information of the Basic Safety AHA on page 1, upper left corner.
- Attach the appropriate SDS. Copying your Safety Plan again in this section is not appropriate.
- Attach the OSHA 30 training certificate of your supervisor.
- Attach the OSHA 10 certificates of your workers.
03/17/2025 9:12 AM
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