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STATUS:
APPROVED
320A1 Linda Lentin K-8 Center
General Information
Subcontractor:
Professional Flooring Contractors
Subcontractor Project Manager:
Frank Ciriago
Phone #:
9544445578
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:
Kearra Millonig
Position:
Admiration Assistant
Email:
Signature:
⚠️ For LEGO CO Safety Department Use ONLY
Observations:
- Please use the Basic Safety AHA template provided in the form.
- Attach the COI that includes the WOC. (I read your note; at the moment I will not be able to approve your mobilization until all documents are completed, but it is good to be able to make progress—thank you for your help.)
09/30/2025 2:54 PM
Observations:
- CORRECTED
- CORRECTED
10/14/25 10:34 AM
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