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STATUS:
APPROVED
319A1 - Indian River Brown Center Building Y
General Information
Subcontractor:
Rapid Removal, Inc
Subcontractor Project Manager:
Anthony Batista
Phone #:
561-670-3653
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:
Eric Robertson
Position:
Estimator
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
- Please complete page 14 of the Basic Safety AHA properly, including the name and signature.
- Please include the COI that contains Workers’ Compensation.
- Instead of attaching the SDS, the Safety Plan was attached again. Please attach the SDS only.
8/27/2025 9:43 AM
- Please complete page 14 of the Basic Safety AHA properly, including the name and signature. NOT CORRECTED
- Please include the COI that contains Workers’ Compensation. DO NOT REMOVE THE GENERAL LIABILITY
- Instead of attaching the SDS, the Safety Plan was attached again. Please attach the SDS only. NOT CORRECTD
09/05/2025 11:58 AM
- CORRECTED
- CORRECTED
- CORRECTED
09/08/2025 1:25 PM
MOBILIZATION APPROVED
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