HomeMy WebLinkAboutContract 63607CSC No. 63607
SORTWORTHO
NON-EXCLUSIVE VENDOR SERVICES AGREEMENT
This NON-EXCLUSIVE VENDOR SERVICES AGREEMENT ("Agreement") is made and
entered into by and between the CITY OF FORT WORTH ("City"), a Texas home rule municipal
corporation, acting by and through its duly authorized Assistant City Manager, and LONE STAR
HAZMAT RESPONSE, LLC ("Vendor"), a Texas limited liability company acting by and through its
duly authorized representative, each individually referred to as a "party" and collectively referred to as the
"parties."
AGREEMENT DOCUMENTS:
The Agreement documents shall include the following:
1. This Non -Exclusive Vendor Services Agreement;
2. Exhibit A — Scope of Services;
3. Exhibit B — Price Schedule;
4. Exhibit C — Vendor's Bid Response to City's RFP No. 25-0118:
5. Exhibit D — Verification of Signature Authority Form;
Exhibits A, B, C, and D, which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. In the event of any conflict between the terms and conditions of Exhibits A, B,
C, or D and the terms and conditions set forth in the body of this Agreement, the terms and conditions of
this Agreement shall control.
1. Scope of Services. The vendor shall provide all labor, materials, and equipment necessary
to perform emergency and non -emergency response services for spills, abandoned waste, and other
environmental hazards as deemed necessary by the City ("Services"), which are set forth in more detail in
Exhibit "A.".
2. Term. The initial term of this Agreement is for one year, beginning on the date the
Assistant City Manager signs this Agreement ("Effective Date") unless terminated earlier in accordance
with this Agreement ("Initial Term"). City will have the option, in its sole discretion, to renew this
Agreement under the same terms and conditions, for up to four (4) one-year renewal option(s) (each a
"Renewal Term").
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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3. Compensation.
3.1 City will pay Vendor in accordance with the provisions of this Agreement,
including Exhibit "B," which is attached hereto and incorporated herein for all
purposes. Total compensation under this Agreement will not exceed One -
Hundred Thousand Dollars and Zero Cents ($100,000.00). The City may award
this Agreement to multiple vendors. The Vendor agrees that the City shall not be
required to guarantee any amount of work or compensation under this Agreement.
Vendor also agrees that this Agreement does not contain any guarantee or promise
of any work or compensation by the City.
3.2 Vendor will not perform any additional services or bill for expenses incurred for
City not specified by this Agreement unless City requests and approves in writing
the additional costs for such services. City will not be liable for any additional
expenses of Vendor not specified by this Agreement unless City first approves
such expenses in writing.
3.3 City will pay Vendor in accordance with the Prompt Payment Act (Chapter 2251
of the Texas Government Code) and provisions of this Agreement, including
Exhibit "C," which is attached hereto and incorporated herein for all purposes.
Following acceptance of the Services by the City, Vendor must provide the City
with a signed, readable invoice no later than 15 days after the end of the prior
month summarizing (i) the Service(s) that have been completed during the prior
month; (ii) purchase order number, and (iii) requesting payment. If the City
requires additional reasonable information, it will request the same promptly, in
writing, after receiving the above information, and the Vendor must provide such
additional reasonable information in writing, to the extent the same is available.
Vendor must submit invoices to Supplierinvoices@fortworthtexas.gov and
ENV_Purchasing@fortworthtexas.gov. Invoices must include the applicable City
Department business unit number and complete City of Fort Worth Number (ex.
FW013-0000001234).
3.3.1 The Vendor shall submit corrected/revised invoices within seven
(7) calendar days after receiving written notice from the City for
a corrected/revised invoice.
3.3.2 Unpaid invoices and/or appeals for service performed throughout
the fiscal year (October 1 - September 30) must be resolved within
thirty (30) days of the City's new fiscal year. Vendor shall provide
its invoices for the last month of the City's prior fiscal year
(September 1-30) no later 10 days after the start of the City's new
fiscal year (i.e. no later than October 10.) No previous year
invoices will be paid after October 30th of the current year.
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4. Termination.
4.1. Written Notice. City or Vendor may terminate this Agreement at any time and for
any reason by providing the other party with 30 days' written notice of termination.
4.2 Non -appropriation of Funds. In the event no funds or insufficient funds are
appropriated by City in any fiscal period for any payments due hereunder, City will notify Vendor
of such occurrence and this Agreement will terminate on the last day of the fiscal period for which
appropriations were received without penalty or expense to City of any kind whatsoever, except as
to the portions of the payments herein agreed upon for which funds have been appropriated.
4.3 Duties and Oblisations of the Parties. In the event that this Agreement is
terminated prior to the Expiration Date, City will pay Vendor for services actually rendered up to
the effective date of termination and Vendor will continue to provide City with services requested
by City and in accordance with this Agreement up to the effective date of termination. Upon
termination of this Agreement for any reason, Vendor will provide City with copies of all
completed or partially completed documents prepared under this Agreement. In the event Vendor
has received access to City Information or data as a requirement to perform services hereunder,
Vendor will return all City provided data to City in a machine-readable format or other format
deemed acceptable to City.
5. Disclosure of Conflicts and Confidential Information.
5.1 Disclosure of Conflicts. Vendor hereby warrants to City that Vendor has made full
disclosure in writing of any existing or potential conflicts of interest related to Vendor's services
under this Agreement. In the event that any conflicts of interest arise after the Effective Date of this
Agreement, Vendor hereby agrees immediately to make full disclosure to City in writing.
5.2 Confidential Information. Vendor, for itself and its officers, agents and employees,
agrees that it will treat all information provided to it by City ("City Information") as confidential
and will not disclose any such information to a third parry without the prior written approval of
City.
5.3 Public Information Act. City is a government entity under the laws of the State of
Texas and all documents held or maintained by City are subject to disclosure under the Texas Public
Information Act. In the event there is a request for information marked Confidential or Proprietary,
City will promptly notify Vendor. It will be the responsibility of Vendor to submit reasons objecting
to disclosure. A determination on whether such reasons are sufficient will not be decided by City,
but by the Office of the Attorney General of the State of Texas or by a court of competent
jurisdiction.
5.4 Unauthorized Access. Vendor must store and maintain City Information in a secure
manner and will not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Vendor must notify City immediately if the security or integrity of any
City Information has been compromised or is believed to have been compromised, in which event,
Vendor will, in good faith, use all commercially reasonable efforts to cooperate with City in
identifying what information has been accessed by unauthorized means and will fully cooperate
with City to protect such City Information from further unauthorized disclosure.
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6. Right to Audit. Vendor agrees that City will, until the expiration of three (3) years after
final payment under this Agreement, or the final conclusion of any audit commenced during the said three
years, have access to and the right to examine at reasonable times any directly pertinent books, documents,
papers and records, including, but not limited to, all electronic records, of Vendor involving transactions
relating to this Agreement at no additional cost to City. Vendor agrees that City will have access during
normal working hours to all necessary Vendor facilities and will be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City will give Vendor
reasonable advance notice of intended audits.
7. Independent Contractor It is expressly understood and agreed that Vendor will operate
as an independent contractor as to all rights and privileges and work performed under this Agreement, and
not as agent, representative or employee of City. Subject to and in accordance with the conditions and
provisions of this Agreement, Vendor will have the exclusive right to control the details of its operations
and activities and be solely responsible for the acts and omissions of its officers, agents, servants,
employees, contractors , and subcontractors. Vendor acknowledges that the doctrine of respondeat superior
will not apply as between City, its officers, agents, servants and employees, and Vendor, its officers, agents,
employees, servants, contractors, and subcontractors. Vendor further agrees that nothing herein will be
construed as the creation of a partnership or joint enterprise between City and Vendor. It is further
understood that City will in no way be considered a Co -employer or a Joint employer of Vendor or any
officers, agents, servants, employees, contractors, or subcontractors. Neither Vendor, nor any officers,
agents, servants, employees, contractors, or subcontractors of Vendor will be entitled to any employment
benefits from City. Vendor will be responsible and liable for any and all payment and reporting of taxes on
behalf of itself, and any of its officers, agents, servants, employees, contractors, or subcontractors.
8. Liability and Indemnification.
8.1 LIABILITY - VENDOR WILL BE LIABLE AND RESPONSIBLE FOR ANY
AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT
ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF
VENDOR, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, VENDORS, OR
SUBVENDORS.
8.2 GENERAL INDEMNIFICATION -VENDOR HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS,
AGENTS, SERVANTS AND EMPLOYEES, FROMAND AGAINST ANYAND ALL CLAIMS
OR LAWSUITS OFANYKIND OR CHARACTER, WHETHER REAL OR ASSERTED, FOR
EITHER PROPERTYDAMAGE OR LOSS (INCLUDINGALLEGED DAMAGE OR LOSS TO
VENDOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, ARISING OUT OF OR IN
CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF VENDOR, ITS OFFICERS,
AGENTS, SERVANTS, EMPLOYEES, VENDORS, OR SUBVEND ORS
.
8.3 INTELLECTUAL PROPERTY INDEMNIFICATION — Vendor agrees to
defend, settle, or pay, at its own cost and expense, any claim or action against City for
infringement of any patent, copyright, trade mark, trade secret, or similar property right
arising from City's use of the software and/or documentation in accordance with this
Agreement, it being understood that this agreement to defend, settle or pay will not apply if
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City modifies or misuses the software and/or documentation. So long as Vendor bears the
cost and expense of payment for claims or actions against City pursuant to this section,
Vendor will have the right to conduct the defense of any such claim or action and all
negotiations for its settlement or compromise and to settle or compromise any such claim;
however, City will have the right to fully participate in any and all such settlement,
negotiations, or lawsuit as necessary to protect City's interest, and City agrees to cooperate
with Vendor in doing so. In the event City, for whatever reason, assumes the responsibility
for payment of costs and expenses for any claim or action brought against City for
infringement arising under this Agreement, City will have the sole right to conduct the
defense of any such claim or action and all negotiations for its settlement or compromise and
to settle or compromise any such claim; however, Vendor will fully participate and cooperate
with City in defense of such claim or action. City agrees to give Vendor timely written notice
of any such claim or action, with copies of all papers City may receive relating thereto.
Notwithstanding the foregoing, City's assumption of payment of costs or expenses will not
eliminate Vendor's duty to indemnify City under this Agreement. If the software and/or
documentation or any part thereof is held to infringe and the use thereof is enjoined or
restrained or, if as a result of a settlement or compromise, such use is materially adversely
restricted, Vendor will, at its own expense and as City's sole remedy, either: (a) procure for
City the right to continue to use the software and/or documentation; or (b) modify the
software and/or documentation to make it non -infringing, provided that such modification
does not materially adversely affect City's authorized use of the software and/or
documentation; or (c) replace the software and/or documentation with equally suitable,
compatible, and functionally equivalent non -infringing software and/or documentation at no
additional charge to City; or (d) if none of the foregoing alternatives is reasonably available
to Vendor terminate this Agreement, and refund all amounts paid to Vendor by City,
subsequent to which termination City may seek any and all remedies available to City under
law.
8.4 ENVIRONMENTAL INDEMNIFICATION THE VENDOR HEREBY
RELEASES, INDEMNIFIES, DEFENDS, REIMBURSES, AND HOLDS HARMLESS THE
CITY, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS, AGAINST ANY
AND ALL ENVIRONMENTAL DAMAGES, CLAIMS, AND THE VIOLATION OF ANY
AND ALL ENVIRONMENTAL REQUIREMENTS RESULTING FROM THE REMOVAL,
PACKAGING, TRANSPORTING, AND DISPOSING OF ENVIRONMENTALLY
HAZARDOUS MATERIALS.
8.4.1 Environmental Damages shall mean all claims, judgments, damages,
losses, penalties, fines, liabilities (including strict liability), encumbrances,
liens, costs, and expenses of investigation and defense of any claim,
whether or not such claim is ultimately defeated, and of any good faith
settlement or judgments, of whatever kind or nature, contingent or
otherwise, matured or unmatured, foreseeable or unforeseeable, including,
without limitation, reasonable attorney's fees and disbursements and
consultant's fees, any of which are incurred as a result of handling,
collection, transportation, storage, disposal, treatment, recovery, and/or
reuse of waste pursuant to this Agreement, or the existence of a violation
of environmental requirements pertaining to, and including without
limitation:
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8.4.1.1 Damages for personal injury and death, or injury to
property or natural resources;
8.4.1.2 Fees incurred for the services of attorneys, consultants,
contractors, experts, laboratories and all other costs in
connection with the excavation, removal, and backfill of
possibly contaminated soils and related wastes or
violation of environmental requirements including, but
not limited to, the preparation of any feasibility studies or
reports of the performance of any cleanup, remediation,
removal, response, abatement, containment, closure,
restoration, or monitoring work required by any federal,
state, or local governmental agency or political
subdivision, or otherwise expended in connection with the
existence of such wastes or violations of environmental
requirements, and including without limitation any
attorney's fees, costs, and expenses incurred in enforcing
this contract or collecting any sums due hereunder; and
8.4.1.3 Liability to any third person or governmental agency to
indemnify such person or agency for costs expended in
connection with the items referenced in sub -paragraph 2
of this part.
8.4.2 Environmental requirements shall mean all applicable present and future
statutes, regulations, rules, ordinances, codes, licenses, permits, orders,
approvals, plans, authorizations, concessions, franchises, and similar
items, of all governmental agencies, departments, commissions, boards,
bureaus, or instrumentalities of the United States, states, and political
subdivisions thereof and all applicable judicial, administrative, and
regulatory decrees, judgments, and orders relating to the protection of
human health or the environment, including without limitation:
8.4.2.1 All requirements, including, but not limited to, those
pertaining to reporting, licensing, permitting,
investigation, and remediation of emissions, discharges,
releases, or threatened releases of hazardous materials,
pollutants, contaminants, or hazardous or toxic
substances, materials, or wastes, whether solid, liquid, or
gaseous in nature, into the air, surface water,
groundwater, stormwater, or land, or relating to the
manufacture, processing, distribution, use, treatment,
storage, disposal, transport, or handling of pollutants,
contaminants, or hazardous or toxic substances, materials,
or wastes, whether solid, liquid, or gaseous in nature; and
8.4.2.2 All requirements pertaining to the protection of the health
and safety of employees or the public.
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Assignment and Subcontracting.
9.1 Assisnment. Vendor will not assign or subcontract any of its duties, obligations
or rights under this Agreement without the prior written consent of City. If City grants consent to
an assignment, the assignee will execute a written agreement with City and Vendor under which
the assignee agrees to be bound by the duties and obligations of Vendor under this Agreement.
Vendor will be liable for all obligations of Vendor under this Agreement prior to the effective date
of the assignment.
9.2 Subcontract. If City grants consent to a subcontract, the subcontractor will execute
a written agreement with Vendor referencing this Agreement under which subcontractor agrees to
be bound by the duties and obligations of Vendor under this Agreement as such duties and
obligations may apply. Vendor must provide City with a fully executed copy of any such
subcontract.
10. Insurance. Vendor must provide City with certificate(s) of insurance documenting
policies of the following types and minimum coverage limits that are to be in effect prior to commencement
of any Services pursuant to this Agreement:
10.1 Coverage and Limits
(a) Commercial General Liability:
$1,000,000 - Each Occurrence
$2,000,000 - Aggregate
(b) Automobile Liability:
$1,000,000 - Each occurrence on a combined single limit basis
Coverage will be on any vehicle used by Vendor, or its employees, agents, or
representatives in the course of providing Services under this Agreement. "Any
vehicle" will be any vehicle owned, hired and non -owned.
(c) Worker's Compensation:
Statutory limits according to the Texas Workers' Compensation Act or any other
state workers' compensation laws where the Services are being performed
Employers' liability
$100,000 -
Bodily Injury by accident; each accident/occurrence
$100,000 -
Bodily Injury by disease; each employee
$500,000 -
Bodily Injury by disease; policy limit
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(d) Professional Liability (Errors & Omissions):
$1,000,000 - Each Claim Limit
$1,000,000 - Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage must be claims -made, and maintained for the duration of the contractual
agreement and for two (2) years following completion of services provided. An
annual certificate of insurance must be submitted to City to evidence coverage.
10.2 General Requirements
(a) The commercial general liability and automobile liability policies must
name City as an additional insured thereon, as its interests may appear. The term
City includes its employees, officers, officials, agents, and volunteers in respect to
the contracted services.
(b) The workers' compensation policy must include a Waiver of Subrogation
(Right of Recovery) in favor of City.
(c) A minimum of Thirty (30) days' notice of cancellation or reduction in
limits of coverage must be provided to City. Ten (10) days' notice will be
acceptable in the event of non-payment of premium. Notice must be sent to the
Risk Manager, City of Fort Worth, 200 Texas Street, Fort Worth, Texas 76102,
with copies to the Fort Worth City Attorney at the same address.
(d) The insurers for all policies must be licensed and/or approved to do
business in the State of Texas. All insurers must have a minimum rating of A- VII
in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial
strength and solvency to the satisfaction of Risk Management. If the rating is
below that required, written approval of Risk Management is required.
(e) Any failure on the part of City to request required insurance
documentation will not constitute a waiver of the insurance requirement.
(f) Certificates of Insurance evidencing that Vendor has obtained all required
insurance will be delivered to the City prior to Vendor proceeding with any work
pursuant to this Agreement.
it. Compliance with Laws, Ordinances, Rules and Regulations. Vendor agrees that in the
performance of its obligations hereunder, it will comply with all applicable federal, state and local laws,
ordinances, rules and regulations and that any work it produces in connection with this Agreement will also
comply with all applicable federal, state and local laws, ordinances, rules and regulations. If City notifies
Vendor of any violation of such laws, ordinances, rules or regulations, Vendor must immediately desist
from and correct the violation.
12. Non -Discrimination Covenant. Vendor, for itself, its personal representatives, assigns,
Vendors, subVendors, and successors in interest, as part of the consideration herein, agrees that in the
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performance of Vendor's duties and obligations hereunder, it will not discriminate in the treatment or
employment of any individual or group of individuals on any basis prohibited by law. IF ANY CLAIM
ARISES FROM AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT
BY VENDOR, ITS PERSONAL REPRESENTATIVES, ASSIGNS, VENDORS, SUBVENDORS,
OR SUCCESSORS IN INTEREST, VENDOR AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY AND DEFEND CITY AND HOLD CITY HARMLESS FROM SUCH CLAIM.
13. Notices. Notices required pursuant to the provisions of this Agreement will be
conclusively determined to have been delivered when (1) hand -delivered to the other party, its agents,
employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the
transmission, or (3) received by the other party by United States Mail, registered, return receipt requested,
addressed as follows:
To CITY:
City of Fort Worth
Attn: Assistant City Manager
100 Fort Worth Trail
Fort Worth, TX 76102-6314
Facsimile: (817) 392-8654
With copy to Fort Worth City Attorney's Office at
same address
To VENDOR:
Lone Star Hazmat Response, LLC.
Richard Lenius, President
115 W 5th Street
Tyler, TX 75701
14. Solicitation of EmDlovees. Neither City nor Vendor will, during the term of this
Agreement and additionally for a period of one year after its termination, solicit for employment or employ,
whether as employee or independent Vendor, any person who is or has been employed by the other during
the term of this Agreement, without the prior written consent of the person's employer. Notwithstanding
the foregoing, this provision will not apply to an employee of either party who responds to a general
solicitation of advertisement of employment by either party.
15. Governmental Powers. It is understood and agreed that by execution of this Agreement,
City does not waive or surrender any of its governmental powers or immunities.
16. No Waiver. The failure of City or Vendor to insist upon the performance of any term or
provision of this Agreement or to exercise any right granted herein does not constitute a waiver of City's or
Vendor's respective right to insist upon appropriate performance or to assert any such right on any future
occasion.
17. Governing Law / Venue. This Agreement will be construed in accordance with the laws
of the State of Texas. If any action, whether real or asserted, at law or in equity, is brought pursuant to this
Agreement, venue for such action will lie in state courts located in Tarrant County, Texas or the United
States District Court for the Northern District of Texas, Fort Worth Division.
18. Severability. If any provision of this Agreement is held to be invalid, illegal or
unenforceable, the validity, legality and enforceability of the remaining provisions will not in any way be
affected or impaired.
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19. Force Maieure. City and Vendor will exercise their best efforts to meet their respective
duties and obligations as set forth in this Agreement, but will not be held liable for any delay or omission
in performance due to force majeure or other causes beyond their reasonable control, including, but not
limited to, compliance with any government law, ordinance, or regulation; acts of God; acts of the public
enemy; fires; strikes; lockouts; natural disasters; wars; riots; epidemics or pandemics; government action
or inaction; orders of government; material or labor restrictions by any governmental authority;
transportation problems; restraints or prohibitions by any court, board, department, commission, or agency
of the United States or of any States; civil disturbances; other national or regional emergencies; or any other
similar cause not enumerated herein but which is beyond the reasonable control of the Party whose
performance is affected (collectively, "Force Majeure Event"). The performance of any such obligation is
suspended during the period of, and only to the extent of, such prevention or hindrance, provided the
affected Party provides notice of the Force Majeure Event, and an explanation as to how it prevents or
hinders the Parry's performance, as soon as reasonably possible after the occurrence of the Force Majeure
Event, with the reasonableness of such notice to be determined by the City in its sole discretion. The notice
required by this section must be addressed and delivered in accordance with Section 13 of this Agreement.
20. Headings not Controlling. Headings and titles used in this Agreement are for reference
purposes only, will not be deemed a part of this Agreement, and are not intended to define or limit the scope
of any provision of this Agreement.
21. Review of Counsel. The parties acknowledge that each party and its counsel have
reviewed and revised this Agreement and that the normal rules of construction to the effect that any
ambiguities are to be resolved against the drafting party will not be employed in the interpretation of this
Agreement or Exhibits A, B, and C.
22. Amendments / Modifications / Extensions. No amendment, modification, or extension
of this Agreement will be binding upon a party hereto unless set forth in a written instrument, which is
executed by an authorized representative of each party.
23. Counterparts. This Agreement may be executed in one or more counterparts and each
counterpart will, for all purposes, be deemed an original, but all such counterparts will together constitute
one and the same instrument.
24. Warranty of Services. Vendor warrants that its services will be of a high quality and
conform to generally prevailing industry standards. City must give written notice of any breach of this
warranty within thirty (30) days from the date that the services are completed. In such event, at Vendor's
option, Vendor will either (a) use commercially reasonable efforts to re -perform the services in a manner
that conforms with the warranty, or (b) refund the fees paid by City to Vendor for the nonconforming
services.
25. Immigration Nationalitv Act. Vendor must verify the identity and employment eligibility
of its employees who perform work under this Agreement, including completing the Employment
Eligibility Verification Form (I-9). Upon request by City, Vendor will provide City with copies of all I-9
forms and supporting eligibility documentation for each employee who performs work under this
Agreement. Vendor must adhere to all Federal and State laws as well as establish appropriate procedures
and controls so that no services will be performed by any Vendor employee who is not legally eligible to
perform such services. VENDOR WILL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM
ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH
BY VENDOR, VENDOR'S EMPLOYEES, VENDORS, SUBVENDORS, OR AGENTS. City, upon
written notice to Vendor, will have the right to immediately terminate this Agreement for violations of this
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provision by Vendor.
26. Ownership of Work Product. City will be the sole and exclusive owner of all reports,
work papers, procedures, guides, and documentation that are created, published, displayed, or produced in
conjunction with the services provided under this Agreement (collectively, "Work Product"). Further, City
will be the sole and exclusive owner of all copyright, patent, trademark, trade secret and other proprietary
rights in and to the Work Product. Ownership of the Work Product will inure to the benefit of City from
the date of conception, creation or fixation of the Work Product in a tangible medium of expression
(whichever occurs first). Each copyrightable aspect of the Work Product will be considered a "work -made -
for -hire" within the meaning of the Copyright Act of 1976, as amended. If and to the extent such Work
Product, or any part thereof, is not considered a "work -made -for -hire" within the meaning of the Copyright
Act of 1976, as amended, Vendor hereby expressly assigns to City all exclusive right, title and interest in
and to the Work Product, and all copies thereof, and in and to the copyright, patent, trademark, trade secret,
and all other proprietary rights therein, that City may have or obtain, without further consideration, free
from any claim, lien for balance due, or rights of retention thereto on the part of City.
27. Signature Authoritv. The person signing this Agreement hereby warrants that they have
the legal authority to execute this Agreement on behalf of the respective party, and that such binding
authority has been granted by proper order, resolution, ordinance or other authorization of the entity. This
Agreement and any amendment hereto, may be executed by any authorized representative of Vendor. Each
party is fully entitled to rely on these warranties and representations in entering into this Agreement or any
amendment hereto.
28. Change in Comvanv Name or Ownership. Vendor must notify City's Purchasing
Manager, in writing, of a company name, ownership, or address change for the purpose of maintaining
updated City records. The president of Vendor or authorized official must sign the letter. A letter indicating
changes in a company name or ownership must be accompanied with supporting legal documentation such
as an updated W-9, documents filed with the state indicating such change, copy of the board of director's
resolution approving the action, or an executed merger or acquisition agreement. Failure to provide the
specified documentation so may adversely impact future invoice payments.
29. No Bovcott of Israel. If Vendor has fewer than 10 employees or this Agreement is for
less than $100,000, this section does not apply. Vendor acknowledges that in accordance with Chapter
2271 of the Texas Government Code, the City is prohibited from entering into a contract with a company
for goods or services unless the contract contains a written verification from the company that it: (1) does
not boycott Israel; and (2) will not boycott Israel during the term of the contract. The terms "boycott Israel"
and "company" has the meanings ascribed to those terms in Section 2271 of the Texas Government Code.
By signing this Agreement, Vendor certifies that Vendor's signature provides written verification to
the City that Vendor: (1) does not boycott Israel; and (2) will not boycott Israel during the term of
the Agreement.
30. Prohibition on Discrimination Against Firearm and Ammunition Industries. If
Vendor has fewer than 10 employees or this Agreement is for less than $100,000.00, this section does
not apply. Vendor acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, the City is prohibited from entering into a contract for goods or services that has a value
of $100,000 or more that is to be paid wholly or partly from public funds of the City with a company with
10 or more full-time employees unless the contract contains a written verification from the company that
it: (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or
firearm trade association; and (2) will not discriminate during the term of the contract against a firearm
entity or firearm trade association. The terms "discriminate," "firearm entity" and "firearm trade
Vendor Services Agreement Lone Star Hazmat Response, LLC 11 of 257
association" have the meaning ascribed to those terms by Chapter 2274.001 of the Texas Government Code.
To the extent that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this
Agreement, Vendor certifies that Vendor's signature provides written verification to the City thatVendor:
(1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or
firearm trade association; and (2) will not discriminate against a firearm entity or firearm trade
association during the term of this Agreement.
31. Prohibition on Bovcotting Energv Comuanies. If Vendor has fewer than 10
employees or this Agreement is for less than $100,000.00, this section does not apply. Vendor
acknowledges that in accordance with Chapter 2276 of the Texas Government Code, the City is prohibited
from entering into a contract for goods or services that has a value of $100,000 or more that is to be paid
wholly or partly from public funds of the City with a company with 10 or more full-time employees unless
the contract contains a written verification from the company that it: (1) does not boycott energy companies;
and (2) will not boycott energy companies during the term of the contract. The terms "boycott energy
company" and "company" have the meaning ascribed to those terms by Chapter 2276.001 of the Texas
Government Code. To the extent that Chapter 2274 of the Government Code is applicable to this
Agreement, by signing this Agreement, Vendor certifies that Vendor's signature provides written
verification to the City that Vendor: (1) does not boycott energy companies, and (2) will not boycott
energy companies during the term of this Agreement.
32. Electronic Signatures. This Agreement may be executed by electronic signature, which
will be considered as an original signature for all purposes and have the same force and effect as an original
signature. For these purposes, "electronic signature" means electronically scanned and transmitted versions
(e.g. via pdf file or facsimile transmission) of an original signature, or signatures electronically inserted via
software such as Adobe Sign.
33. Entirety of Agreement. This Agreement, including all attachments and exhibits, contains
the entire understanding and agreement between City and Vendor, their assigns and successors in interest,
as to the matters contained herein. Any prior or contemporaneous oral or written agreement is hereby
declared null and void to the extent in conflict with any provision of this Agreement.
(signature page follows)
Vendor Services Agreement Lone Star Hazmat Response, LLC 12 of 257
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples.
CITY OF FORT WORTH:
W44-�
By:
Valerie Washington (Jul3, 202510:08 CDT)
Name: Valerie Washington
Title: Assistant City Manager
Date:
, 2025
APPROVAL RECOMMENDED:
GfJG /u�oa..L
By:
Name: Wyndie Turpen
Title: Assistant Director, Environmental Services
ATTEST:
FONTnaca
opF„eee„oeQpOd
By. anba�zosaa
Name: Jannette S. Goodall
Title: City Secretary
VENDOR:
Lone Star Hazmat Response, LLC.
By:'l
Name: Richard Lenius
Title: President
Date: 07/0 1 2025
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration of
this contract, including ensuring all performance and
reporting requirements.
By:
Name: Nixalis Benitez
Title: Environmental Service Supervisor
APPROVED AS TO FORM AND LEGALITY:
W .. /Ar"-Z� ,A,%al WCl/
By:
M. Kevin Anders, II (Jul3, 202510:06 CDT)
Name: M. Kevin Anders II
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
Form 1295: N/A
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Vendor Services Agreement Lone Star Hazmat Response, LLC 13 of 257
EXHIBIT A
M011]9BMMDI:MA [yM
I. Definitions
a. Emergency Response: Contractor within one and half hours after notification and
authorization for action by City, the Contractor shall be at the worksite with sufficient
personnel, materials, and equipment necessary to effectuate an adequate response.
b. Initial Notification. Official notification from the City to the Vendor of a release, or
threatened release, of (1) toxic or hazardous substances, materials, or wastes; (2) oil or
petroleum substance; (3) pollutants; or (4) contaminants.
c. Responsible Party. The owner or operator of a vehicle, pipeline, or facility from which
there has been a release or threatened release of toxic or hazardous substance,
materials, or waste; oil or petroleum substance; pollutants; or contaminants.
II. Vendor's Duties. Vendor shall provide all labor, materials, and equipment necessary to
perform emergency and non -emergency response services for spills, abandoned waste, and
other environmental hazards as deemed necessary by the City.
a. Vendor shall provide the following spill control services, which may include, but
are not limited to, spill control analysis, disposal, consulting, and remediation
services at all facilities and locations under the control of the City (whether City -
owned, non -City -owned, &/or leased by the City), including structures, rights -of -
way, storm sewers, surface water bodies, and illicit narcotics laboratories.
b. Vendor shall have the following responsibilities:
i. Response Time:
1. Emergency Responses
a. Vendor shall respond within one hour (60 minutes) after
receiving the Initial Notification.
b. Within one and one-half hours (90 minutes) of the Initial
Notification, Vendor shall provide the necessary personnel,
materials, and equipment for an adequate response. The
adequacy of the response shall be determined by the City in
its sole reasonable judgment.
2. Non -Emergency Responses: Vendor shall respond within twenty-four
(24) hours to an Initial Notification for a Non -Emergency Response.
ii. Upon the City's request, Vendor shall collect samples and perform analytical
testing to characterize and profile waste for disposal. All analytical testing
shall be performed at a City -designated laboratory.
Vendor Services Agreement Lone Star Hazmat Response, LLC 14 of 257
iii. Vendor shall negotiate approval with the City regarding the profile and the
disposal plan for Class II Non -Hazardous Waste.
iv. For Hazardous or Class I Non -Hazardous Waste, Vendor shall contact the City
to plan for disposal through the Vendor under a separate agreement with the
City.
v. Vendor, under the command of the Fort Worth Fire Department ("Fire
Department"), shall assist the Fire Department with confined space entry or
reactive chemical ordnances until the Fire Department passes command to the
control of other City staff.
vi. Vendor shall provide onsite waste remediation, upon the City's request (e.g.
bio-remediation).
vii. Vendor shall be able to transport hazardous and non -hazardous solid and liquid
wastes.
viii. Vendor shall provide the City, on an as -needed basis, with sorbent products
that, at a minimum, must contain oil pads, oil booms and socks, universal pads,
universal booms and socks, universal spill kits, and biodegradable sorbents.
ix. Within seventy-two (72) hours after the Vendor completes all response
actions, Vendor shall provide the City a comprehensive written report of its
actions that it took on behalf of the City. The comprehensive written report
shall be at least one page, and include a summary of all actions, including the
final cleanup and the name of the City employee who made the Initial
Notification to the Vendor. Vendor shall include a detailed report of the
incident and response with its invoice.
x. Vendor shall provide fully executed copies of waste manifests and all other
paperwork needed to complete waste shipments within thirty (30) calendar
days of waste shipments. No payment shall become due and payable until
Vendor delivers all pertinent waste manifests to the City.
xi. Vendor shall certify that it has and will maintain, during the term of this
Agreement, that it has and will maintain current and appropriate federal, state,
and local licenses and permits to perform the work described in the Agreement.
Vendor also agrees to require any of its subcontractors it uses to perform work
under this Agreement to have current and appropriate federal, state, and local
licenses and permits.
III. CITY'S DUTIES. The City agrees to do the following under this Agreement:
a. City shall designate a City representative to accompany Vendor to the work site, make
decisions for the City, and provide timely direction to the Vendor.
b. City shall provide written confirmation which shall include the Fire Department's
incident number on the next business day following the Initial Notification.
Vendor Services Agreement Lone Star Hazmat Response, LLC 15 of 257
c. City shall coordinate its facilities, departments, and tenants to arrange, coordinate, and
take any and all reasonably necessary actions to obtain and secure ingress and egress
to emergency response sites. Vendor agrees that it shall enter an emergency response
site only upon City's authorization.
d. The City may issue an Order of Cessation to Vendor under the following
circumstances:
i. Vendor has entered into an agreement with the Responsible Party for
remediation at the work site. In such event, City shall have no further
responsibility to Vendor after Vendor executes the agreement with the
Responsible Party and provides a copy to the City.
ii. The Responsible Party has entered into an agreement with another contractor
to perform remediation services at the work site, and that contractor has arrived
at the work site. In such event, Vendor shall cancel its response if en route to
the work site or take all appropriate steps to turn control of the remediation
over to the Responsible Parry's contractor.
iii. If the City determines Vendor is performing Services in a hazardous or
unlawful manner. In such event, Vendor shall immediately give City control
of its in -use containment or sorbent products and perform appropriate
demobilization activities. Upon completion of appropriate demobilization
activities, Vendor shall promptly leave the work site.
IV. Citv Holidays. The following days are City holidays:
• New Year's Day (January 1)
• Martin Luther King Day (The third Monday in January)
• Memorial Day (The fourth Monday in May)
• Juneteenth (June 19)
• Independence Day (July 4)
• Labor Day (The first Monday in September)
• Thanksgiving Day (The fourth Thursday in November)
• The day after Thanksgiving (The fourth Friday in November)
• Christmas Day (December 25)
Vendor Services Agreement Lone Star Hazmat Response, LLC 16 of 257
City Secretary Contract No.
EXHIBIT B
PRICE SCHEDULE
Bid/No Bid
#
Item
UOM
Unit
Brand/Equivalent
Decision
Price
Bid
# 1-1
HR
$ 100.00
NA
Principal Project
Accountant
Bid
#1-2
HR
$ 130.00
NA
Manager - Project
Bid
#1-3
HR
$ 120.00
NA
Supervisor - Senior
Supervisor
Bid
#14
HR
$ 120.00
NA
Supervisor - Response
Foreman
Bid
#1-5
HR
$ 70.00
NA
Supervisor - Assistant
Superintendent
Bid
#1-6
HR
$ 95.00
NA
Site Safety Officer
Bid
#1-7
HR
$ 95.00
NA
Certified Industrial
Hygienist (CIH)
Bid
#1-8
HR
$ 120.00
NA
Scientist - Chemist
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 1 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 17 of 257
Bid #1-9
Scientist - Geologist
City Secretary Contract No.
HR $ 250.00 NA
Bid
#1-
HR
$ 250.00
NA
10
Scientist - Hydrologist
Bid
#1-
HR
$ 250.00
NA
11
Scientist - Biologist
Bid
#1-
HR
$ 250.00
NA
12
Engineer
Bid
#1-
HR
$ 90.00
NA
13
Technician - Hazmat and
Confined Space Trained
Bid
#1-
HR
$ 80.00
NA
14
Technician - Recovery
Truck Operator
Bid
#1-
HR
$ 80.00
NA
15
Technician - CDL Driver
Bid
#1-
HR
$ 250.00
NA
16
Specialist - Consultant
Bid
#1-
HR
$ 50.00
NA
17
Clerical- Administratve
Assistant
No Bid
# 1-
HR
18
Other - Courier
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 2 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 18 of 257
City Secretary Contract No.
Bid
#2-1
PR
$ 60.00
DuPont
Booties - Pair
Bid
#2-2
PR
$ 150.00
C1eanFreak
Boots - Acid Resistant
Bid
#2-3
PR
$ 60.00
Dublop
Overshoes - Rubber
Bid
#2-4
PR
$ 1.50
U-Line
Gloves - Nitrile
Bid
#2-5
PR
$ 20.00
U-Line
Gloves - Leather
Bid
#2-6
PR
$ 42.00
U-Line
Gloves - Chemical
Resistant
Bid
#2-7
PR
$ 25.00
Go Thermax
Glove Liners - Vinyl
Bid
#2-8
EA
$ 864.00
Zytron
Level "A" Suit - Kappler
Responder
Bid
#2-9
EA
$ 440.00
Dupont
Level `B" Suit
Bid
#2-
EA
$ 125.00
DuPont
10
Splash Suit - Poly
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 3 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 19 of 257
Bid
#2-
11
Level "C" Suit
Bid
#2-
12
Gloves
Bid
#2-
13
Level "A" Suit
Bid
#2-
14
Level "C" Suit - other
Bid
#2-
15
Splash Suit
Bid
#2-
16
Saranex Suit
Bid
#2-
17
Tyvek Suit
Bid
#2-
18
Face Shields
Bid
#2-
19
Safety Glasses
Bid
#3-1
Absorbent - Clay
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B
Vendor Services Agreement Lone Star Hazmat Response, LLC
City Secretary Contract No.
EA $ 80.00 DuPont
EA $ 864.00
EA $ 80.00
EA $ 125.00
EA $ 80.00
EA $ 125.00
EA $ 25.00
EA $ 0.00
Bags $ 20.00
U-Line
DuPont
DuPont
DuPont
DuPont
DuPont
U-Line
U-Line
Oil-Dri
Page 4 of 12
20 of 257
City Secretary Contract No.
Bid
#3-2
Ft
$ 1.15
Fyter Tech
Absorbent - Oil Boom
Bid
#3-3
Lbs.
$ 1.00
U-Line
Absorbent - Vermiculite
No Bid
#34
CY
Absorbent - Sand Mix
No Bid
#3-5
CY
Absorbent - Clay Mix
Bid
#3-6
CY
$ 785.00
Coco Absorb
Absorbent
Bid
#3-7
Bx
$ 15.00
Monk
Wipes
Bid
#3-8
Bags
$ 50.00
Costech
Lime
Bid
#3-9
Gal
$ 25.00
Fyter Tech
Sodium Hypochlorite
Bid
#3-
Gal
$ 35.00
BioRem
10
Spill Control/Bio
Remediation
Bid
#3-
EA
$ 25.00
ESP Supply
11
Decon Supplies - Brush
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 5 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 21 of 257
City Secretary Contract No.
Bid #3- EA $ 20.00 DQE
12 Decon Supplies - Pails
Bid #3- EA $ 400.00 Husky
13 Decon Supplies - Pools Containment
Disposable
No Bid #3- EA
14 Decon Supplies
Bid #3- RL $ 136.00 U-Line
15 Plastic Sheeting - Rolls 6
mil
Bid #3- EA $ 20.00 Abatix Approved
16 Samplers - Coliwasa
Bid #3- EA $ 295.00 Abatix Approved
17 Samplers - Bailers
Bid #3- EA $ 300.00 Grainger
18 Samplers - Eckman
Dredge
Bid #3- EA $ 450.00 NA
19 Other - Confined Space
Entry Kit -Daily
Bid #3- EA $ 92.00 Fyter Tech
20 Absorbent - Oil Pad per
Bale
Bid #3- Ft $ 1.50 New Pig
21 Absorbent - Oil Pad
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B
Vendor Services Agreement Lone Star Hazmat Response, LLC
Page 6 of 12
22 of 257
City Secretary Contract No.
Bid #3- Lbs. $ 5.00 Bell
22 Absorbent - Hay Bales
Bid #3- GPM $ 145.00 Wacker Neuson
23 Pump - >100 gallon per
minute
Bid #3- GPM $ 120.00 Wacker Neuson
24 Pump - 50-100 gpm
Bid #3- GPM $ 76.00 Wacker Neuson
25 Pump 2-50 gallons per
minute
Bid #3- Mil $ 160.00 U-Line
26 Plastic Sheeting - rolls 8
mil
Bid #3- Mil $ 100.00 U-Line
27 Plastic Sheeting - rolls 4
mil
Bid #3- CFM $ 80.00 Kobalt
28 Compressor 1-4 CFM
Bid #3- CFM $ 180.00 Ingersoll Rand
29 Compressor >4 CFM
Bid #3- EA $ 25.00 U-Line
30 Pump - Hand Siphon
Bid #3- EA $ 50.00 Tsurumi
31 Pump - Electric Trash
Pump
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 7 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 23 of 257
Bid
#3-
32
Pump-12Volt
Submersible
Bid
#3-
33
Pump - 2 Gasoline Trash
Pump
Bid
#3-
34
Pump - Pneumatic Pump
Bid
#3-
35
Boat - 12 ft
Bid
#3-
36
Boat - 20 Ft
Bid
#3-
37
Boat - 8 Ft
Bid
#3-
38
Broom - - Shop Push
Bid
#3-
39
Boom - Floating
Bid
#3-
40
Boom - Oil
Bid
#3-
41
Boom - Multi
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B
Vendor Services Agreement Lone Star Hazmat Response, LLC
City Secretary Contract No.
EA $ 75.00 U-Line
EA $ 100.00
EA $ 120.00
Ft $ 200.00
Ft $ 500.00
Ft $ 200.00
EA $ 25.00
linear ft $ 3.15
Linear $ 3.15
Ft
Linear $ 3.15
Ft
Honda
Vevor
Grizzly
Grizzly
Grizzly
Lowes
Fyter Tech
Fyter Tech
Fyter Tech
Page 8 of 12
24 of 257
City Secretary Contract No.
Bid
#3-
EA
$ 484.00
Elastec
42
Skimmer
Bid
#3-
CFM
$ 64.00
Stihl
43
Blower - Gasoline 180
CFM
Bid
#3-
CFM
$ 50.00
Stihl
44
Blower - Electric 180
CFM
Bid
#3-
In
$ 130.00
Honda
45
Auger - 8" Diamater
Bid
#3-
In
$ 150.00
Honda
46
Auger - 12" Diamater
Bid
#3-
EA
$ 240.00
Predator
47
Generator >5500 Watts
Bid
#3-
EA
$ 50.00
Wesco
48
Drum de -header
Bid
#3-
EA
$ 0.00
Coast
49
Lights - Handheld
Flashlights
Bid
#3-
EA
$ 300.00
Generac
50
Light plant w/ generator
Bid
#3-
EA
$ 25.00
Lowes
51
Post hole digger - Manual
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 9 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 25 of 257
City Secretary Contract No.
Bid
#3-
EA
$ 125.00
Honda
52
Pressure Washer - >1800
psi
Bid
#3-
EA
$ 265.00
Honda
53
Pressure washer - >4000
psi
No Bid
#3-
EA
54
Reactive chemical carrier
No Bid
#3-
EA
55
Remote drilling apparatus
- Geoprobe
Bid
#3-
EA
$ 200.00
Vevor
56
Fire Suit
No Bid
#3-
EA
57
Non -sparking tool kit
Bid
#3-
EA
$ 100.00
Tornado
58
Vacuum - Wet vacuum -
55 gallon
Bid
#3-
EA
$ 100.00
DeWalt
59
Vacuum - Dry vacuum
Bid
#3-
EA
$ 660.00
Laymor
60
Vacuum - Street Vacuum
Bid
#4-1
EA
$ 25.00
Questar
Bucket - 2.5 gal
DOT/Plastic
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B Page 10 of 12
Vendor Services Agreement Lone Star Hazmat Response, LLC 26 of 257
City Secretary Contract No.
Bid #4-2 EA $ 60.00 Questar
Bucket - 5 gal DOT/Metal
Bid #4-3 EA $ 50.00
Bucket - 10 gal.
Bid #4-4 EA $ 184.00
Drum - 1Al CH steel 55
Gallon
Bid #4-5 EA $ 128.00
Drum - 1H1 55 Gallon
Bid #4-6 EA $ 250.00
Drum - Poly Salvage 85
Gallon
Bid #4-7 EA $ 280.00
Drum - Steel Salvage 85
Gallon
Bid #4-8 EA $ 165.00
Drum - 30-gallon Steel
Bid #4-9
Drum - 14 Gallon Poly
Drum
Bid #4-
10 Drum - 10 gal.
Bid #4-
11 Boxes w/ pallet
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B
Vendor Services Agreement Lone Star Hazmat Response, LLC
EA $ 105.00
EA $ 85.00
CY $ 115.00
Questar
Questar
Questar
Questar
Questar
Questar
Questar
Questar
Questar
Page 11 of 12
27 of 257
Bid
#4-
12
Boxes 2.5 g lab pack
Bid
#4-
13
Roll off
Bid
#4-
14
Roll off
Bid
#4-
15
Drum - 30 gal steel
Vendor Services Agreement
Lone Star HAZMAT Response, LLC
Exhibit B
Vendor Services Agreement Lone Star Hazmat Response, LLC
City Secretary Contract No.
CY $ 25.00 Basco
CY $ 36.00
CY $ 36.00
EA $ 165.00
LSHR
LSHR
Questar
Page 12 of 12
28 of 257
EXHIBIT C
VENDOR'S BID RESPONSE
FORT WORTH. CITY OF FORT WORTH - PURCHASING DIVISION
RFP - CIQ I RFP Ref #: 25- 0118 I Pagel of 3
RFP Title: Emergency and Non -Emergency Cleaning Services
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a
person who contracts or seeks to contract for the sale or purchase of property, goods,
or services with a local governmental entity (i.e. City of Fort Worth) must disclose
in the Conflict of Interest Questionnaire Form "CIQ" the person's affiliation or
business relationship that might cause a conflict of interest with the local
governmental entity. Bylaw, the Questionnaire must be filed with the City of Fort
Worth Secretary no later than seven days after the date the person begins contract
discussions or negotiations with the City or submits an application or response to a
request for proposals or bids, correspondence, or another writing related to a
potential agreement with the City. Updated Questionnaires must be filed in
conformance with Chapter 176.
A copy of the Questionnaire Form CIQ is enclosed with the submittal documents.
The form is also available at hhts:Hvv,ww.ethics.state.tx.us/forms/conflict/
If you have any questions about compliance, please consult your own legal counsel.
Compliance is the individual responsibility of each person or agent of a person who
is subject to the filing requirement. An offense under Chapter 176 is a Class C
misdemeanor.
NOTE: If you are not aware of a Conflict of Interest in any business
relationship that you might have with the City, state the Proposer name in # 1,
and use N/A in each of the areas on the form. However, a signature is required
in the #7 box in all cases.
Vendor Services Agreement Lone Star Hazmat Response, LLC 29 of 257
FORT WORTH CITY OF FORT WORTH - PURCHASING DIVISION
RFP - CIQ I RFP Ref.#: 25- 0118 1 Page 2 of 3
RFP Title: EMERGENCY AND NON -EMERGENCY CLEANING SERVICES
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local govemmental entity
This questionnaire reflects changes made to the law by H.B. 23, a4th leg., Regular Session
"is questionnaire is being filed in accordance with Chapter 176. Local Government Code, by a vendat who
nas a business relationship as defined by Section 176.00- (1-a) with a Local governmental entity and the
vendor meets requirements undw Section 176.006(a).
By iati t''is questionnaire must be filed with the records administrator of the local governmental erdily not later
than he 7th business day aW the date the vendor becomes aware of facts that require the : to be
tr]. Sae Section 176.o b-a-1), Local Government Code.
A vandx commits an olense if the vendor Knowingly vwlates Secton 176.006, _ocat Government Cale. An
-isr_...cr samisdemeanor.
Name of vendor who has a business relationship with local governmental entity.
Lone Star Hazmat Response, LLC
FORM CIQ
OFFICE USE ONLY
Date Aecen®d
J ❑Check this bozlfyou are filing an updaw to a prvviousty f i led questionnaire. Gila law requires that you file an updated
completed questionnaire with the appropriate a authority _'. ater than the 7th business day after tho data on which
you became aware that the originally filed questionnaire was incomplete or inaccurate.)
J Name of local government officer about whom the information is being disclosed.
NIA
Name of Officer
J Describe each employment or other business relationship with the local government officer, or a family member of the
officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIQ as necessary.
A_ Is local government officer or a family member of the officer receiving or r , to =ecerve taxa_ : ricome.
other than investment income, from the vendor?
Yes F-1 No
S. Is the vendor receiving or likely to receive taxable income, other than investment income. from or at the d:raction
local oovemment officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes ❑No
J Doscribo oach employment or business relationship that the vondor named in Section i maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer or director, or holds an
ownership inlerest of one percent or more.
J
❑Check this box if the vendor has given the local government after or a family member _ one or more gifts
as described in =n:ion 176.0M(a)(2)(B), excluding gifts described it, 176.003(a-1).
?J
4/17/2025
at. a AveA cr _mg b s ns_et^'ht goverr*ien
Form provided by Tax Ph::s ssCr wvvw.ethics.state.ix.us Re;sed 1;112021
Vendor Services Agreement Lone Star Hazmat Response, LLC 30 of 257
FORT WORTH CITY OF FORT WORTH - PURCHASING DIVISION
RFP - CIQ RFP Ref. #: 25- 0118 Page 3 of 3
RFP Title: EMERGENCY AND NON -EMERGENCY CLEANING SER)d
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local Govemment Code maybe found at httpJNnm.statutes_legis.state.tx.usr
Docs/LG1htm,fLG 176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code & 176.00111-al: "Business relationship' means a connection between two or more parties
based on commercial activity otone of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an
agency of a federa, state, or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and
that t:'ect to regular examination by, and reporting to, that agency.
Local Government Code & 176.003("2)(A) and (8):
(a) A local government officer shall file a conflicts disclosure statement with respect to avendor ii:
(2) thevendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor,
(B) has given to the local government officer cra family member of the officer one or moregifts
that have an aggregate value of more than $100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code & 176.006(a) and (a-11
(a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of t- -
governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer, one or more gitiswifh the aggregate value specified by Section 176.003(a)(2)(B), excluding any
gift described by Section 176.003(a-1); or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application, response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity; or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer„ or a
family member of the officer, described by Subsection (a);
(B) that thevendor has given one or more gifts described by Subsection (a); or
(C) of a family relationship with a local government officer.
Form provided by Texas Elhkx= ssro^ vrvw.etNcs.stato.tx.us Rem5ed1/11M21
Vendor Services Agreement Lone Star Hazmat Response, LLC 31 of 257
FORT WORTH. CITY OF FORT WORTH - PURCHASING DIVISION
AUTHORIZED SIGNATURE AND CONTACT DETAILS
RFP Ref. #: 25- 0118 1 Doc. Ref#: RFP-03 I Page 1 of 1
RFP Title: EMERGENCY AND NON -EMERGENCY CLEANING SUPPLA
Legal Name of Proposer: Lone Star Hazmat Response, LLC
D/B/A Name of Proposer: Lone Star Hazmat Response, LLC
City of Fort Worth Bidder/Supplied Id or Federal Id Number (TIN): 81-2927774
Address: 115 W 5th St, Tyler, Texas 75701
Name of the Authorized Representative: Dana Taylor
Title: Vice President QA/QC
The undersigned, by his/her signature, represents that he/she is submitting a binding
Proposal and is authorized to bind the respondent to fully comply with the
solicitation document contained herein. The Respondent, by submitting and signing
below, acknowledges that he/she has received and read the entire document packet
for this RFP and agrees to be bound by the terms therein.
The undersigned agrees if the Proposal is accepted, to furnish any and all items
and/or services upon which prices are offered, at the price(s) and upon the terms,
conditions, and scope/specifications contained in this RFP.
Signature of the Authorized Representative:
Email: dana@lonestarhazmat.com
Name of Contact Person - 1:
Title of Contact Person - 1:
Email:
Name of Contact Person - 2:
Title of Contact Person - 2:
Email:
Name of Contact Person - 3:
Title of Contact Person - 3:
Email:
Phonr 03-531-0000
M4
Phone:
Phone:
Phone:
Vendor Services Agreement Lone Star Hazmat Response, LLC 32 of 257
Legal Name of Proposer: Lone Star Hazmat Response, LLC
1.0 PROPRIETARY INFORMATION
i. All material submitted to the City becomes public property and is
subject to the Texas Public Information Act upon receipt.
ii. If a Bidder does not desire information that it believes to be proprietary
in the bid to be disclosed, the bidder must list each page number in the
chart below and must clearly mark and identify each page by including
the word "PROPRIETARY" in all caps and highlighted yellow on the
bottom center of each page at the time of submittal. The City will, to
the extent allowed by law, endeavor to protect such information from
disclosure. The final decision as to the information that must be
disclosed lies with the Texas Attorney General. Note: Pricing may not
be marked proprietary and will be made publicly available in the form
of a bid tab following evaluation of all bids. By submitting a response,
Bidders agree that pricing is not proprietary and may be released.
iii. Failure to identify proprietary information, as required in section 15.6
of "RFP-01 Instruction to Proposers," will result in all unmarked
sections being deemed non-proprietary and available upon public
request.
Pages with information Please indicate if only specific sections
believed to be on the page are believed to be
Proprietary Proprietary
2.0 PROPOSEWS QUALIFICATION QUESTIONNAIRE
The information provided on this questionnaire and in the Proposal, submittal
will be used to determine the responsiveness of the Proposal. Please answer
Vendor Services Agreement Lone Star Hazmat Response, LLC 33 of 257
each question thoroughly. Answers may be provided on a separate sheet as
long as each response is labeled according to the question.
2.1 Will the agreement be available for Cooperative Agreement use?
Please refer to the Cooperative Purchasing clause in the "RFP-01
Instruction to Proposers" document.
Yes X No
2.2 Prompt Payment Discount Terms: 5% Percent 10 Days (i.e.,
3% Net 15, etc.)
2.3 How long has your company been in business? 9
(Attach information that can be used to verify your years of
experience.)
2.4 Indicate whether your company is local, regional, or international
Local and Regional
2.5 Provide the name of the person who is authorized to answer questions
regarding the company's proposal
Dana Taylor
2.6 Is your company licensed to perform Hazardous Waste Transport?
Yes X No
2.7 Is your company licensed to perform Non -Hazardous Waste
Transport?
Yes X No
Vendor Services Agreement Lone Star Hazmat Response, LLC 34 of 257
2.8 Is your company licensed to transport any other types of waste? If yes,
list below.
Yes X No
Other types of Waste:
Medical Waste
2.9 Would your company be able to respond within one hour of being
notified by the City to a release or threatened release of toxic or
hazardous substances, materials, or waste; oil or petroleum substance;
pollutants or contaminants?
Yes X No
2.10 Within one and half hours of initial notification, would your company
be able to provide the necessary personnel, materials, and all the
necessary equipment that are needed for an adequate response?
Yes X No
2.11 Does your company perform routine waste pick-ups for laboratory
hazardous and non -hazardous waste?
Yes X No
Vendor Services Agreement Lone Star Hazmat Response, LLC 35 of 257
2.12 Does your company perform routine waste pick-ups for
industrial/municipal hazardous and non -hazardous wastes?
Yes X No
2.13 How many people do you provide in order to provide emergency and
non -emergency cleaning services?
As many as the release deems necessary. Each call will have a Response
Manager and Technician at the least. Could have upwards of 15 people on site if needed.
2.14 What is your TRIR (Total Recordable Incident Rate) since January
2024?
2.26
2.15 What is your DART (Days Away, Restricted, or Transferred) since
January 2024
2.26
2.16 What is your EMR (Experience Modification Rate) since January
2024?
1.77
Vendor Services Agreement Lone Star Hazmat Response, LLC 36 of 257
2.17 Can you provide all the necessary credentials, and certifications?
Yes X No
2.18 Do you have an email address and phone number that is regularly
monitored?
Email Address: dispatch@lonestarhazmat.com I dana@lonestarhazmat.com
Phone Number: 24/7 Dispatch 888-942-9628 1 Corporate 903-531-0000
2.19 How often will emails be responded to? Within an Hour
2.20 What are your business hours and days?
Office Hours: Monday - Friday 8am-5pm
Response Hours: 24/7
2.21 Describe the range of size of your clients, their industries, and the
range of incidents responded to.
Clients range from residents for Household Hazardous Waste, to Municipalites
and State/Government Entities for Hazardous/Non-Hazardous/Bio Spill Response
and Mitigation
2.22 List the types of incidents your company responds to (ferric sulfate,
untreated wastewater, wastewater sludge, chlorine, sodium hydroxide,
etc.).
Vendor Services Agreement Lone Star Hazmat Response, LLC 37 of 257
LSHR is an All Hazards Response Company. We can handle anything from Non -
Hazardous Waste Removal to IDLH Incident Response.
2.23 Identify how many response teams and clean-up crews you have
available proposed to perform work for the City of Fort Worth and
which branch/location they are based out of.
DFW - 4233 S. Walton Walker Dallas, TX 75236 - 3 Crews
Tyler - 4865 American Legion Road, Tyler, TX 75708 - 2 Crews
Ardmore - 2071 Cimmaron Rd., Wilson, OK 73463 - 2 Crews
Abilene - 233 First Street, Tuscola, TX 79562 - 2 Crews
2.24 How many people are on each team/crew
Crews consist of 4 people each.
2.25 Provide a statement describing the status of each member of your
crew proposed to perform work for the City who is adequately
credentialed and has the requisite experience such as Hazardous
Materials Technician, Confined Space Entry Competent Person, Fall
Protection and Rescue Competent Person, Department of
Transportation HAZMAT Shipper, etc. (Please use an additional sheet
to provide information if needed)
Each member of the crew is Hazwopper 40 Certified. DFW has a full team of
confined space competenet persons.
Vendor Services Agreement Lone Star Hazmat Response, LLC 38 of 257
2.26 Do you utilize temporary employees/temporary labor?
Yes No X
2.27 If you utilize temporary employees/temporary labor, what percentage
of your response teams is made up of temporary labor and what
scenarios require their use?
N
2.28 Identify the companies/firms that are utilized for subcontracted labor/
temporary employee staffing as well as the Treatment, Storage, and
Disposal (TSD) facilities used for services under this agreement.
See possible Subcontractors and TSD Facilities that follow
2.29 Provide a minimum and maximum guaranteed response time for both
emergency and non -emergency projects.
Emergency Response: Minimum Time - 45min I Maximum Time - 1.5hr
Non -Emergency Response: Minimum Time - 4hr I Maxmium Time - 24hr
2.30 Describe your capabilities to respond to emergency incidents that
happen without prior notice 24/7.
Utilizing LSHR 24/7 Dispatch. Once dispatch receives the needed information
they will pa_ e out the job and the nearest Response Manager will be in contact with
the city point of contact within 10 minutes and headed to the scene to arrive in the
hour and a half window.
Vendor Services Agreement Lone Star Hazmat Response, LLC 39 of 257
2.31 List locations of branches and equipment storage yards.
4233 S. Walton Walker, Dallas, TX 75236
2071 Cimmaron Rd., Wilson, OK 73463
4865 American Legion Rd., Tyler, TX 75708
233 First Street, Tuscola, TX 79562
2.32 Describe your minimum and maximum offered project length.
Minimum - 4 Hours
Maximum - Length of Contract
2.33 Provide your range of response time offered and identify your average
response time for each incident type: Land, water, and air.
Land - Less than 2 hours
Water - Less than 2 hours
Air - Less than 2 hours
2.34 SUBCONTRACTOR AND DISPOSAL FACILITY INFORMATION
AND QUALIFICATIONS
i) For each Subcontractor and Treatment, Storage and Disposal (TSD)
facility to be used for services under this Agreement, provide the
information requested in Table-1 and Table-2 below and include
qualifications and capabilities (as detailed in Section 2.b) pertinent to the
services to be provided under the Agreement. Include a brief description
of tasks that will be performed by the Subcontractor/TSD facility.
ii) Table-1: Subcontractor Information
Subcontractor's Name I Proposed Tasks on the Project
Vendor Services Agreement Lone Star Hazmat Response, LLC 40 of 257
Brooksky Crow Excavation Services
Industrial Cleaning Vaccum Services
NOTE: If the waste is either Hazardous or Class I Non -Hazardous Waste, the Provider
shall contact the City to make arrangements for disposal through the hazardous waste
disposal company under a separate contract with the City.
IF NECESSARY, PROVIDE MORE SHEETS TO DESCRIBE ADDITIONAL
SUBCONTRACTORS.
INCLUDE A COPY OF THE TSD QUALIFICATIONS FOLLOWING THIS PAGE
WITHIN THE PROPOSAL PACKAGE
Table 2: Proposed Disposal Facilities
List all disposal facilities, including Class II Landfills, grease/grit trap waste
facilities, and other disposal facilities that are proposed under this Contract.
Vendor Services Agreement Lone Star Hazmat Response, LLC 41 of 257
Facility Name,
Owner,
And Address
The City plans on using its existing hazardous waste disposal company for
Class I Non -Hazardous and Hazardous Waste.
Phone Number Primary Contact Type of Disposal EPA and State ID
Person Numbers
Cactus Reclamation 214-307-5968 Steve Ayotte
3851 South Miller
Ferry Rd, Wilmer,
Texas 75172
Robstown Facility
Republic Services
3277 CR 69
Robstown, Texas
78380
832-672-2800 Adam Thompson
Tulsa Facility 918-582-9595 Adam Thompson
Republic Services
2700 S 25th West A-e
Tulsa, OK 74107
AEL
1984 FM 3034
Abilene, Texas
79601
Silver Creek
Materials
2251 Silver Creek
Rd, Fort Worth, Tx
-7E 108
325-437-3093 Ashley Moa
817-246-2426 Noel Espericueta
Class 2 Waste, Grit Trap, TXR000085036
Oily Water
Solid Waste, Recycling
RCRA Part B Permittec
Treatment facility of ha=
and non-haz solids and
liquids
Non -Hazardous Industria
Class 1, 2, 3
Liquid & Organic
Recycling
TXD069452340
OKD000402396
110031248317
liIIIIIINT41
NOTE: If the waste is either Hazardous or Class I Non -Hazardous Waste, the Provider
shall contact the City to make arrangements for disposal through the hazardous waste
disposal company under a separate contract with the City.
IF NECESSARY, PROVIDE MORE SHEETS TO DESCRIBE ADDITIONAL
SUBCONTRACTORS AND FACILITIES.
3.0 PROPER REQUIREMENTS IN ORDER TO BE EVALUATED -
The Proposer shall:
Vendor Services Agreement Lone Star Hazmat Response, LLC 42 of 257
3.1 Proposer shall have a minimum of two (2) — five (5) years of
experience performing similar or related to the Scope of Services.
3.2 Have and operate a full-time, permanent business address with the
ability to be reached by email and telephone from 8:00 am — 5:00 pm,
Monday — Friday.
4.0 DOCUMENTS REQUIRED FOR PROPOSAL TO BE CONSIDERED
RESPONSIVE
The following documents and information are required to be submitted to be
considered responsive:
4.1 Completed RFP-02-Form CIQ
4.2 Completed RFP-03-Authorized Signature and Contact Details
4.3 Completed RFP-04-Reference Sheet
4.4 Completed RFP-07-Questionnaire and Requirements
4.5 Completed RFP-09 List of employees' certifications and total years of
experience in cleaning Hazardous and Non -Hazardous Waste.
4.6 Completed RFP-10-Licenses and Certificates.
4.6.1 Provide copies of individual licenses and certificates upon
request from the City.
4.6.2 Provide a statement describing the status of each member of
your crew proposed to perform work for the City of Fort
Worth that is adequately credentialed and has the requisite
experience (Hazardous Materials Technician, Confined Space
Entry Competent Person, Fall Protection and Rescue
Competent Person, Department of Transportation (DOT
Hazmat Shipper, etc.).
4.7 Completed RFP-I I -Equipment capabilities.
4.8 Completed Bid Table — BT-89EK
4.9 Provide a brief overview of your company, including history, mission,
and/or philosophy, services offered, areas of expertise, and
organizational structure.
4.10 Company's Occupational Health and Safety Statement
4.10.1 Include your company's Occupational Safety and Health
Statement confirming that your company will abide by and
Vendor Services Agreement Lone Star Hazmat Response, LLC 43 of 257
follow OSHA, EPA, NFPA, and other appropriate regulations,
consensus, and recognized non -consensus standards while
performing work for the City of Fort Worth.
4.11 Provide a list of sorbents and associated costs
4.11.1 Provide a list of sorbents and costs that are associated with the
transportation of hazardous and non -hazardous solid and
liquid waste.
4.12 Any Exceptions to the Proposal or Draft Vendor Service Agreement.
If there are no exceptions, the Proposer must expressly state that no
exceptions are taken.
4.13 Signed Addendum(s) acknowledging receipt. Note: If no addendum is
issued, please attach a page stating "No Addendum Issued"
Vendor Services Agreement Lone Star Hazmat Response, LLC 44 of 257
Corporations Section �� g 0 Jane Nelson
P.O.Box 13697 �,� Secretary of State
Austin, Texas 78711-3697
Office of the Secretary of State
Certificate of Fact
The undersigned, as Secretary of State of Texas, does hereby certify that the document, Certificate of
Formation for Lone Star HazMat Response, LLC (file number 802469584), a Domestic Limited
Liability Company (LLC), was filed in this office on May 31, 2016.
It is further certified that the entity status in Texas is in existence.
In testimony whereof, I have hereunto signed my name
officially and caused to be impressed hereon the Seal of
State at my office in Austin, Texas on December 20,
2023.
Come visit us on the internet at https: //www. sos. texas.gov/
PhoYw.4drI30 4630%j56ement Lone Star Hazmat ResponFeAa LU12) 463-5709 Dial: 7-1-1 for Relq(RdlUces
Prepared by: SOS -WEB TID: 10264 Document: 1316035110002
Jon Niermann, Chairman 0:1 0
Bobby Janecka, Commissioner `v
x
Catarina R. Gonzales, Commissioner 0
Kelly Keel, Executive Director
TEXAS COMMISSION ON ENVIRONMENTAL QUALITY
Protecting Texas by Reducing and Preventing Pollution
May 03, 2024
DANA TAYLOR
LONE STAR HAZMAT RESPONSE LLC
115 W 5TH ST
TYLER, TX, 75701-4007
Re: Medical Waste Transporter Notice of Registration by Rule
LONE STAR HAZMAT RESPONSE
MSW 50278 CN605415454 RN111967980
Registered Since February 26, 2024
Registration Expires: September 30, 2025
Dear DANA TAYLOR:
The Texas Commission on Environmental Quality (TCEQ) has received your "Application to Claim a
Registration by Rule" in accordance with Title 30 Texas Administrative Code (TAC) Section (§) 326
Subchapter E.
This letter acknowledges receipt of your claim. It is not an acknowledgment regarding compliance
of your operation with state and federal rules and regulations. Failure to comply with all rules and
regulations regarding the transporting of untreated medical waste may result in enforcement
action and/or the revocation of your transporter registration.
A copy of your claim for registration and notice of registration must be available at all times and
at all locations where business is being transacted under this registration, including all motorized
vehicles or trailers operated under this registration. If any information provided in the claim
changes, you must provide an update application within 30 days. Enclosed is a copy of your notice
of registration.
If you wish to renew your claim, an application for renewal should be submitted at least 60 days
prior to the above expiration date. By March 1 of each year a report summarizing transportation
activities for the preceding calendar year (January 1 through December 31) must be submitted to
the TCEQ.
This action is taken under the authority delegated by the Executive Director of the TCEQ.
If you have any questions, please contact the IHW/MSW team at (512) 239-6413.
Sincerely,
Shannon Frazier, Section Manager
Registration and Reporting Section
Occupational Licensing and Registration Division
SF/GC
Enclosure
cc: TCEQ Region Office, TX
P.O. Box 13087 • Austin, Texas 78711-32087 512-239-1000 tceq.texas.gov
Vendor Services Agrej149 'd1&9h &ref &sWp�r�s',ct�tC tceq.texas.gov/customersurvey 46 of 257
TEXAS COMMISSION ON ENVIRONMENTAL QUALITY
MEDICAL WASTE TRANSPORTER NOTICE OF REGISTRATION
%\
Reaistration Number: 50278 RN111967980 CN605415454 Company: LONE STAR HAZMAT RESPONSE LLC
HENN Registered Since: February 26, 2024 Region:
TCEQ Expiration Date: September 30, 2025 Status: ACTIVE Regulated Entity: LONE STAR HAZMAT RESPONSE
Print Date: May 03, 2024
Physical Address:
115 W 5TH ST
TYLER, TX, 75701-4007
Mailing Address:
115 W 5TH ST
TYLER, TX, 75701-4007
REG# V TYPE
50278
Contact Information:
Contact: DANA TAYLOR
Phone: 903-531-0000
Fax:
APT/SUITE:
MEDICAL WASTE VEHICLE INFORMATION
ISSUED ISSUED START
V. YR V MAKE V M EL VIN PLATE # STATE YEAR OWNER NAME DATE
1
TRUCK
2021
DODGE
RAM 4500
3C7WRKFL3M 21590
RNY7364
TX
2024
LONE STAR HAZMAT
4/26/24
2
TRUCK
202
3136
LONE STAR HAZMA
26/24
3
TRUCK
2022
DODGE
RAM 2500
3C6UR5JLXNG271574
SSK1184
_y _r24
TX
2024
LONE STAR HAZMAT
4/26/24
4
7WRKBLPj001kn623
NWF1365
T
TAR HAZM
5
TRUCK
2017
DODGE
RAM 2500
3C6UR5JL5HG678450
LSC3250
TX
2024
LONE STAR HAZMAT
4/26/24
6
TRUCK
2022
DODGE
RAM 4500
37WRLFLONG268300
RZJ9645
LONE STAR HAZMAT
4/26/24
7
TRUCK
2020
DODGE
RAM 4500
3C7WRKFL3LG113134
NWF1429
TX
2024
LONE STAR HAZMAT
4/26/24
8
TRUCK
2020
FORD
F550 M
1 FDOW5GT1 LEE90207
TEMP 3
TX
2024
LONE STAR HAZMAT
4/26/24
9
TRUCK
2021
DODGE
RAM 4500
3C7WRKFL3M 21590
RNY7365
TX
2024
LONE STAR HAZMAT
4/26/24
RUCK
6UR5
02
STAR HAZMA
11
TRUCK
2018
DODGE
RAM 5500
3C7WRNEL3JG137367
LDK3112
TX
2024
LONE STAR HAZMAT
4/26/24
12
TRUCK
W DODGE
RNY73
NE STAR HAZMA
13
TRUCK
2019
DODGE
RAM 45
3C7WRLFL5KG535751
M M4769
TX
2024
LONE STAR HAZMAT
4/26/24
14
BOX VAN
2018
ISUZU
NPR HC
54DC4W1B4JS811998
TDS7996
TX
2024
LONE STAR HAZMAT
4/26/24
15
BOX VAN
2023
HINO
S5
JALEM 69P7301172
TEM
2024
LONE STAR HAZMAT
4/26/24
16 VenJdor ervices Agreemen{�o0ne�tOar-I lazmat Respo RAM 3C7WRKFL1 LG300890 PBN6902 TX 2024 LONE STAR HARK Af �57 4/26/24
V TYPE VYR V MAKE V MODEL VIN PLATE # ISSUED ISSUED START
50270278 V. — STATE YEAR OWNER NAME DATE
17 TRUCK 2022 DODGE RAM 4500 3C7WRLFL6NG405577 SPX6729 TX 2024 LONE STAR HAZMAT 4/26/24
18
TRUCK
i 2020
DODGE
RAM 4500
3C7WRLFL3LG127475
PPW4
002024
LONE STAR HAZMAJjj§§i24
19
TRUCK
2017
FORD
F550
1 FDOW5HT6HEE82834
STC8615
TX
2024
LONE STAR HAZMAT
4/26/24
20
TRUCK
2017
DODGE
RAM 5500
3C7WRNELOHG773206
MLG1825
TX
2024
LONE STAR HAZMAT
4/26/24
21
TRUCK
2019
FORD
F150
1 FTEX1 EBKKD332594
MNW3059
TX
2024
LONE STAR HAZMAT
4/26/24
UCK
M 3500`7Ww665
E STAR HAZMA�
4/26/24
23
TRUCK
2021
DODGE
RAM 3500
3CWRKFLXMG699316
RSX6611
TX
2024
LONE STAR HAZMAT
4/26/24
24
TRUCK
� DODGE
RAM 450
35232
TX STAR HAZMAT
1/26/21F
25
TRUCK
2023
CHEVROLET
SILVERADO M[
1HTKHPVK3PH509556
TEMP 2
TX
2024
LONE STAR HAZMAT
4/26/24
26
TRUCK
2022
DODGE
3C7WRLFL9NG105080
RHL5871
TX
2024
LONE STAR HAZMAT
4/26/24
27
TRUCK
2017
DODGE
RAM 2500
3C6UR5HL8HG706392
LNF1603
TX
2024
LONE STAR HAZMAT
4/26/24
28
TRUCK
2020
DODGE
RAM 4500
3C7WRLFL3LG127475
PPW4377
ask
2024
LONE STAR HAZMAT
4/26/24
29
TRUCK
2022
DODGE
RAM 4500
3C7WRLFLONG105081
RCW2034
TX
2024
LONE STAR HAZMAT
4/26/24
UCK
M 4500`7WR
KZPMG66?007
E STAR HA ZMA
6/24
31
TRUCK
2018
DODGE
RAM 3500
3C7WRTCL8JG312767
MTZ5056
TX
2024
LONE STAR HAZMAT
4/26/24
32
TR
11
HAZ jW
4/26/24
33
TRUCK
2020
DODGE
RAM 4500
3C7WRNFL3NG159132
RNY7363
TX
2024
LONE STAR HAZMAT
4/26/24
34
TRUCK
2018
DODGE
RAM 2500
3C6UR5DL1JG400436
RXV6626
TX
2024
LONE STAR HAZMAT
4/26/24
TOTAL VEHICLES: 34
Vendor Services Agreement Lone Star Hazmat Response, LLC 48 of 257
CHRISTI CRADDICK, CHAIRMAN DANNY SORRELLS
WAYNE CHRISTIAN, COMMISSIONER 5 ASSISTANT EXECUTIVE DIRECTOR
JIM WRIGHT, COMMISSIONER z s DIRECTOR, OIL AND GAS DIVISION
RAILROAD COMMISSION OFTEXAS
Environmental Permits and Support
12/19/2024
LONE STAR HAZMAT RESPONSE, LLC
115 W 5TH STREET
TYLER, Texas 75701
RE: PERMIT ISSUED
Form No. 98567 for a Waste Hauler Permit Application
WHP No. WH-00007160
Dear Operator:
Technical Permitting has reviewed the above -referenced application, submitted in hard copy
and entered by RRC staff on 12/19/2024. The Application is complete, and the permit is
hereby administratively granted. An updated list of approved vehicles and disposal/injection
systems is in the attached permit.
For questions or additional information, contact Environmental Permits and Support by phone
at 512-463-7371 or by email at whp@rrc.texas.gov.
Sincerely,
S/ Christine Peters
Christine Peters, Manager
Environmental Permits and Support
Technical Permitting
1701 NORTH CONGRESS AVENUE* POST OFFICE BOX 12967 * AUSTIN, TEXAS 78711-2967 *PHONE: 512/463-5339 *FAX: 512/463-6955
TOO 900/735-2989 OR TOY 512/463-72B4 * AN EQUAL OPPORTU LAITY EMPLOYER * https://v,vwv ,e.rrc.texas.gov
Vendor Services Agreement Lone Star Hazmat Response, LLC 49 of 257
2OF7
12/19/2024
Document ID: 340172
Authority is granted by the Railroad Commission of Texas (Commission) to haul, handle, and
dispose of oil and gas waste in accordance with 16 Texas Administrative Code JAC), Part 1,
Chapter §3.8 (Statewide Rule 8) and is subject to the following conditions:
A. The authority granted by this permit is effective 12/19/2024 and will expire on 12/31/2025,
unless suspended or revoked for cause shown.
B. This permit authority is limited to the hauling, handling, and disposal of oil and gas waste off
a lease, unit, or other oil and gas property.
C. This permit authorizes the permitted hauler to dispose of the oil and gas waste only at the
following disposal/injection systems:
1. Commission -permitted disposal/injection systems listed in Appendix A and Appendix B.
2. Disposal systems operated under authority of a minor permit issued by the Commission.
3. Disposal systems permitted by another state agency, or another state provided the
Commission has granted separate authorization for the disposal.
D. The permitted hauler must only carry waste that was generated by the disposal/injection
system operator to a disposal/injection system marked as non-commercial in Appendix A or
Appendix B.
E. Each vehicle must be marked on both sides and in the rear with the permitted hauler's
name (exactly as shown on the P-5 Organization Report) and permit number in characters not
less than three inches high.
F. This permit authorizes the permitted hauler to use only those vehicles shown on the
Commission -issued listing of approved vehicles which are listed on Permit Appendix C.
G. Each vehicle must carry a copy of this permit including all permit appendices that are
relevant to that vehicle's activities.
H. Each vehicle must be operated and maintained in such a manner as to prevent spillage,
leakage, or other escape of oil and gas waste during transportation.
I. The permitted hauler must make each vehicle available for inspection upon request by
Commission personnel.
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Vendor Services Agreement Lone Star Hazmat Response, LLC 50 of 257
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12/ 19/2024
Document ID: 340172
J. The permitted hauler must compile and keep a current list of all persons by whom the
permitted hauler is hired to haul and dispose of oil and gas waste and furnish such list to the
Commission upon request.
K. The permitted hauler must adequately train all drivers to ensure compliance with
Commission rules, including record keeping requirements, and adherence to proper
emergency response and notification procedures.
L. The permitted hauler must keep a daily record of the oil and gas waste hauling operations of
each approved vehicle. The daily record, signed and dated by the vehicle driver, must be kept
open for Commission inspection and must be kept on file for a period of three years from the
date of operation and recordation . The record must contain the following information:
1. The permitted hauler must keep a daily record of the oil and gas waste hauling
operations of each approved vehicle. The daily record, signed and dated by the vehicle
driver, must be kept open for Commission inspection and must be kept on file for a period
of three years from the date of operation and recordation . The record must contain the
following information:
a. Operator name
b. Lease name or facility name
c. Lease number and well number(s), or API well number(s), or permit number, or
latitude and longitude coordinates in decimal degrees if waste was not generated on a
lease
d. County
2. Type and volume (specify units) of oil and gas waste received by the hauler at the
property where it was generated
3. Identity of the disposal system to which the oil and gas waste is delivered, including:
a. Operator name
b. Lease name or facility name
30F7
Vendor Services Agreement Lone Star Hazmat Response, LLC 51 of 257
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12/ 19/2024
Document ID: 340172
c. Lease number and well number(s), or API well number(s), or permit number, or
latitude and longitude coordinates in decimal degrees if waste was not generated on a
lease
d. County
4. Type and volume (specify units) of oil and gas waste transported and delivered to the
disposal system
M. The permitted hauler must file an application to renew this permit, using the assigned
permit number,no sooner than 60 days before the expiration date specified in this permit.
N. This permit is not transferable.
This authorization is granted subject to review and cancellation should investigation show that
such authorization is being abused.
APPROVED AND ISSUED ON 12/19/2024
Sincerely,
S/ Christine Peters
Christine Peters, Manager
Environmental Permits and Support
Technical Permitting
Attachments:
Appendix A: Approved Injection Disposal Systems
Appendix B: Approved Surface Disposal Systems
Appendix C: Approved Vehicles
40F7
Vendor Services Agreement Lone Star Hazmat Response, LLC 52 of 257
5OF7
12/ 19/2024
Document ID: 340172
Attachments: Appendix A: Approved Injection Disposal Systems
Hauler Name Permit No. Permit Date Expiration Date
LONE STAR HAZMAT WH-00007160 12/19/2024 12/31/2025
RESPONSE, LLC
A COPY OF THE PART OF THIS LISTING RELEVANT TO THAT VEHICLES ACTIVITIES
MUST BE CARRIED IN EACH VEHICLE SUBJECT TO THIS PERMIT
UIC Number System Operator Nam ommerical
000095730 SOUTHWEST OPERATING, INC.- Yes
TYLER(806415)
5OF7
Vendor Services Agreement Lone Star Hazmat Response, LLC 53 of 257
Attachments: Appendix B: Approved Surface Disposal Systems
Hauler Name
LONE STAR HAZMAT
RESPONSE, LLC
Permit No. Permit Date
WH-00007160 12/ 19/2024
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12/ 19/2024
Document ID: 340172
Expiration Date
12/31 /2025
A COPY OF THE PART OF THIS LISTING RELEVANT TO THAT VEHICLES ACTIVITIES
MUST BE CARRIED IN EACH VEHICLE SUBJECT TO THIS PERMIT
Facility ID I System Operator Name I Permit Number I Commercial
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Vendor Services Agreement Lone Star Hazmat Response, LLC 54 of 257
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12/ 19/2024
Document ID: 340172
Attachments: Appendix C: Approved Vehicles
Hauler Name Permit Number Permit Date Expiration Date
LONE STAR HAZMAT WH-00007160 12/19/2024 12/31/2025
RESPONSE, LLC
A COPY OF THE PART OF THIS LISTING RELEVANT TO THAT VEHICLES ACTIVITIES
MUST BE CARRIED IN EACH VEHICLE SUBJECT TO THIS PERMIT
Vehicle VIN I License Plate# I Make I Model I Year
14000515010990091 1877222J ITRCR 1 11999
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Vendor Services Agreement Lone Star Hazmat Response, LLC 55 of 257
*** TEXAS COMMISSION ON ENVIRONMENTAL QUALITY ***
Notice of Registration
Industrial and Hazardous Waste
LONE STAR HAZMAT RESPONSE
Solid Waste Registration Number: 96816 EPA Id: TXR000094245
Company Name:
Lone Star HazMat Response, LLC
Site Name:
LONE STAR HAZMAT RESPONSE
Site Location:
Primary Contact:
LENIUS, RICHARD
Mailing Address:
5504 AMERICAN LEGION RD
TYLER, TX 75708-6114
Registration Status: Active
Registration Type: Transporter Transfer Facility
Generator Type:
Receiver Type:
Transporter Type: FOR HIRE
Transport Wst Class: H 1
Universal Waste Activity:
Large Quantity Handler of Universal Waste (you accumulate 5,000 kg or more): No
Type(s) Managed:
Destination Facility for Universal Waste: No
NAICS Code: 562910 Remediation Services
Tax Identification #: 32060631614
Handler Status:
Operator Information
Name: Lone Star HazMat Response, LLC
Phone: 903-234-1415
Address: 5624 AMERICAN LEGION RD
TYLER, TX 75708-6115
Other Contact: Manager, Environmental
Mailing Address: 5624 AMERICAN LEGION RD
TYLER, TX 75708-6115
As of 09/05/2017 - The next unassigned sequence number for WASTES is 0001 and
The next unassigned sequence number for UNITS is 001
Region: 5
County: 212 SMITH
Land Type: Private
Title: GENERAL MANAGER
Site Street Address: 5624 AMERICAN LEGION RD
TYLER, TX 75708
Hazardous Waste Generation Status:
Page: 1
Date: 09/12/2017
Initial Registration Date: 09/05/2017
Last Amendment Date: 09/05/2017
Last Date NOR Computer update: 09/07/2017
Phone: 903-234-1415
Reporting Method: PAPER
Owner Information:
Name: Lone Star HazMat Response, LLC
Phone: 903-234-1415
Address: 5624 AMERICAN LEGION RD
TYLER, TX 75708-6115
Role: IHW: Owner Contact
Phone: 903-234-1415
Vendor Services Agreement Lone Star Hazmat Response, LLC 56 of 257
*** TEXAS COMMISSION ON ENVIRONMENTAL QUALITY *** Page: 2
Notice of Registration Date: 09/12/2017
Industrial and Hazardous Waste
96916 1 f1NF STAR HA7MAT RFSPnNSF
**** WASTE INFORMATION ****
Texas Waste Date of Managed Radio- TCEQ Audit
Waste Class Status Status Onsite/ active Complete
Code Offsite
** No Longer Generated Wastes **
As of 09/05/2017, The next unassigned sequence number for WASTES is 0001
**** UNITS AT THIS SITE MANAGING WASTE ****
Unit Unit Unit Date of Classes of Waste Unit Unit # Regulatory Deed Recording
Number Type Status Status Managed in Unit Permit on Status Needed/Date
Onsite / Offsite Number Permit
As of 09/05/2017, The next unassigned sequence number for UNITS is 001
Vendor Services Agreement Lone Star Hazmat Response, LLC 57 of 257
2025 UCR Registration is VALID!
(D
Confinnation # 000-0.195-3613
Registered on: 1010912024 08:39 EST
Generated: 1010912024 08:39 EST
Year: 2025
Date Bracket UCR Fee Conv. Fee Total
Paid:
10/09/2024 Bracket 4 [51 veh.] $963.00 $28.60 $991.60
Bracket: 21 to 100 vehicles [51 vehicle(s)]
USDOT #: 2951564
Classifications: Motor Carrier
Legal Name: LONE STAR HAZMAT RESPONSE LLC
Base State: Texas
115 W 5TH STREET
Principal: TYLER, TX 75701
US
Payor: LONE STAR HAZMAT RESPONSE LLC
*** Expires: 12/31/2025 ***
Vendor Services Agreement Lone Star Hazmat Response, LLC 58 of 257
FORT WORD
%!"OPOIr"
ADDENDUM TO REQUEST FOR PROPOSAL NO.25-0118
Emergency and Non -Emergency Cleaning Services
PURCHASING DIVISION
ADDENDUM NO. 1
REQUEST FOR PROPOSAL (RFP): 25-0118
PROPOSAL CLOSING DATE: APRIL 24, 2025 (UNCHANGED)
RFP No. 25-0118 issued April 2, 2025, is hereby amended as follows:
DATE ISSUED: April 16, 2026
1. The Questions and Answers document is hereby incorporated, in full text, on page 2.
2. Line items #5-14 through #5-16 added Dump Truck, Vacuum Truck, and Recovery Truck to the
Bid Table BT-89EK.
3. Bid Table BT-89EK on Section 5, Monitor/Mobile Equipment, updated the Quantity Required and
Unit of Measure (UOM).
4. Bid Table BT-89EK on Section 5, Monitor/Mobile Equipment, line item #5-11, DO was changed to
read "Dissolved Oxygen (DO) Meter".
5. Bid Table BT-89EK on Section 5, Monitor/Mobile Equipment, line item#5-12, Sub -surface Soil
Sampler was changed to read "Sub -surface Soil Sampler -Manually Operated".
All other terms and conditions remain unchanged.
Y-47 Y_�
Juby Jacob
BUYER
■■■■■■■■■■■■■■■■■■rr■■■■■■■■■■■■■■■■■■■■■■rr■■■■■■■■■■■r■■■■■■■■■■■■■■r■■■■■■■.
By the signature affixed below, Addendum No. 1 is hereby incorporated into and made part of the above -
referenced RFP
COMPANY NAME: Lone Star azmat Response, LLC
SIGNATURE:
NOTE: Company name and i ature must be the same as on the original bid documents. Failure to
return this form with your sealed bid may constitute grounds for rejection of your offer.
Vendor Services Agreement Lone Star Hazmat Response, LLC 59 of 257
Questions and Answers
Q1. Is it possible to add pricing for equipment such as (Pickups, vac
trucks & recovery trucks)? We didn't see this equipment listed in
the original bid table.
Al. Yes, line items can be added to the Bid Table for inclusion of certain
line items, such as above, to be listed in the price sheet.
Q2. In the price sheet under materials and monitor/mobile
equipment, there are items listed such as various pumps and
testers.
a) Are these prices to be used on jobs such as hourly rates?
b) Are these prices for these items to be purchased by the city?
c) There are also boats listed with the unit of measure listed as
per foot. Just wanted to verify if these things will need to be
billed as parts of jobs, or supplied to the city.
A2. Below are the answers for each question.
a) The prices can be used as a Daily Rate only or each (EA).
b) No, the prices for the items will not be purchased by the City.
c) It will be billed as part of a job; if needed, the boat description
would be the length of the boat for the type of work needed.
However, boats will not be supplied by the City.
Examples: 10 Ft. Jonboat; 14 ft. V-Botton; 20 ft. Pontoon.
RFP 25-0118 Emergency and Non -Emergency Cleaning Supplies
Addendum No. 1, Page 2 of
Vendor Services Agreement Lone Star Hazmat Response, LLC 60 of 257
� LONE STAR HAZMAT
The Lender in Emergency Response
Health and Safety Manual
Last Review or Revision Date
12/29/2023
Lone Star Hazmat Response — Health & Safety Program
Table of Contents
CorporatePolicy Statement................................................................................................................................................ 3
Drugand Alcohol Policy...................................................................................................................................................... 4
Fleet and Driver Vehicle Safety Policy................................................................................................................................. 9
DisciplinaryPolicy............................................................................................................................................................. 23
Accident Investigation and Reporting Procedures............................................................................................................ 25
Vendor Services Agreement Lone Star Hazmat Response, LLC 61 of 257
Injured Worker's Early and Safe Return to Work Policy................................................................................................... 30
Access to Employee Exposure and Medical Records........................................................................................................
34
FirstAid Policy...................................................................................................................................................................
37
Bloodborne Pathogen Exposure Control Plan..................................................................................................................47
JobHazard Analysis...........................................................................................................................................................
53
Personal Protective Equipment Policy..............................................................................................................................
67
Hearing Conservation Program.........................................................................................................................................
70
RespiratoryProtection......................................................................................................................................................79
LadderSafety Policy........................................................................................................................................................106
FallProtection Policy.......................................................................................................................................................
108
ElectricalPolicy - General................................................................................................................................................
123
Energy Control (Lockout/Tagout)....................................................................................................................................
143
Hazard Communication Program....................................................................................................................................
150
ConfinedSpace Policy.....................................................................................................................................................
165
ToolSafety and Inspection..............................................................................................................................................
178
FirePrevention Policy.....................................................................................................................................................
181
EmergencyAction Plan...................................................................................................................................................
184
ActiveShooter...........................................................................................................................................................................
187
Non-Negotiables........................................................................................................................................................................
189
2
Vendor Services Agreement Lone Star Hazmat Response, LLC 62 of 257
Corporate Policy Statement
Management, staff, and hourly employees of Lone Star Hazmat Response (LSHR) must have a common objective to be
successful. Our objective is the healthy, safe, environmentally sound, and productive operation of all LSHR's activities. We have
an obligation to preserve the human, physical, and financial resources of our company. In satisfying this obligation, worker safety
and health will always be our #1 priority. As such, this basic policy must be considered in every phase of our business including
acquisition, job planning, job setup, and performance. Accordingly, our principal objectives are to:
• Provide a work environment that is free of unmitigated recognized hazards.
• Comply with all laws that regulate employee safety, health, and our environment.
• Recognize the priority of safety and health factors over purely economic considerations.
• Hold each employee accountable for the safe execution of all jobs assigned and full compliance with all
environmental, safety, and health related procedures and training.
• Train our employees in safe and proper job procedures and required compliance with established procedures,
policies, and practices.
• Provide comprehensive New Employee Safety Training to all new hires.
• Hire only those people who demonstrate the capacity to comprehend and execute all jobs in a safe and healthy
manner consistent with the policies and procedures of the company and the training and job instruction provided.
• Promote workers' health and safety both on and off the job.
• Maintain leadership in safety and accident/incident prevention by continuously improving safety performance and
work methods and procedures.
First -line supervision has the greatest impact and thus the greatest opportunity to influence and promote safe work
practices among our work force in the field. The prevention of accidents/incidents requires everyone's concerted effort
and daily attention. Every employee has equal authority and responsibility to take appropriate action to correct unsafe
acts/or conditions. If corrections can't be immediately addressed, all employees have the authorization to issue a STOP
WORK order.
A properly planned and executed job will eliminate the chance for losses and return benefits that satisfy needs in each of
these areas:
• Health, Safety, & Environment • Morale
• Cost • Production
• Quality • Customer Satisfaction
All employees will contribute to the company environmental, health, and safety program by following all policies and
procedures, bringing unsafe conditions/acts to the attention of management, and recommending actions to improve the
effectiveness of the program. Supervisors shall insist that employees observe and obey every rule and regulation necessary
for the safe conduct of work and shall take such action necessary to obtain compliance.
RLe*Li4 y
Richard Lenius, President
3
Vendor Services Agreement Lone Star Hazmat Response, LLC 63 of 257
Drug and Alcohol Policy
The company's safety sensitive work, the widespread availability and use of unauthorized, prohibited, illegal or
controlled substances, and the company's commitment to maintain a drug free work force, requires the pre-
employment, post -accident and unannounced periodic or random drug and alcohol testing of all employees.
Additionally, all employees will be subject to searches and inspections of their person, vehicle and personal
effects for the presence of illegal or controlled drugs, chemicals or substances, alcohol, explosives, contraband
or firearms.
Administration
Prohibited Activity
The Use, bringing onto company property or job site, possession, concealment, transportation, promotion
or sale of the following substances or items, by any employee, contractor, subcontractor, their employees
and invitees is strictly prohibited, to wit:
• Illegal drugs, unauthorized controlled substances, look -a -likes, designer, synthetic or any other drug
which may affect an employee's motor functions or alter a person's perception.
• Prescription drugs/over the counter medication except under the following conditions:
• The employee shall inform his supervisor prior to using any prescription drugs or over the counter
medication and receive written permission to possess such drug while working on the job.
• The prescription vial shall be labeled by the dispensing pharmacy and the label shall show the
employee's name, physician, prescription number, date the prescription was filled and the dosage
rate. Prescriptions more than 30 days old will not be allowed.
• The over-the-counter medication will be in its original package or container.
• The employee shall only possess enough medication for his normal shift.
• Alcoholic beverages.
• Firearms, weapons, explosives, and ammunition
• Unauthorized items such as stolen property or drug paraphernalia
Enforcement
As a condition of employment or continued employment, all employees shall be deemed to have and agreed to
cooperate with the implementation of this policy and abide by its terms. In addition, as a condition of
employment or continued employment, all employees shall be deemed to have agreed to the following
enforcement procedures.
Searches and Inspections
• An individual's entry into, or presence at, company property, or project work sites, is conditioned upon such
persons to consent to the right of the company, its authorized representative, or appropriate law
enforcement personnel to search the person, his vehicle and personal effects for the presence of
unauthorized, prohibited, illegal, or controlled drugs, chemicals or substances, alcohol, explosives,
contraband, or firearms.
4
Vendor Services Agreement Lone Star Hazmat Response, LLC 64 of 257
Drug and Alcohol Testing
o A pre -employment drug and alcohol screen will be required of all persons, prior to being
approved for work on the premises of any customer.
o A post -accident drug and alcohol screen will be required of any employee involved in an on-the-
job accident resulting in injury, to himself or others; a serious or potentially serious accident or
incident in which safety rules and precautions were violated; issuing unsafe orders or
instructions, damaging equipment or property of the company or others, usually careless acts, or
where the cause was employee's failure to wear required personal protective equipment.
o A "for cause" drug and alcohol screen will be required of all persons who show signs of possible
intoxication or using or being under the influence of drugs or alcohol, or when such other
circumstances exist that would lead a prudent supervisor to be concerned about the employee's
safety and the safety of others. All employees will be subject to unannounced drug and alcohol
testing, unless prohibited by law or regulation.
o Random or periodic testing will be conducted, as permitted by statute or regulation. These tests
will be without cause, suspicion, detectable performance problems, or the occurrence of an
accident, incident or safety violation.
o Employees involved in a rehabilitation program as outlined below will be given random drug and
alcohol screens for a period of 5 years following its completion.
All searches, inspections and drug screens will be performed in a professional manner, with concern for the
privacy and confidentiality of all individuals.
Testing Procedures
Laboratory Testing
The company will designate the laboratories to perform substance testing on blood or urine specimens in
accordance with standards set for by the National Institute for Drug Abuse. The substances and detection
levels covered by this testing program are set forth below. Employees may be asked by collection site
personnel to indicate whether there is the potential that they will test positive for prescription or other
substances. A consent form and information sheet will be provided. If the employee fails to provide and
acceptable urine specimen the company may take the following steps:
• Extend the stay of the employee at the designated collection site, if feasible, until an acceptable
specimen can be collected.
• Reschedule the test due to unusual circumstances, i.e. post -operative situations.
• Discipline the employee, up to and including termination, on the first offense for failing to cooperate or
refusing to provide an acceptable specimen.
All positive urine specimen test results for employees on active status will be confirmed by standard
laboratory procedures, generally gas chromatography/mass spectrometry (GC/MS), using a portion of the
same specimen. In cases of testing by means other than urine (i.e. breath or other samples), reliable
laboratory or instrument testing procedures will be followed.
5
Vendor Services Agreement Lone Star Hazmat Response, LLC 65 of 257
Non -Lab Testing
A visual one-step panel immunoassay for simultaneous, qualitative detection of multiple drugs and
metabolites in human urine may be used for the purpose of administering Random, Post Accident and For
Cause drug screens in the field.
• In the event of a positive reading, the specimen will be sealed, and a chain of custody form will be
completed, and it will be sent to a NIDA certified lab for GC/MS analysis.
• If the additional test results are positive, or if the employee fails or refuses to execute the Chain of
Custody forms as directed by the company, termination will result. If this additional drug screen is
required and the results are positive for the presence of drugs or alcohol the employee will authorize
the company to deduct, from his/her final paycheck, the sum of $50.00 to defray its cost of administering
the program.
• If the additional drug screen results are negative, the employee will return to work and be compensated
for time lost from the job.
Disciplinary Action for Policy Violation
Applicants
If the final result of a pre -employment drug screen is positive, the applicant will not be employed. No
applicant can be reconsidered for employment sooner than six (6) months following the date of the positive
drug screen.
Employees
• No search, inspection or drug test will be conducted without written consent. However, any employee
who refuses to provide such written consent and fully cooperate with this policy will be subject to
disciplinary action up to and including discharge from employment.
• Under certain circumstances, disciplinary action may include a mandatory referral to and enrollment in
an approved rehabilitation program at the employee's expense. This action may also require an
indefinite suspension of regular employment.
• An employee's job is not in jeopardy by reason of his voluntary admission to having a substance problem
and request for help and referral to an approved rehabilitation program, provided there has been no
prior violation of this policy, and the employee has not previously been through rehabilitation while
employed with the company, and further provided that such request is made prior to, and well in
advance of, any consideration of being tested under the provisions of this policy. The cost of this
rehabilitation will be at the employee's expense. The employee will be placed on one-time
administrative leave, without pay, for no longer than 30 calendar days. Employees participating in this
rehabilitation program will be subject to follow-up or "maintenance" testing for a 5-year period.
• If the final result of a "random", "for cause", "post -accident" or "maintenance" drug screening is positive,
the employee will be terminated from employment, and he may not then request rehabilitation. No
terminated employee can be reconsidered for employment sooner than six (6) months following
termination.
• Any terminated employee who is subsequently rehired and later fails another drug screen will no longer
be eligible to be reconsidered for employment under any circumstances.
6
Vendor Services Agreement Lone Star Hazmat Response, LLC 66 of 257
Contractors, Subcontractors, Vendors, Their Employees' Agents, or Representatives.
• No search, inspection or drug test will be conducted without written consent. However, anyone who
refuses to provide such written consent and does not fully cooperate with this policy will be subject to
disciplinary action up to and including removal from the job or job site, as may be appropriate.
Preliminary findings of a policy violation may require that the individual involved be suspended from the
job pending the results of the company investigation.
• If the final result of a "random", "for cause" or "post -accident" drug screen is positive, the individual will
be permanently barred from job.
Administrative Guidelines
• All employees will be informed of this policy at the time of employment. Additionally, it will be discussed
periodically at "tail gate" safety meetings.
• In the even an employee or terminated employee requests a review be conducted regarding his/her
positive test result, the laboratory will conduct a retest of a portion of the same sample previously tested
and will make the results of the retest available to the employee or terminated employee provided the
request is made within 12 months following the initial test. In the event that the retest is also positive,
the employee or terminated employee will be required to pay for the cost of such retest.
• A good faith effort will be made to advise any employee who receives a positive test result via a meeting
with the employee's Supervisor.
• An employee who has a substance problem is encouraged to seek immediate assistance. The Human
Resources Department will provide the employee with the name and address of local agencies or
facilities that are equipped to provide the rehabilitation assistance needed by the employee.
• The employee may be eligible for a one-time leave of absence from work for a period of up to 30 days,
for the purpose of enrolling in an approved rehabilitation program. As a condition of employment an
employee must test negative on a substance test in order to return to work. Such a request must be
made well in advance of any request by the company to submit to a random or for -cause substance
screen.
• The employee cannot use as a defense against termination the existence or availability of a rehabilitation
program or make any claim that participation in any program is a reason for reinstatement or job
retention.
Target Substances
As a minimum, the following substances and detection levels shall be tested for:
Alcohol
.04 BAL
Amphetamines
1000 NG/ML
Opiates
2000 NG/ML
Cannabinoids
50 NG/ML
Cocaine
300 NG/ML
Phencyclidine
25 NG/ML
Concentrations at or in excess of the above levels shall be conclusive proof of unacceptable levels of
unauthorized, prohibited, illegal or controlled substances.
7
Vendor Services Agreement Lone Star Hazmat Response, LLC 67 of 257
Client Requirements
If a client has Drug Testing Guidelines that are more stringent than those outlined above, the client's guidelines
will be followed for all work done with that client. Examples of more stringent guidelines include but are not
limited to:
• A greater number of substances (panels) to be tested for
• A lower detection/cut off level
• Specified number or percent of employees to be tested on site
• DOT or similar mandated programs
0
Vendor Services Agreement Lone Star Hazmat Response, LLC 68 of 257
Fleet and Driver Vehicle Safety Policy
Lone Star Hazmat Response (LSHR) is committed to instituting and maintaining a Fleet Safety Program.
The goal of the Fleet Safety Program is to take the proper steps to prevent loss of life, injury, or property
damage to all employees and members of the public. LSHR recognizes that the responsibilities for safety
and loss prevention must be shared by everyone.
Responding to emergency incidents does not in any manner reduce the responsibility to operate vehicles
safely. While prompt response to emergency incidents is an organizational priority, safety is always a
higher priority. The responding units must arrive safely at the location where they are needed before they
can deliver the required services. Unsafe operation of company vehicles or POV creates an unacceptable
risk to LSHR employees, to the public, and to our customers.
The motor vehicle laws of the state of Texas grant specific allowances and exemptions to emergency
vehicles, when they are responding to emergency incidents and using the required warning devices. These
provisions only apply to officially recognized emergency vehicles, while they are responding to emergency
incidents in compliance with all the applicable laws and regulations. Lone Star Hazmat does not overate
anv such vehicles.
Responsibilities
1. Management
• Assume responsibility for the driving record of employees while they are on duty.
• Affirm that no shipments of hazardous materials or hazardous wastes, requiring DOT placards, are
transported on company vehicles or trailers.
• Frequently check for compliance of the established requirements and policies in which all personnel
are required to adhere.
• Personally review the decisions on accidents and take all steps necessary to prevent a recurrence.
• Establish and adhere to policies on disciplinary actions in accordance with the policy regarding
actions that will be taken against employees who show a repeated disregard for safe driving
practices.
• Ensure that annual physical exams, required of CDL drivers and within 29 CFR 1910.120
(HAZWOPER) are completed for all applicable employees.
• Insist that all assigned vehicles are maintained adequately for safe operation.
• Establish periodic inspection of assigned vehicles for safety discrepancies, malfunctions, signs of
abuse, unreported damage and cleanliness. Have repairs made as soon as possible.
• Fully support the LSHR's driver training program to promote defensive driving and fatigue
management/avoidance.
• Review each preventable vehicle accident and unsafe driving report with the employee and his
supervisor to emphasize management's intolerance of irresponsibility behind the wheel.
• Establish an aggressive campaign to enforce the wearing of seat belts on all trips.
2. Supervisors
• Ensure that employees do not drive any LSHR vehicle unless they have a VALID Drivers' License and
are familiar with LSHR driving rules and regulations.
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• Ensure that only authorized personnel are allowed to operate LSHR vehicles, special purpose
vehicles, and trucks.
• Must be alert in observing unsafe practice of employees and ensure that action is taken immediately
to correct the driver.
• Review all preventable vehicle collisions with employees at Safety Meetings and discuss each unsafe
act that was responsible.
• Periodically ride with the vehicle and truck drivers to check for compliance with operating
instructions and traffic regulations.
• Ensure that unsafe vehicles are not driven until safety discrepancies have been corrected.
3. Employees
Employees who drive LSHR vehicles are responsible for following all guidelines set forth in the Fleet Safety
Program. These responsibilities include:
• Safe operation of vehicles and for the safety of passengers and cargo.
• Having a valid driver's license in their possession.
• Inspecting the vehicle which they are about to drive, in accordance with established policies.
• Reporting any vehicle accidents.
4. Safety / Loss Control Officer
The Safety/Loss Control Officer will oversee implementing the policies associated with the Fleet Safety
Program. Responsibilities will include:
• Monitoring the driving experience of employees who operate entity vehicles. Ensure proper
maintenance procedures are being followed to keep vehicles in a safe operating condition.
• Verify that adequate insurance limits are maintained by drivers who use their personal vehicle for
entity business.
S. Vehicle Operator Responsibilities
The driver is responsible for checking the safety and general condition of the vehicle, including gas, oil, and
other fluid levels, lights, and brakes. With the assistance of the Safety/loss Control Officer, supervisors will
furnish vehicles with inspection checklists. If there is something wrong with the vehicle, which may affect
safety, repairs will be made before use.
1. Fit for Driving.
Drivers will take regular and adequate rest breaks, at least every two hours, stop when tired and plan their
journeys (considering pre -journey work duties, the length of the trip and post -journey commitments).
Drivers may stay overnight if driving time and non -driving duties exceed 12 hours in one day.
2. Vehicle Abuse.
No employee will use a vehicle or equipment for any purpose for which it was not designed, operate it
beyond its designed limits, operate it in areas or locations for which it was not designed, or cause damage
through neglect, misuse, improper driving techniques, or improper handling.
3. Transporting Employees in LSHR Vehicles
No more than two employees will ride in the front seat or five employees maximum in a crew cab of a
vehicle. Each position will be equipped with a seat belt, and each person will use the seat belt provided. No
employee will be authorized to ride or work from the bed or rear of a vehicle while it is in motion.
4. Traffic Laws
Employees will adhere to all traffic laws and regulations when operating LSHR vehicles. An employee will
always operate LSHR vehicles in such a manner as to avoid injury to persons or damage to property.
5. Use of Warning Lights
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The use of warning lights does not automatically grant the right-of-way to a company vehicle. These
warning devices are intended to make other drivers aware of the presence of an emergency situation. Other
drivers are required to yield the right -of way to an emergency vehicle; however, they cannot be expected
to yield the right-of-way if they do not see or are not aware of your vehicle.
6. Unauthorized Use of Vehicles
LSHR vehicles are to be used for LSHR business only. Persons found using LSHR vehicles for their personal
errands may be subject to disciplinary action.
7. Operation and Occupancy of Entity Vehicle by Unauthorized Persons
Employees will not permit unauthorized employees or non -employees of LSHR to ride in LSHR vehicles,
except when such persons are conveyed in the performance of duty or authorized to ride by supervisory
staff.
8. Parking Vehicles
All employees will park their vehicles in a legal and proper manner. Wherever possible, vehicles will be
backed into parking spots, allowing for forward vehicle motion when departing. Employees will remove
the keys and lock the vehicles, except when specifically instructed otherwise. Employees will not park on
the wrong side of a street or highway, unless it is mandatory to park in such a location to perform a job. All
signs, cones, lights, and warning devices as required by law will be used when vehicles are parked or in use
in a public travel lane. Employees will use all safety brakes, lockout devices, and other parking safety
methods when parking equipment.
9. Use of Personal Vehicles for LSHR Business
Supervisors will identify and authorize those employees who are required, as part of their normal job
duties, to use their personal vehicle to conduct LSHR business. The employee's own insurance policy is the
primary coverage and, therefore, LSHR will not be responsible for any claims that arise out of any motor
vehicle accident that the employee is involved in while operating their personal vehicle. The mileage
reimbursement the employee receives is intended to fully cover all costs of the operation of the employee's
personal vehicle including but not limited to fuel, maintenance, repairs, insurance, etc.
10. Transporting Equipment
Employees using LSHR vehicles, or their own vehicles while conducting company business, will exercise
caution when transporting equipment, packages or other materials in the driver/passenger compartment
that would become flying projectiles in the event of an accident. Such items as briefcases, laptop computers,
tools, etc. need to be transported in the trunk of passenger vehicles. Pickups, whether standard cab or
extended, should have secured storage capabilities in the bed of the vehicle such as tool storage or camper
shells if they are used with any regularity in the transport of items that could injure the driver or
passenger(s) in the event of an accident. Vans used in the regular transport of such items should have
screen type barriers between such cargo and the driver/passenger compartment. It is always important to
keep the driver/passenger as free as possible of objects that could distract their attention or could cause
unexpected movement.
11. Use of Mobile Phones and Other Communication Devices
The vehicular use of a cellular telephone or other wireless voice/data communication devices is permitted
only when the device is used with available hands -free listening technology such as integration (syncing)
with the vehicle prior to its operation, a Bluetooth earpiece, a wired ear bud, or temporary vehicle -mounted
hands -free technology. If available, utilization of the device's speakerphone capability is acceptable in
meeting the intent of this section.
Driver Selection
LSHR believes knowing the ability, experience and attitude of drivers is a key factor in the selection
process. An important area in this process is to establish qualification standards for new employees and
existing employees that have driving duties. To enforce these standards, LSHR has implemented the
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following driver qualification procedures.
1. Driver Age Requirements
All drivers must be a minimum of eighteen years of age to drive company vehicles, or as required for CDL
licenses.
2. Application for Employment
All driver applicants shall complete an Application for employment containing all the information required
for positions in which driving is required. LSHR's hiring standards also require that driver applicants list
all former employers. Any gaps in employment for more than a one-year period must be satisfactorily
accounted for on the application.
3. License
LSHR will obtain a legible copy of the license of all driver applicants. A review of the license will be
conducted to be certain it is valid, has not expired, and is appropriate for the class of vehicles in which
driving is required, including any requisite CDL endorsements (as appropriate). Whenever driving LSHR
vehicles or operating their personal vehicle for company business, employees must have in their
possession a valid driver's license. Employees will notify their supervisor if their license is suspended,
revoked, or expired. Employees who drive vehicles which require a Commercial Driver's License (CDL),
will comply with Texas Department of Motor Vehicles' requirements for medical examinations and license
renewal. Supervisors will maintain a system that insures all employees operating vehicles have the proper
class of license and check licenses for current status at frequent intervals.
4. MVR Check and Evaluation
LSHR will request an MVR for driver applicants being considered for employment in which driving entity
vehicles or operating their own vehicle for entity business will be required. An MVR will be requested from
every state the applicant has lived in during the past (enter number of years) years. The MR Manager will
review all MVR information to determine if the driver applicant meets the qualification standards
regarding driving records. A formal review of the driver's MVR will be conducted on an annual basis (or
more frequently where warranted) to ensure that existing drivers are meeting the established qualification
standards. MVRs are personal and confidential and should only be discussed with the driver or other
people authorized to know. The HR Manager will receive the results of the MVR check and any needed
corrective action will be applied in a timely manner.
5. Investigation of Previous Employment
LSHR may contact all former and current employers of the driver applicant for the previous three years to
verify as much of the following information as possible:
• Dates of employment.
• Type of work performed.
• Type of vehicle(s) operated.
• Extent of driving experience.
• Vehicle accident record; and
• Overall work history and performance.
All former and current employer information gathered from the inquiries must be in writing and will be
retained in the driver's (if hired) qualification file. In the event a former or current employer refuse to
release information, a note stating this will be placed in the file. The HR Manager will review all former and
current employer information to determine if the driver applicant meets the hiring standards regarding
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past and current employment, and to determine if the applicant was truthful about information listed on
the employment application.
6. Driver Qualification Standards
To ensure that potential new and existing drivers meet LSHR's qualification standards for motor vehicle
records set forth in the Commercial Vehicle Safety Program, the following policies have been instituted
regarding:
A. Actions taken based on the number of points and violations shown from the MVR checks and
evaluations, and
B. Standards and penalties for drivers involved in preventable accidents.
A point system structure has been established to evaluate new hire and current employee motor vehicle
records. If a potential new employee or existing employee meets or exceeds seven (7) points total within
the previous three (3) years or exceeds four (4) points within the previous 12 months, they are not eligible
for a position that requires driving an entity vehicle. Motor Vehicle Records will be obtained on all entity
vehicle drivers every twelve months. Each MVR received will be reviewed in a timely manner and evaluated
for compliance. A copy of all records will be maintained in the employees file along with any corrective
action documentation.
Point Structure
Automatic Disqualification to operate an entity vehicle:
No potential new or current employee will be allowed to drive a company vehicle (including personal
vehicle) for company business if his/her MVR reveals:
• Murder or assault with a motor vehicle
• Theft of a vehicle
• Hit and run
• Negligent homicide
• An alcohol related offense in the last 3 years
• Illegal drug offense in the last 3 years
7-point offenses - citations for:
• DWI, DUI, OWI (alcohol or drugs)
• Reckless driving resulting in bodily injury or property damage
• Fleeing a police official
• Leaving the scene of an accident
• Driving with a suspended/cancelled/revoked license
• Racing on public road
4-point offenses - citations for:
• Speed in excess of 15 mph over posted speed limit
• Failing to stop for a school bus
• Failing to stop at a railroad crossing
• Second preventable accident
3-point offenses - citations for:
• Failure to obey a traffic control device
• Failure to yield right of way
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• Speed too fast for conditions
• Following too close
• Careless/Reckless driving
• One preventable accident
1-point offenses - citations for:
• Seat belt violations
• Failure to use turn signal
• Improper stop/parking
7. Driver Performance
LSHR requires all driver applicants who will require a CDL license for their driving position to successfully
complete a road test examination conducted by an LSHR supervisor prior to an offer of employment. Note:
the road test may be waived if the employee will only be driving automobiles and mini vans and has a clean
driving record. The road test examination shall be performed in the type of vehicle the driver will operate.
Performance will be monitored during the selection process as well as at periodic intervals throughout the
driver's career using information obtained from motor vehicle records and file data.
8. Driver Qualification File
The driver selection process includes developing a driver qualification file. Elements of this file will include
such items as:
• Employment application.
• Interview notes.
• MVR checks.
• Driver training information; and
• Driver evaluation and performance reviews.
Driver Training and Reviews
LSHR's goal is to have a process in place to hire only qualified and safe drivers. Once on board, LSHR is
committed to retaining these drivers. In order to keep drivers and supervisors well trained and informed,
LSHR has instituted several policies regarding driver training. These policies include driver orientation,
periodic driver meetings, and driver performance evaluation and reviews.
1. Driver Orientation
LSHR has an orientation program which all new drivers are required to complete. The orientation
program consists of comprehensive classroom training that will cover a variety of subjects. Among the
topics are established driving policies and procedures, regulatory compliance, vehicle maintenance and
inspections, accident reporting procedures, fatigue management and defensive driving procedures. After
successfully completing the classroom portion of the orientation, all new drivers will be assigned to a
driver trainer. The purpose is to evaluate the new employee's overall driving skills and techniques, and to
apply what has been learned in the classroom to an actual job situation. This time should also be used to
familiarize the new driver with paperwork procedures relating to vehicle maintenance and inspections
and to answer any questions or concerns that were not addressed in the classroom training.
2. Driver Meetings
Every month, a drivers meeting will be conducted by driver supervisors. These meetings between
supervisors and drivers are held to share news and information, and to give our drivers a forum to
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discuss issues, questions, or concerns. All drivers are expected to participate in these meetings, and all
drivers' input is welcomed and appreciated.
3. Driver Evaluation and Performance Reviews
Driver supervisors are responsible for conducting a periodic, structured performance review with each of
their drivers a minimum of every twelve months. It is important for LSHR drivers to understand that their
performance will be evaluated on an on -going basis, and they may request, or their supervisor may
recommend, a review at any time. However, all drivers will receive periodic structured reviews of their
individual performance.
4. On Road Performance Evaluation
The on -road evaluation is conducted by the supervisor to monitor the performance of current drivers by
riding with them or following them. The supervisor should document the results and counsel drivers
concerning problems or deficiencies that were observed. This is the best way for the supervisor to ensure
that the driver is following the proper vehicle inspection and defensive driving procedures.
5. Performance Review
Driver performance reviews should be held in private and away from the operation area. The review is
considered the driver's time and interruptions should not be allowed. The actual driver performance
review should cover, but is not limited to, five basic areas. These are:
1. The measurement of the driver's actual results against established goals and standards of the
company.
2. Recognition of the driver's contributions and accomplishments.
3. Correction of any new or existing performance problems.
4. Establishment of goals or standards for the next review period.
5. Review of Driver's MVR.
Once the driver and his/her supervisor have concluded their discussion of past performance; addressed
any development, training, or corrective action needs; and have established new goals and standards for
the future, they are expected to reach mutual agreement and wrap up the review. The wrap-up should
include the following:
1. A positive summary of the performance review discussion including all mutually agreed upon plans
and goals.
2. An opportunity for the driver to react, ask questions, and give additional ideas and suggestions.
3. A sincere and meaningful expression of appreciation for the driver's participation, time, and efforts.
4. A written record of what was discussed, agreed upon, and corrective action/training plans. A copy
of the written performance review and MVR check shall be given to the driver, the supervisor's
immediate manager, and the original placed in the driver's personnel file.
Samsara
LSHR has installed GPS tracking and forward facing and cab facing dash cameras in its fleet vehicles. The
system allows for real time tracking of vehicle operations, with immediate alerts for hard acceleration,
hard braking, and excessive speed incidents. Cab facing cameras are capable of detecting and alerting
incidents of distracted drivers, non -hands -free use of devices, as well as failure to wear seat belts. Dash
cam footage is available for review and could be used for follow-on instructions or disciplinary action, if
warranted.
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Accident Investigation
LSHR 's policy is to fully investigate any accident involving LSHR personnel and vehicles. All accidents
involving LSHR vehicles regardless of the severity must be reported immediately. The investigation of
minor accidents involving LSHR property only is the responsibility of the driver and supervisor only. The
Safety/Loss Control Officer will oversee the investigation of accidents in which serious property damage
or death to a LSHR employee has occurred. The Safety/Loss Control Officer will also oversee accident
investigations in which a third party is involved. Management may initiate any other investigations deemed
appropriate.
1. Accident Investigators
At the scene, the accident investigator(s) will carefully survey the scene, noting the position of any debris
from the accident. The investigator(s) should take photos of the scene, with careful notes of what the
photos depict. A map of the site should be drawn to scale, with any landmarks near the scene noted as to
position. Photos of all vehicle and property damage incurred from accident should be taken from all sides,
with careful notes made. The more accurate the information provided is, the easier it is when it comes to
canvassing the accident scene. It is important that the accident investigator(s) be as objective as possible
in gathering and evaluating data from the accident scene.
2. Driver Responsibility in Accident Investigation
Certain driver responsibilities must be carried out at the scene of an accident. Two main concerns at the
scene of an accident are to deal with immediate problems and to gather and report pertinent accident
information promptly. These two items can be broken down into a 6-step accident procedure for drivers
to follow.
Step 1: Stop, stay calm.
Step 2: Turn on your emergency flashers as an immediate warning signal. Then do a quick evaluation of
accident victims, if any, and aid. Next, set out emergency warning devices on the roadway.
Step 3: Either contact local law enforcement personnel and your supervisor yourself or arrange to have
someone do it for you. Be courteous and cooperative when providing information to authorities. Never
admit guilt or liability at the scene of an accident. Never leave the scene of an accident.
Step 4: Write down names, license numbers and other information regarding the accident and those people
involved in it. Draw a simple diagram of the accident scene. The more detail you can provide, the better it
will be for insurance and/or legal purposes later. Use your phone to take pictures. The more detail, the
better. Take a 360-degree video of the scene. License plates number and any other identifying items of the
vehicles.
Step 5: After the vehicle has been secured, warning devices put in place, assistance rendered to injured
person(s) (if any), and law enforcement personnel contacted, you (the driver) should communicate the
accident to your supervisor.
Step 6: Complete Vehicle Accident Report Form at the scene of the accident.
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Vehicle Accident Review
The Safety/Loss Control Committee will review all vehicle accidents to determine the true cause and
whether it was preventable or non -preventable. A preventable collision is one in which the driver failed to
do all that could be reasonably expected of them to avoid the collision. The functions of the Committee in
reviewing vehicle collisions are as follows:
1. Convene as soon as possible after a collision involving a/an LSHR vehicle to objectively consider the
evidence presented. This evidence includes any information given by the driver, his or her
supervisor and the police report of the accident. These same rules also apply to any employee
officially authorized to drive his or her personal cars on official LSHR business.
2. Determine the true cause of the collision and whether it was preventable or non -preventable.
3. Review the driver's past driving record.
4. Report in writing on the Management Committee's findings, and the recommendations for
corrective action.
5. In the case of a preventable ruling, schedule a personal one-to-one meeting with the driver to
discuss the decision, possible remedial training, and/or possible disciplinary action. This meeting
will be scheduled as soon as possible after the preventability determination has been made.
Vehicle Selection
It is important to ensure that vehicles selected for a specific function are adequate in design and capability
for the intended purpose. It is the responsibility of each driver to select the appropriate vehicle to be used
in performing tasks.
Vehicle Maintenance
It is the policy of LSHR to keep all vehicles well always maintained and in safe and efficient operating
condition. The specifics of that approach will be detailed in the procedures to follow. A good preventive
maintenance program lowers repair frequency and lowers overall maintenance cost. The service portion
of Preventive Maintenance is scheduled maintenance. LSHR vehicles will be given Preventive
Maintenance according to the current fleet maintenance schedule.
Vehicle Inspections
LSHR is committed to following a strong daily inspection program. All vehicles are to be inspected every
day they are operated.
Driver Pre -trip Inspection
Each driver must be satisfied that his/her assigned vehicle is in proper working condition prior to
operating. Each driver must also be satisfied that any cargo is properly distributed and secured. The driver
will also review the last completed Driver's Vehicle Inspection Report to verify that any repairs needed
were made to the vehicle. If the defects noted were not acknowledged by an authorized signature, the
driver shall not drive the vehicle until the defects are handled appropriately.
When a driver reports safety related problems or vehicle damage, the vehicle inspection report should be
submitted to his/her supervisor. The Supervisor will sign the report indicating that repairs have been
made (or are not required to be made). The original inspection report and certification of repairs will be
retained in the Vehicle Maintenance File. The original inspection reports on which no defects were noted
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and on which defects were noted, and the certification of repairs, will be retained in the Vehicle
Maintenance File.
Driver On -The -Road Inspections
Once on the road, the driver must examine any cargo and its load securing devices and make any necessary
adjustments. If a problem is found, the driver will notify his/her supervisor and either have the necessary
repairs or adjustments made prior to operating the vehicle, or safely travel to the nearest repair facility.
Vehicle Maintenance File
A complete record of each vehicle in the fleet will be kept. It will include basic vehicle information and
information indicating the nature and due date of any inspection and maintenance operations to be
performed on the vehicle, and a record of any inspections, repairs and maintenance performed on the
vehicle in question, including dates performed and specifics on the nature of the operations.
Vehicle Breakdown
Driver's responsibilities when a breakdown happens include:
• Safely stopping and securing the vehicle and load,
• Safely placing the warning devices,
• Diagnosing and calling in the breakdown to his/her supervisor
Supervisor responsibilities when a breakdown occurs include:
• Determining the nature of the breakdown and best course of action
• Locating, contacting, and dispatching a vendor to facilitate repairs
• Obtaining all vehicle repair records
Defensive Driving Policy
LSHR is strongly committed to a sound and thorough defensive driving policy. While operating entity
vehicles, drivers should always drive in the safest manner possible. Specifically, our drivers must operate
entity vehicles in accordance with all provisions of The Commercial Vehicle Safety Program. Full-time and
designated part-time employees driving LSHR vehicles shall be required to attend a Defensive Driving
Course and a Fatigued Driver Management Course.
1. Assignments for classes shall be made by the employee's supervisor to ensure class quotas are met and
to maintain satisfactory work schedules.
2. The frequency of employee attendance on Defensive Driving Courses shall be once per year.
3. New employees required to drive company vehicles shall be required to complete the Defensive
Driving Course satisfactorily before starting their driving assignment.
The core concepts of defensive driving are:
• Recognize the hazard.
• Understand the defense.
• Act in time
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Defensive Driving Procedures
Intersections. Getting into and out of intersections without an accident is a mark of a good defensive
driver. Besides your own skill level, intersections also demand anticipation of the actions of other drivers
and taking appropriate evasive action as required.
Backing is an extremely hazardous maneuver. If you are backing with the assistance of a guide, the ultimate
responsibility for the safety of the backing maneuver remains with you as the driver.
Front -End Collisions. The primary way to avoid front-end collisions is by maintaining a safe and adequate
following distance. You should be prepared for possible obstructions on the roadway, either in plain sight
or hidden by curves or the crests of hills. A special situation occurs at night, when speed should be kept to
a level that will allow you to stop within the distance illuminated by the headlights of your vehicle.
Rear -End Collisions. As a driver, you risk being struck from behind if you do not maintain an adequate
margin of safety in your own following distance. If enough space is not allowed in front of your vehicle,
chances go way up that somebody can (and will) impact you from the rear. Passing Failure to pass safely
indicates faulty judgment on your part as a defensive driver, and failure to consider one or more of the
factors that need to be checked:
• Is there enough room ahead?
• Is there adequate space to move back into your lane of traffic after passing?
• Have you signaled your intentions?
• Being Passed.
As a driver, you must be aware of the actions of other drivers and give way if another driver begins to
sideswipe you or to cut you off. A good defensive driver will avoid problems with this kind of accident
situation.
Encroaching on Other Traffic Lanes.
Observant defensive drivers will not usually get trapped when other drivers change lanes abruptly. In the
same manner, entrapment in merging traffic can be avoided by a good defensive driver with a little
preplanning and willingness to yield. Blind spots are not valid excuses for this kind of accident - allowances
must be made in areas of limited sight distance.
Railroad Grade Crossings.
Driving across railroad crossings, or in areas where there are rail vehicles of some sort, demands special
care. Careful observance of the traffic situation is your best defense.
Oncoming Traffic.
A defensive driver will avoid a collision with an oncoming vehicle at all costs. Even if the vehicle enters
your lane of traffic, an accident can be avoided with some evasive maneuvers.
Turning.
Turning, like passing, is a dangerous maneuver, and demands special care and an observant eye from you
as a defensive driver. You should be aware of other vehicles in your path, and of the complete
configuration of the turn you are about to undertake.
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Pedestrians.
As a sensible defensive driver, always assume that if there is a pedestrian (or small vehicle of some sort)
involved in a situation, slowing down is your best defense. Be certain to give people and small vehicles
the benefit of the doubt.
Extreme Weather and Road Conditions.
Bad weather and other road hazards place special stress upon any defensive driver. The best rule in any
kind of bad weather or extreme road condition is to get off the road safely and as soon as possible. If you
absolutely must continue, slowing way down and increasing the following distance are your best
defenses, along with increased awareness.
Fog reduces available visibility and impairs distance perception, making it perhaps the most dangerous
type of extreme weather condition. Because of this, it is company policy that, whenever possible, drivers
are to avoid driving in foggy conditions. Pull off the road and park safely until such time as the fog dissipates
or is burned off, if possible. If you cannot safely pull off the road, follow these procedures:
• You should never assume the depth or thickness of any fog. Fog can range from a momentary
blurring of the windshield to being several miles thick.
• Slow your vehicle's speed. Reduction in speed should be made gradually in order to avoid becoming
a hazard for other motorists. Determining a correct and safe speed depends on the thickness of the
fog and is left to your best judgment.
• Use low -beam headlights only when driving in fog. Low beams serve two purposes. They help you
see the immediate roadway and allow other motorists to see your vehicle.
• Avoid the use of high -beam headlights while driving in fog. The water particles that make up fog
will reflect more light back at you than onto the roadway when high beams are used and will further
reduce visibility for you.
• You should make use of windshield wipers and the defroster when driving in fog. Driving in foggy
conditions will cause a constant fine mist of water to develop on the vehicle's windshield, reducing
visibility in the process. Using the windshield wipers and defroster will alleviate this condition.
• Avoid passing other vehicles while driving in fog.
• You should avoid stopping on any roadway while driving in foggy conditions unless necessary. If
you must stop, use the emergency or breakdown lane, activate your emergency flashers, turn off the
headlights, and follow approved breakdown procedures.
Rain causes roadways to become slippery, especially when it first begins. Roadways become covered with
a thin layer of oil and other residues. When rain mixes with this layer, it results in an extremely slippery
and dangerous road surface. This condition remains until additional rain can break down and wash away
the oily mixture from the pavement. This process can take anywhere from a few minutes to several hours,
depending on the severity of the rain. Water on the road surface can also create a potential hazard of
hydroplaning. Hydroplaning happens when a thin layer of water separates the vehicle's tires from the road
surface. When a vehicle is hydroplaning, it is literally riding on water. When the tires ride on water, they
lose all traction and create an extremely dangerous situation. The faster a vehicle travels on standing water,
the greater the chance of hydroplaning. Reducing speed is the best and safest way to avoid hydroplaning.
Rain also reduces visibility. Because rain presents these hazards, drivers are expected to adhere to the
following procedures when driving in rainy conditions:
• You should slow the vehicle's speed to avoid hydroplaning. Reduction in speed should be made
gradually to avoid becoming a hazard for other motorists. Determining the correct and safe speed
depends on how heavy the rain is and will be left to your best judgment.
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• You are expected to increase your following distance from other motorists. Since rain causes the
road surface to become slippery, you need to allow for greater stopping distance if the need to stop
arises.
• You should make use of windshield wipers and the defroster when driving in the rain. Driving in
rainy conditions will cause a constant film of water to develop on the vehicle's windshield, reducing
visibility in the process. Using the windshield wipers and defroster will alleviate this condition.
• You should avoid passing other vehicles while driving in the rain. In addition, you are encouraged
to follow other vehicles at a safe distance since vehicles traveling ahead will throw water off the
pavement and leave "tracks". Driving on these tracks will give you the best possible traction under
rainy conditions.
Snow, depending on the type and severity, can present a variety of dangerous conditions. Because of this,
the following procedures have been developed for this defensive driving policy:
• Light, powdery snow presents few problems since it is quickly blown off the road surface. However,
if there is enough of this type of snow to cover the roadway, it will form a slick, smooth surface. You
should reduce speed and increase the following distance. Determining the correct speed and safe
following distance will be left to your best judgment.
• Heavier, slushy snow can affect vehicle control. If snow becomes hard packed it can cause an ice
hazard on the road surface. Again, you should reduce speed and increase the following distance.
Determining the correct speed and safe following distance will be left to your best judgment.
• All slow maneuvers such as starting out, steering, backing, and turning should be done smoothly
and with extreme care to minimize skids and slides.
• Falling or blowing snow can greatly reduce visibility. In addition, falling and blowing snow can make
it hard to see the road, road markings, road signs, and off ramps. If you must continue in snowy
conditions, reducing speed and increasing the following distance are the best techniques a driver
can use to maintain vehicle control.
• As with driving in foggy conditions, the use of high beam headlights while driving in snowy
conditions should be always avoided. The high beam "shooting" light will reflect off falling and
blowing snow and reflect back at you, further reducing visibility.
• Drivers will also be educated on the dangers of "snow hypnosis". Snow hypnosis occurs when a
driver is traveling directly into heavy snow and begins to focus on the falling snow instead of the
road ahead. This can cause a hypnotic -like effect on the driver. The danger of snow hypnosis is
especially prevalent at night.
• In extreme conditions, chains may be necessary.
Ice
All drivers need to be aware of changes in road surface conditions that may affect the vehicle's traction. To
help, the following procedures for driving on icy roads for this defensive driving policy have been
developed:
• As with all extreme weather conditions, if you must continue, the safest techniques to employ are
to reduce speed and increase your following distance. But of these two, increasing the following
distance is by far the most important. Depending on the temperature and road conditions, stopping
distance (distance needed to come to a complete stop) on icy roads can increase four to ten times
versus stopping from the same speed on a dry road.
• Black Ice" forms when temperatures drop rapidly and any moisture on the road surface freezes into
a smooth, almost transparent layer of ice. What makes black ice particularly dangerous is that you
may not realize you are on it until it's too late. Determining the correct speed and safe following
distance will be left to your best judgment.
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Bridges and overpasses are other areas to which you should give special attention. Ice will tend to
form first on bridges and overpasses because cold air circulates both above and below these
structures causing the temperature to drop more rapidly than on normal roads. Any moisture on
the road surface of a bridge or overpass will freeze quicker and harder than elsewhere on the road.
Extreme caution and a reduction in speed should be used while traveling over bridges and
overpasses.
Night Driving
All drivers need to be aware of the potential hazards driving at night present. These hazards include fatigue,
reduced visibility, poor lighting, other (impaired) motorists, and animals on the road. To help drivers better
prepare for driving at night, the following procedures have been developed for this defensive driving
policy: Fatigue is perhaps the most dangerous hazard of driving at night. Nothing we do is worth anyone
getting hurt. Fatigue usually sets in at night, but a tired driver, at any time of day, is an unsafe driver. Fatigue
reduces drivers' reaction time and perception.
All drivers are to review the following fatigue warning signs:
• Your eyes close or go out of focus by themselves.
• You can't stop yawning.
• You are experiencing trouble keeping your head up.
• You experience short-term memory loss. For example, you can't remember the last several miles
you have driven.
• Your thoughts wander or you begin to daydream.
• You start drifting into other lanes of traffic, tailgate, or miss traffic signs.
• You experience an inability to maintain a constant rate of speed.
• You must j erk the steering wheel hard to correct a drift and get back into your lane. If you experience
any of these signs, it's time to get off the road as soon as safely possible and get some rest.
Other Night Driving Hazards
• Reduced visibility is a hazard of driving at night. At night, visual acuity (degree of perception) and
peripheral vision (side vision) are reduced, and the eyes may have difficulty adjusting from light to
darkness. These factors all contribute to reduced visibility while driving at night. The best and safest
techniques to counteract these night driving hazards are to reduce your speed and increase your
following distance. Reducing speed is also the best way to prevent "outdriving" your headlights.
• Poor lighting on the open highway or on rural roads is another hazard drivers should be made aware
of. At night, with poor or no lighting aside from the vehicle's headlights, hazards in the road are
much more difficult to see and avoid. You should reduce speed and use extra caution when traveling
on poorly lit or unfamiliar roads.
• Impaired motorists (drunk drivers) are a hazard to everyone on the road. Drivers should be
especially cautious when driving between the hours of midnight and 0300 (typical bar and tavern
closing times). Drivers should be wary of motorists driving in an erratic manner including weaving
in and out of traffic lanes, having difficulty maintaining a constant rate of speed, or braking
suddenly. If you, as a driver, suspect that you are sharing the road with an impaired motorist, reduce
your speed, let the motorist pass, and increase the following distance.
• Animals on the road present another kind of hazard while driving at night. Drivers are to be
especially alert when driving on roadways lined by woods or tall grass. Animals, especially deer, can
jump out in front of a moving vehicle with no warning and minimal reaction time.
• Expect the unexpected.
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Disciplinary Policy
Purpose
The purpose of this policy is to define behavior which is considered unacceptable on LSHR jobsites and to define
the corrective measures which will be taken in response to unacceptable behavior.
It is LSHR policy to treat our fellow employees in a fair and even manner while maintaining the discipline
necessary to assure the safety, quality, and productivity of our operations. The following is a list of violations
which are unacceptable:
Class "A" Violations
Class "A" Violations are considered behavior of such a serious nature as to warrant immediate termination.
Class "A" Violations are as follows:
• Fighting or disorderly conduct on Company or Customer premises.
• Theft or willful destruction of Company property
• Violation of LSHR prohibition of illegal drugs, alcohol, or other articles.
• Willful endangerment of the life, safety, or health of oneself or one's fellow employees.
Class "B" Violations
Class "B" Violations are recognized as unacceptable and require disciplinary action which may include
termination. Class "B" Violations are as follows:
• Abuse or destruction of Company or Customers property
• Dishonesty
• Excessive absenteeism
• Failure to follow instructions
• Falsification of Employment Applications or LSHR time sheets.
• Harassment based on an individual's sex, race, color, national origin, religion, disability, or age in any
form by an employee.
• Inability to perform assigned tasks.
• Insubordination
• Leaving the job without permission or job abandonment
• Solicitation or distribution of literature on Company or Customer property.
• Tardiness or excessive absenteeism
• Theft
• Unsafe behavior
• Violation of safety rules
• Other violations for which LSHR feels corrective action is warranted.
This list is to be representative of the types of activities which may result in disciplinary action. It is not intended
to be comprehensive and does not alter the employment at -will relationship between the employee and LSHR
Violations will be reported to the Supervisor for resolution. The infraction will be reviewed with the employee,
and a written copy of the incident shall be prepared. The employee will be required to acknowledge the
infraction by signing a written copy of the incident. A written copy of the incident and the resulting actions taken
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will be filed in the employee's personnel file. Subsequent violations by the employee will be causes for
suspension or termination, at the discretion of the LSHR Safety Officer.
Audits shall be performed by the Safety Officer to evaluate each site's commitment to safety performance.
Supervisors whose projects display an overall lack of safety commitment shall be notified by the LSHR Safety
Officer for review. This review will include an overview of company safety policies and objectives, discussion of
the infractions, and the corrections deemed necessary to correct the infractions. A written copy of the review
shall be signed by the supervisor and kept in the supervisor's employee file. Continued lack of safety
performance on the supervisor's project shall be cause for suspension or termination, at the discretion of the
Safety Officer.
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Accident Investigation and Reporting Procedures
Policy
LSHR requires all employees to immediately report to their supervisor all accidents and incidents that result in injury or
property damage, and all near misses with the potential for serious injury or property damage. Supervisors will report the
accident promptly to management. Each incident will be analyzed to determine causes and contributing factors and the
analysis will be used to reduce or eliminate the risk of further incidents.
Definitions
An Accident is defined as an unplanned event that causes harm to people or damage to property. Accidents are
categorized as one of the following:
Lost Time Injury (LTI) refers to any injury that prevents a worker from coming to work on the day following the day of
the injury.
Medical Aid refers to any injury not severe enough to warrant more than the day of injury off, but where medical
treatment by a doctor is given.
First Aid refers only to injuries that can be treated on the job without any days lost.
An Incident is defined as property damage but with no injury to workers.
A Near Miss is a situation in which no injury or damage occurred but might have if conditions had been slightly different.
Occupational Illness is defined as a condition resulting from a worker's exposure to chemical, biological or physical
agents in the workplace to the extent that the health of the worker is impaired.
Critical Injury is defined as an injury of a serious nature that:
• Places life in jeopardy;
• Produces unconsciousness;
• Results in substantial loss of blood;
• Involves the fracture of a leg or arm but not a finger or toe;
• Involves the amputation of a leg, arm, hand or foot but not a finger or toe;
• Consists of burns to a major portion of the body; or
• Causes the loss of sight to an eye.
Role of Supervisor in an Accident Investigation
The Supervisor and the Safety Officer must investigate all accidents and incidents that involve workers. This includes
completing the Accident Investigation Report (See Accident Report, Attachment 4-1), taking statements from witnesses
(See Witness Statement Form, Attachment 4-2) and collecting any other pertinent information and ensuring the injured
worker has received the necessary medical assistance.
The supervisor is responsible for ensuring that all accident reports are transmitted to the Safety Department as described
below. If a worker sustaining a First Aid later seeks medical aid, the supervisor must advise the Safety Department and
have the treating practitioner complete a Functional Abilities Form.
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The supervisor should contact the injured worker as frequently as the injury deems, or at least once a week. If you require
assistance, contact the Safety Officer.
Procedure
• The employee reports a work -related accident
• Administer first aid as required
• Arrange for transportation for injured employee to medical treatment if required
• Ensure Return to Work package accompanies worker
• Eliminate the hazard if possible or guard the accident scene if worker is critically injured
• Investigate the cause of the accident and report findings in the Accident Incident Report form. Ensure all areas of the
form are completed.
• Send copy of the form to Safety Officer
• Report all accidents/incidents as follows:
o Lost Time Injuries
• Medical Aid
o First Aid
o Incidents and Near Misses
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LONE STAR HAZMAT
The Leader in Emergency Response
Accident Report
Injured Worker's Last Name
Location where injury/accident occurred
Hospital or Clinic Attended for Medical Aid
Nature of Injury
Person who transported employee
First Name Occupation
First Aid Provider
Treating Physician's Name
Project Location of Accident/Injury
Will this be a lost time injury? No ❑ Yes ❑ Is injury work -related? No ❑ Yes ❑
Were any subcontractors involved? No ❑ Yes ❑
Injury Details
Date and Hour of Injury Date and Hour Reported to Employer
Day Month Year Time Day Month Year Time
a.m. a.m.
p.m. p.m.
Date and Hour Last Worked Normal Working Hours
Day Month Year Time From to
a.m. a.m. a.m.
p.m. p.m. p.m.
Who was the injury reported to?
What caused the injury? Describe the injury, the body part involved and specify left or right side (use back of sheet if necessary)
Describe the worker's activities at the time of the injury. Include details of equipment or materials used (use back of sheet if
necessary).
Did anyone else witness the accident or know more about the injury?
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LONE STAR HAZMAT
The Leader in Emergency Response
Witness Statement Form
Date of injury/incident:
Name of witness:
Date
Name of interviewer:
Details of interview:
Signature of witness:
Signature of interviewer:
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Injury/incident number:
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LONE STAR HAZMAT
The Leader in Emergency Response
Corrective Action Form
Date of injury/incident:
Date
Corrective action taken (as indicated on the Accident/Investigation Form):
Recommendations:
Date assigned:
Responsibility assigned to:
Details of what has to be done:
Who has completed it?
When was it completed?
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Injury/incident number:
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Injured Worker's Early and Safe Return to Work Policy
Return to work is the process or strategy of safely returning employees to the workplace on a timely basis.
Policy
The Management of LSHR is committed to cooperating with all their employees who have been injured on the job site
and will do everything they can for an early and safe return to work. At LSHR, we will provide a modified work program to
any of our injured employees until he/she is able to return to their pre -accident job, wherever possible.
Roles and Responsibilities
Employer
Employer will:
• Contact injured worker ASAP and stay in regular contact. Cooperate in providing suitable work.
• Provide workers with Functional Abilities Form (Attachment 5-2) to take to the testing practitioner for completion.
• Educate workers about the return -to -work program.
• Set specific time frames for the return to work.
• Review worker's progress regularly.
• Pay full wages and benefits for the day or shift on which the injury occurred.
• Make certain that workers understand their obligations to co-operate.
• Set clear procedures to follow in reporting injuries.
Worker
Worker will:
• Contact supervisor immediately of any injury. If not available, phone the office and contact the employer.
• Stay in regular contact.
• Help identify and cooperate in suitable work arrangements.
• Return to work within 24 hours with the completed form to develop with the employer an early and safe return
to work.
• Choose a doctor or qualified practitioner.
Goals
LSHR will:
• Assess everyone's situation according to any practitioner's report and recommendations and provide modified
work to suit the degree of injury.
• Assist in the employee's active recovery and encourage the worker to return to work to their pre -accident job,
wherever possible.
Identify jobs that are suitable for accommodating injured workers on a temporary basis to facilitate the early and safe
return to work program and limit any loss of their earnings
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Accommodations
A change or modification to the job or workplace so that the work is within the injured or ill person's functional capabilities
and the risk of injury is reduced.
Types of Accommodations:
• Reduce hours
• Graduate RTW hours
• Re -assign duties
• Restructure the job
• More frequent rest breaks
• Work platform vs. ladders
• Ladders for climbing scaffolds
• Mini stretch breaks (10-15 minutes)
• Chair with back support vs. Picnic table
• Anti -vibration tools (e.g. anti -vibration jackhammer)
• Make heavy tools available at waist height
• Light shop work, general clean-up
• Painting trailers, containers (light work with brush)
• Washing trucks
• Pickup or delivery
• Training in their selected field, where possible
• Computer training in safety prevention, if available
• Increasing of awareness
First Aid
First Aid Stations are available at all job sites. ONLY Employees with Valid First Aid Certificate will provide first aid
assistance when required.
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Attachment 5-1 - Return to Work - Letter to Attending Physician
Dear Doctor:
LSHR has adopted a Return -to -Work Program for its employees. Through this program, we are committed
to return our employees to their regular jobs following an occupational or non -occupational sickness or
injury.
The program is designed to help reintroduce the employee back into their work environment as quickly as
possible. The program can be up to 6 weeks duration of reduced hours and modified or suitable work.
To accomplish the return to work of your patient (our employee), we request that you complete this form
and have the employee return it to his/her supervisor.
Thank you for your assistance and cooperation.
►F IM
Signature:
Date
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Attachment 5-2 - Functional Abilities Form
Name of Patient I Date of Birth SSN
A RECOMMENDATIONS for RETERN TO WORK
1 Have you discussed returning to work with your patient? ❑ Yes ❑ No
Please explain:
2 Does your patient require assistance or retraining in preparing for return to full duties, etc.? ❑ Yes ❑ No
Please explain:
3 Recommendations for work hours and start date:
❑ Regular full-time hours effective
❑ Modified hours effective ,
❑ Graduated hours effective ,
hours/day and/or hours/week.
hours/day for week(s), then hours/day for week(s)
4 Recommended date of next appointment to review abilities and/or restrictions:
B ABILITIES AND LIMITATIONS
— Include comments in Section C
5 Walking:
Standing:
Sitting:
Lifting from floor to waist:
❑ Full Abilities
❑ Full Abilities
❑ Full Abilities
❑ Full Abilities
❑ Up to 2 hours/day
❑ Up to 2 hours/day
❑ Up to 2 hours/day
❑ Up to 10 lbs.
❑ Up to 4 hours/day
❑ Up to 4 hours/day
❑ Up to 4 hours/day
❑ 10 — 20 lbs
❑ Other (please specify)
❑ Other (please specify)
❑ Other (please specify)
❑ Other (please specify
Lifting from waist to shoulder:
❑ Full Abilities
❑ Up to 10 lbs.
❑ 10 — 20 lbs
❑ Other (please specify
Cognitive limitations:
❑ Full Abilities
❑ Memory
❑ Concentration
❑ Fatigue
❑ Interaction with
others
❑ Other (please
describe)
Kneeling or squatting
❑ Full Abilities
❑ None
❑ Limited to
Stair Climbing:
❑ Full Abilities
❑ 1- 2 flights at a time
❑ 3 — 4 flights at a time
❑ Other (please specify)
Ladder climbing:
❑ Full Abilities
❑ None
❑ Limited to
Bending/twisting Work above chest/
repetitive movement: shoulder level: R L
❑ Full Abilities ❑ Full Abilities
❑ None ❑ None
❑ Limited to ❑ Limited to
Operating motorized equipment (i.e. forklift)
❑ Full Abilities
❑ None
❑ Limited to
C COMMENTS —Abilities and Limitations
Travel to work:
Ability to use public transit
❑ Yes ❑ No
Ability to drive a car
❑ Ye, ❑ No
Forceful or repetitive Pushing/pulling with: R
grasping with: R L L
❑ Full Abilities ❑ Full Abilities
❑ None ❑ None
❑ Limited to ❑ Limited to
Other:
6 Additional Comments on abilities and limitations listed above:
7 From the date of this assessment, the abilities and limitations noted above will expire on:
D PHYSICIAN'S INFORMATION
Physician's Name (Please Print): Physician's Signature: Date:
Email:
Degree/Specialty: Address: Phone:
Fax:
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Access to Employee Exposure and Medical Records
Purpose
The purpose of this section is to provide employees and their designated representatives with a right of access
to relevant exposure and medical records in order to fulfill responsibilities under the Occupational Safety and
Health Act. Access by employees and their representatives is necessary to yield both direct and indirect
improvements in the detection, treatment, and prevention of occupational disease.
Scope
This section applies to all employee exposure and medical records, and analyses thereof, made, or maintained
in any manner, including on an in-house or contractual basis. LSHR shall assure that the preservation and access
requirements of this section are complied with regardless of the way records are made or maintained.
Notification
Upon initial employment employees will be briefed and at least annually thereafter, informed via a bulletin
board posting of the following:
• The existence, location, and availability of employee records for exposure to toxic substances or harmful
physical agents.
• The person responsible for maintaining and providing access to the records. Contact your Resources
Manager or Safety Representative to initiate this request.
• The employee right of access to those records.
• The entire section pertaining to Access to Employee Exposure and Medical Records is available for employee
review by contacting the Safety Representative.
Record Keeping
• The Human Resources Manager is responsible for maintaining and providing access to employees' medical
records. These records are kept separately from other employee records.
• The medical records of employees who have worked for less than (1) year for the employer need not be
retained beyond the term of employment if they are provided to the employee upon the termination of
employment.
• Employee exposure records shall be maintained for the duration of employment and for 30 years thereafter
and should include the following:
o Environmental (workplace) monitoring including personal, area, grab, swipe (wipe over a designated
area), etc. type samples.
o Biological monitoring —level of chemical in the blood, urine, hair, fingernails, etc.
o Safety data sheets or a chemical inventory or any other record which reveals where and when used and
the identity (e.g., chemical, common, or trade name) of a toxic substance or harmful physical agent.
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Access
• Each employee or designated representative has the right to request access to his/her records. The company
shall assure that access is provided in a reasonable time, place, and manner.
• The employee may access his/her records by making a request to the Human Resources Manager. The
company will release an employee's medical records only if the employee has given specific, written consent
(see Attachment 6-1).
• If the company cannot reasonably provide access to the record within fifteen (15) working days, the company
shall within the fifteen (15) working days apprise the employee or designated representative requesting the
record of the reason for the delay and the earliest date when the record can be made available.
• In the case of an original X-ray, the employer may restrict access to on -site examination or make other suitable
arrangements for the temporary loan of the X-ray.
• Records or copies will be provided at no cost to the employee.
o Whenever a record has been previously provided without cost to an employee or designated
representative, the company may charge reasonable, non-discriminatory administrative costs (i.e.,
search and copying expenses but not including overhead expenses) for a request by the employee or
designated representative for additional copies of the record.
o There is no charge for an initial request for a copy of new information that has been added to a record
which was previously provided.
o No charge for an initial request by a recognized or certified collective bargaining agent for a copy of an
employee exposure record or an analysis using exposure or medical records.
Transfer of records
• Whenever ceasing to do business, the company shall transfer all records subject to this section to the
successor employer. The successor employer shall receive and maintain these records.
• Whenever ceasing to do business and there is no successor employer to receive and maintain the records
subject to this standard, the company shall notify affected employees of their rights of access to records at
least three (3) months prior to the cessation of business.
References
Code of Federal Regulation, Title 29, Part 1910.1020
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Attachment 6-1 - Release of Employee Medical Records
Sample Authorization letter for the release of employee medical record information to a designated
representative
(full name of worker/patient) hereby authorize
(individual or organization holding the medical records) to release to
(individual or organization authorized to receive the medical
information), the following medical information from my personal medical records:
(Describe generally the information desired to be released).
I give my permission for this medical information to be used for the following purpose:
But I do not give permission for any other use or re -disclosure of this information.
(Note: Several extra lines are provided below so that you can place additional restrictions on this authorization
letter if you want to. You may, however, leave these lines blank. On the other hand, you may want to (1) specify a
particular expiration date for this letter (if less than one year); (2) describe medical information to be created in
the future that you intend to be covered by this authorization letter; or (3) describe portions of the medical
information in your records which you do not intend to be released as a result of this letter.)
Full name of Employee or Legal Representative
Signature of Employee or Legal Representative & Date
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First Aid Policy
This policy is to ensure that prompt and effective medical assistance is provided to the employees of LSHR in case of
workplace injury or illness, the following first aid and medical services procedure is provided.
It is the responsibility of each manager / supervisor to ensure that compliance with the First Aid & Medical
Services Procedure is provided.
This policy covers minimum performance standards applicable to all LSHR employees and locations. Local
practices requiring more detailed or stringent rules, or local, state or other federal requirements regarding this
subject can and should be added as an addendum to this procedure as applicable.
Purpose
This First Aid & Medical Services Procedure is designed to establish specific common guidelines for LSHR to
follow in assuring that prompt medical attention is provided to employees suffering from either a work related
or non -work -related injury or illness.
LSHR facilities and jobsites must ensure that readily available medical personnel and first aid supplies are
available to all employees to provide advice and consultation within reason, regarding matters of employee
occupational health and to respond in case of accident. This includes identifying and posting the location of a
designated medical treatment facility and/or emergency care center in a conspicuous location at each fixed
location or fixed jobsite. Should outside medical services be unable to respond in a reasonable amount of time
as defined by OSHA (3 to 4 minutes), LSHR facilities and jobsites may use various strategies to provide access
within this time frame, such as training internal personnel who will be capable of acting as voluntary first
responders.
Scope
Applies to all LSHR work sites, i.e., offices, client job sites, etc., and includes visitors, vendors, and
subcontractors.
Definitions
Established Medical Treatment Facility means the occupational medical treatment provider and/or emergency
care center identified as being capable of and established by an LSHR location to initially treat employee injuries
and illnesses.
First Aid means the following types of treatment:
• Using non-prescription medications at non-prescription strength
• Cleaning, flushing, or soaking wounds on the skin surface
• Using wound coverings, such as bandages, 'Band-Aids', gauze pads, etc., or using'Steri-strips' or butterfly
bandages
• Using hot or cold therapy
• Using any totally non -rigid means of support, such as elastic bandages, wraps, etc.
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• Using temporary immobilization devices while transporting an employee, such as splints, slings, neck
collars, or back boards
• Drilling a fingernail or toenail to relieve pressure, or draining fluids from blisters
• Using eye patches
• Using simple irrigation or a cotton swab to remove foreign bodies not embedded in or adhered to the
eye
• Using irrigation, tweezers, cotton swab or other simple means to remove splinters or foreign material
from areas OTHER than the eye
• Using finger guards
• Using massages
• Drinking fluids to relieve heat stress
Illness can be classified as a skin disease/disorder, respiratory condition, poisoning, or other illnesses resulting
from an event in the work environment. Examples include, but are not limited to:
• Contact dermatitis
• Eczema
• Silicosis
• Asbestosis
• Toxic inhalation
• Poisonings by lead, mercury, or other metals
• Poisonings by carbon monoxide, hydrogen sulfide, or other gases
• Poisonings by organic solvents or by other chemicals
• Heatstroke, sunstroke, heat exhaustion, or other heat -related factors
• Freezing, frostbite, or other cold -related factors
• Effects of non -ionizing radiation (welder's flash or lasers)
• Bloodborne Pathenogenic diseases
• Microbial Exposure
• Ionizing Radiation
Injury means any wound or damage to the body resulting from an event in the work environment. Examples
include:
• Cut/laceration
• Puncture
• Abrasion
• Contusion/bruise
• Fracture
• Chipped tooth
• Amputation
• Insect bite
• Electrocution
• Thermal, chemical, electrical or radiation burn, and
• Sprain/strain injuries to muscles, joints and connective tissues when the result from a slip, trip, fall or
other similar accident
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Medical Treatment means managing and caring for a patient for the purpose of combating disease or disorder.
The following activities are NOT medical treatment:
• First aid
• Visits to a doctor solely for observation or counseling
• Diagnostic procedures, including the administering prescription medications that are used solely for
diagnostic procedures
Work -related Injury or Illness means an injury or illness resulting from an event or exposure in the work
environment causing or contributing to the condition or significantly aggravating a preexisting condition.
Work Environment means includes work sites where one or more employees are present as a condition of their
employment.
Requirements
Designated Medical Treatment Facility
LSHR will ensure that readily available medical personnel are available to employees to provide advice and
consultation within reason regarding matters of employee occupational health.
The facility and jobsite must identify and post the location of a designated medical treatment facility and/or
emergency care center including name, address, telephone number, and hours of operation. This
information should be posted in a conspicuous location at the facility or job site. The designated medical
treatment facility or emergency care center should maintain similar hours of operation as the facility and be
able to respond to a workplace emergency within a reasonable amount of time.
First Aid
ALL INJURIES, REGARDLESS OF HOW SMALL, MUST BE REPORTED TO THE EMPLOYEE'S IMMEDIATE
SUPERVISOR AND TREATED AS SOON AS POSSIBLE AFTER AN ACCIDENT.
If an employee becomes injured or ill anywhere due to a work -related or nonwork related problem and
needs immediate medical aid, it must be reported to his/her supervisor or the Safety Officer. Failure to
report minor injuries or to receive supervised medical treatment may result in serious infections or
complications to the employee's health.
In the absence of a clinic or hospital near the workplace, OSHA regulations require that a person or
persons be trained to render first aid and that first aid supplies be readily available. Although the term
"readily available" has not been defined in the regulations, OSHA has indicated that 3-4 minutes is
acceptable as the time frame within which to begin first aid.
OSHA's interpretation presents a challenge to a service company like LSHR because our "workplace" is not
always in a fixed location -- it is a changing environment that follows the employee wherever they may be
working. Accordingly, LSHR will use various strategies to provide employees with access to First Aid. These
may include training LSHR personnel to self-administer First Aid; training LSHR personnel who are willing
to serve as "first responders" and render First Aid/CPR to others on a voluntary basis; providing access to
trained individuals from other companies who work alongside LSHR at job sites; providing access to client
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medical clinics; or calling 9-1-1 or local emergency phone numbers as indicated in the Health and Safety
Plan.
Because of the potential for exposure to bloodborne pathogens and significant liability concerns, there is
no job in the Company that requires an employee to render First Aid or cardiopulmonary resuscitation
(CPR) in the course and scope of their employment, unless such a requirement becomes necessary due to
local, State or Federal Safety and Health Regulations.
Transportation of injured persons will be by ambulance unless a volunteer chooses to assist by driving the
injured employee to a medical facility. If there is any question as to the best method of transportation an
ambulance should be utilized.
When LSHR's strategy for providing access to First Aid/CPR involves the use of "first responders", a First
Responders Program should be established and administered at the local level. The Safety Officer is
responsible for monitoring and maintaining this program, if implemented.
Elements of the First Responder Program should include:
• Safety Officer must be certified in basic First Aid & CPR per a recognized certification source such as the
Red Cross, local hospital, etc. The Red Cross first aid course and CPR course are approximately 8 hours
in duration. CPR requires annual refreshers. First Aid requires refresher every three (3) years.
• Safety Officer will seek employees who wish to volunteer to be trained and certified in basic First Aid &
CPR per a recognized certification source as defined by local or State requirements. These employees
must maintain "current" First Aid and CPR certification, appropriately documented, in their personnel
file.
Basic First Aid & CPR will be administered by First Responders only to stabilize the employee until
professional medical attention can be provided.
Employee First Aid / CPR
Employee training in basic First Aid and cardiopulmonary resuscitation (CPR) is encouraged because of its
value and benefit to individuals, their families and the community.
The company also supports any employee who, while on the job, chooses to act as a "Good Samaritan" to
assist a fellow employee or another person with First Aid or CPR. It is LSHR's intent that first Aid supplies
and basic personal protective equipment against bloodborne pathogens be accessible to employees at
every work site during all shifts.
If an employee makes the decision to provide first aid to someone, universal precautions shall be followed,
and it should be assumed that all blood and bodily fluids are contaminated with bloodborne pathogens. In
addition, they should wear protective medical gloves found in the First Aid Kit and use any other personal
protective equipment (such as protective glasses with side shields or a full -face shield) to help avoid
exposure to blood in the eyes or on the face.
First Aid providers should follow the example of emergency medical personnel, doctors and nurses who
wear personal protective equipment to prevent exposure to bloodborne pathogens.
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If blood or potentially contaminated material gets on the skin, it must be washed off immediately using
water and a non-abrasive soap. If available, antiseptic soap or rinse must be used. If blood ever gets in the
eyes, lips, mouth or nose, the employee must go to a sink, water fountain, eye wash or body wash station
and flush the area with running water as quickly as he/she can.
The supervisor must always be aware of the potential exposure to a bloodborne pathogen after the
employee has washed or flushed the exposed area. Decontamination of the exposed surfaces, tools and
equipment should be conducted. This must be done immediately, and no later than the end of the shift or
work period. Remember that there is a vaccine for Hepatitis B. This must be discussed with a physician as
soon as possible after a potential exposure.
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First Aid Stations / First Aid Kits
A First Aid Station or First Aid Kit is to be readily available to employees as described previously. For
employees working off -premises, a first aid kit should be provided in each company vehicle, signed -out for
use when traveling in personal vehicles and rental vehicles, or provided on the jobsite.
Whether within the facility or in a vehicle, each First Aid Kit must be stored in a properly labeled weather-
proof container, stocked with the basic supplies specified in the inventory in Attachment 7-1. The physician's
approval of the inventory list is not required but may be needed to address unusual exposure situations.
IMPORTANT: If an employee declines First Aid and/or medical treatment for a reported on-the-job injury
after the Supervisor recommends it, that employee should NOT be allowed to continue work. Supervisors
should discuss each situation with the Safety Officer or Project Manager before allowing that employee to
return to duty.
The Safety Officer, or someone he/she may designate, is responsible for checking and maintaining the First
Aid Cabinets. Supervisors on jobsites are responsible for assuring suitable supplies are provided in the first
aid kits on -site or in their vehicles. This person will take a weekly inventory of supplies and make sure the
station or kit remains adequately stocked. A basic inventory list for First Aid Kits is provided on Attachment
7-1.
Because of the variety of operations that the Company is involved in, it is suggested that consultation with
the Facility's designated medical treatment facility be arranged to determine if the First Aid Kits are
adequate for the operational exposures of your workplace. Attachment 7-1 can be photocopied and used
as a guide for re -ordering supplies.
Emergency Eye / Body Wash Stations
Where the eyes and/or body of any employee may be exposed to injurious chemical / corrosive materials,
suitable eye and/or body drenching and/or flushing facilities shall be provided whether at the LSHR facility
or at a temporary worksite. Emergency eye and/or body wash stations can be either of temporary or
permanent installation.
In areas where the extent of possible exposure to injurious chemical / corrosive materials is very low, a
specially designated pressure controlled and identified water hose can be used when proper personal
protective equipment also is used (e.g. full -face shield). The hose system must be equipped with a proper
face and body wash nozzle and provide copious amounts of low velocity potable water. An appropriate
portable eye wash device containing not less than one gallon of potable water would also be acceptable
under these conditions.
At locations where hazardous chemical / corrosive materials are handled by employees (e.g. battery
servicing facility), proper eyewash and body drenching equipment must be available. Although OSHA has
not adopted specific requirements regarding flow rates for drenching/flushing facilities, ANSI Z358.1
provides detailed information regarding the installation and operation of emergency eyewash and shower
equipment, including the requirements for flow rate.
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Section 4.1 of ANSI Z358.1 specifies that emergency shower heads should be capable of delivering a
minimum of 20 gallons per minute (gpm) of flushing fluid at a velocity low enough to be non -injurious to the
user. A sufficient volume of flushing fluid shall be available to supply the flow rate for a minimum fifteen -
minute period. As such, both temporary and permanently installed eye / body wash stations must provide
at least 20 gpm for 15 mins.
Inspection and maintenance of eye wash systems should be provided at least weekly by assuring sanitary
conditions and /or following the manufacturer's requirements for maintenance. Plumbed systems should
also provide a water flow test to minimize contaminants in the line. Inspection and maintenance should be
properly documented.
Bloodborne Pathogens (Universal) Precautions Training
When an employee comes into direct contact with blood, bodily fluids or body tissues of another person,
they are at risk of becoming infected with diseases that may be carried in the other person's body fluids.
Accidental exposures can happen on or off the work site, in any number of day-to-day situations.
Therefore, the Company believes that each employee should have a basic understanding and awareness of
the dangers of contracting a potentially deadly disease through such exposures. Communicating basic
information about these hazards, including information contained in this policy, is part of the Company's
safety and health program.
Therefore, employees should receive a basic awareness level training concerning "Universal Precautions"
such that employees may follow Universal Precautions in the event of potential exposure to blood or other
body fluids.
Training Requirements
Training records must be maintained by the Safety Officer containing the date of the training, a summary
of the training session, names and qualifications of the instructors conducting the training and the names
and job titles of the persons attending the training.
Training records must be maintained for a minimum of three (3) years from the date the training was
conducted. Training must be conducted by a qualified and competent person knowledizeable in the
subject matter.
First Responder Exposure
If an employee is a First Responder or decides to be a "Good Samaritan" and provides first aid on an
injured victim involving blood or bodily fluids, personal protective equipment must be used, and
Universal Precautions followed treating all bodily fluids as infectious. Refer to OSHA 29CFR 1910.1030 -
Bloodborne Pathogens Standard and Policy Section 9 — Bloodborne Pathogens for specific information.
In addition to those items listed in Attachment 7-1 and/or possibly required by a consulting physician,
First Aid Stations must at least include the following supplies:
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• latex gloves
• one-way valve CPR mask
• biohazard bags
• plastic baggies
• tongs
References
OSHA 29 CFR 1926.50
OSHA 29 CFR 1910.151
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Attachment 7-1- First Aid Kit Inventory Checklist
The First Aid Kit should contain the following or similar items, but commercially available Kits vary widely and
need not be identical in every respect.
Item
Quantitv
Protective Rubber Gloves (Surgical Type)
2 pair
Protective CPR Mask w/One-Way Valve
1 each
Protective eyewear and face covering
1 each
Antiseptic Soap
1 each
Absorbent gauze, 24" x 72"
1 pkg.
Spool of absorbent gauze
1 spool
Large adhesive bandages, 1"
1 pkg.
Small adhesive bandages, 1/2"
1 pkg.
Bandage compresses, 4", 1 per pkg.
1 pkg.
Eye dressing
1 pkg.
Bandage scissors
1 pair
Tweezers
1 pair
Triangular bandages, 1 per pkg.
3 pkg.
Antiseptic pads, 3 per pkg.
2 pkg.
Medical adhesive tape
1 roll
Self -activating cool packs
2 each
Burn ointment
4 pkg.
Sterile eye wash, in bottle
1 each
Heavy-duty sealable plastic bags
3 each
Disposable splints
1 set
Approved biohazard bags, red in color
4 each
Large Baggies
4 each
Tongs
American Red Cross Pocket First Aid Guide
First Aid Kit Inventory Checklist Forms First Aid Report Forms
Date of order: By:
For
location:
Consulting Physician (If Applicable.):
Address:
Telephone Number:
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Designated Medical Treatment Facility
Attachment 7-2
IN CASE OF EMPLOYEE ACCIDENT OR INJURY, THE FOLLOWING DESIGNATED MEDICAL TREATMENT FACILITY
HAS BEEN IDENTIFIED TO DIRECT THE INJURED EMPLOYEE FOR IMMEDIATE TREATMENT:
NAME OF FACILITY: Nova Care
Each LSHR facility to complete the following for its location:
ADDRESS:
TELEPHONE NUMBER:
EMERGENCY TELEPHONE NUMBER:
HOURS OF OPERATION:
SUPERVISOR OR SAFETY OFFICER:
SUPERVISOR OR SAFETY OFFICER CELL / PAGER NUMBER:
ALL WORK -RELATED INJURIES OR ILLNESSES MUST BE IMMEDIATELY REPORTED TO THE SUPERVISOR.
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Bloodborne Pathogen Exposure Control Plan
Purpose
This Bloodborne Pathogen Exposure Control Plan has been established to ensure a safe and healthful working
environment and act as a performance standard for all employees. This program applies to all occupational
exposure to blood or other potentially infectious materials.
Scope
This program addresses all occupational exposure to blood or other potentially infectious materials. Certain
Regulatory Agencies and Client Sites requires that all employers that can "reasonably anticipate exposure" of
employees to infectious material prepare and implement a written exposure control plan.
Responsibilities
Managers and Supervisors will have an overall responsibility for developing and implementing Exposure
control procedures for all facilities.
Employees will know what tasks they perform that have an occupational exposure, plan and conduct all
operations in accordance with LSHR work practices, and develop good personal hygiene habits.
Training
LSHR shall ensure that all employees with occupational exposure participate in a training program. Training is
conducted for all employees with occupational exposure before initial assignment and within 1 year of
previous training. Training shall be provided at the time of initial assignment & within 1 year of an employee's
previous training. Training shall include:
• What bloodborne pathogens are; how to protect themselves from exposure
• Methods of warnings (signs, labels, etc.)
• The requirements of bloodborne pathogens The Hepatitis B vaccine shall be made available to all
employees that have occupational exposure at no cost to the employee(s).
Procedures
All employees will have access to a copy of the exposure control plan. Access to a copy of the exposure
control plan shall be provided in a reasonable time, place, and manner. The procedure is reviewed annually
and updated whenever we establish new functional positions within our facility that may involve exposure to
biohazards.
Exposure Determination
• There are no job classifications in which some or all employees have occupational exposure to
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bloodborne pathogens that may result from the performance of their routine duties.
• Designated employees are trained to render first aid and basic life support. Rendering first aid or basic
life support will expose employees to bloodborne pathogens and will require them to adhere to this
program.
• In addition, no medical sharps or similar equipment is provided to, or used by, employees rendering
first aid or basic life support.
• This exposure determination has been made without regard to the Personal Protective Equipment that
may be used by employees.
• A listing of all first aid and basic life support trained employees in this work group shall be maintained
at each work site and at each first aid kit.
Methods of Compliance
Universal Precautions
Under circumstances in which differential between body fluids is difficult or impossible, all body fluids will be
considered potentially infectious.
Engineering Controls
Engineering and work practice controls shall be used to eliminate or minimize employee exposure.
Engineering controls should be examined and maintained or replaced on a regular schedule to ensure their
effectiveness. Hand washing facilities shall be readily available at all work locations. If provision of hand
washing facilities is not feasible, then an appropriate antiseptic hand cleanser in conjunction with cloth/paper
towels or antiseptic towelettes shall be provided by LSHR.
Containers for contaminated reusable sharps that our clients provide have the following characteristics:
Puncture -resistant; Color -coded or labeled with a biohazard warning label; Leak -proof on the sides and
bottom.
Secondary containers which are: Leak -proof; Color -coded or labeled with a biohazard warning label; Puncture -
resistant, if necessary.
Work Practice Controls
• Employees shall wash their hands immediately, or as soon as feasible, after removal of potentially
contaminated gloves or other personal protective equipment.
• Following any contact of body areas with blood or any other infectious materials, employees wash
their hands and any other exposed skin with soap and water as soon as possible.
• Hand washing facilities should be available. If hand washing facilities are not feasible LSHR will provide
either an appropriate antiseptic hand cleanser in conjunction with cloth/paper towels or antiseptic
towelettes.
• Contaminated needles and other contaminated sharps should not be handled if you are not
AUTHORIZED or TRAINED to do so. Contaminated needles and other contaminated sharps are not bent
or recapped.
• Eating, drinking, smoking, applying cosmetics or lip balm and handling contact lenses is prohibited in
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work areas where there is potential for exposure to biohazardous materials.
• Food and drink are not kept in refrigerators, freezers, on countertops or in other storage areas where
potentially infectious materials are present.
• All equipment or environmental surfaces shall be cleaned and decontaminated after contact with
blood or other infectious materials.
• Specimens of blood or other potentially infectious materials must be put in leak proof bags for
handling, storage, and transport.
• If outside contamination of a primary specimen container occurs, that container is placed within a
second leak proof container, appropriately labeled for handling and storage.
• Bloodborne pathogens kits are located on top of first aid kits and are to be used in emergency
situations by the caregivers. Once the seal is broken on the kit and any portion has been used it is not
to be reused. Pathogen Kits shall be ordered and replaced promptly. Biohazard bags are identified by
stickers and located in the first aid area. Contaminated supplies are to be disposed of at once.
Personal Protective Equipment
When the possibility of occupational exposure is present, PPE is to be provided at no cost to the employees
such as gloves, gowns, etc. PPE shall be used unless employees temporarily decline to use under rare
circumstances. PPE shall be repaired and replaced as needed to maintain its effectiveness. All PPE shall be of
the proper size and readily accessible.
Our employees adhere to the following practices when using their personal protective equipment:
• Any garments penetrated by blood or other infectious materials are removed immediately.
• All potentially contaminated personal protective equipment is removed prior to leaving the work area.
• Gloves are worn whenever employees anticipate hand contact with potentially infectious materials or
when handling or touching contaminated items or surfaces.
• Disposable gloves are replaced as soon as practical after contamination or if they are torn, punctured
or otherwise lose their ability to function as an "exposure barrier".
• Masks and eye protection (such as goggles, face shields, etc.) are used whenever splashes or sprays
may generate droplets of infectious materials.
• Any PPE exposed to bloodborne pathogens shall be disposed of properly.
• PPE shall be used unless employees temporarily declined to use PPE under rare circumstances.
• PPE should be cleaned, laundered & properly disposed of if contaminated.
• LSHR will repair and replace PPE as needed to maintain its effectiveness.
Housekeeping
Our staff employs the following practices:
• All equipment and surfaces are cleaned and decontaminated after contact with blood or other
potentially infectious materials.
• Protective coverings (such as plastic trash bags or wrap, aluminum foil or absorbent paper) are
removed and replaced.
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• All trash containers, pails, bins, and other receptacles intended for use routinely are inspected, cleaned
and decontaminated as soon as possible if visibly contaminated.
• Potentially contaminated broken glassware is picked up using mechanical means (such as dustpan and
brush, tongs, forceps, etc.).
Post -Exposure and Follow Up
If there is an incident where exposure to bloodborne pathogens occurred, we immediately focus our efforts
on investigating the circumstances surrounding the exposure incident and making sure that our employees
receive medical consultation and immediate treatment. The LSHR Safety Manager/ Supervisor investigates
every reported exposure incident and a written summary of the incident, and its causes is prepared, and
recommendations are made for avoiding similar incidents in the future. We provide an exposed employee
with the following confidential information:
• Documentation regarding the routes of exposure and circumstances under which the exposure
incident occurred.
• Identification of the source individual (unless not feasible or prohibited by law).
Once these procedures have been completed, an appointment is arranged for the exposed employee with a
qualified healthcare professional to discuss the employee's medical status. This includes an evaluation of any
reported illnesses, as well as any recommended treatment.
We will forward the following information to the Health Care Professional:
• Description of the incident
• Other pertinent information
After the consultation, the health care professional provides our facility with a written opinion evaluating the
exposed employee's situation. We, in turn, furnish a copy of this opinion to the exposed employee. The
written opinion will contain only the following information:
• Whether Hepatitis B Vaccination is indicated for the employee.
• Whether the employee has received the Hepatitis B Vaccination.
• Confirmation that the employee has been informed of the results of the evaluation. Confirmation that
the employee has been told about any medical conditions resulting from the exposure incident which
require further evaluation or treatment.
• All other findings or diagnoses will remain confidential and will not be included in the written report.
Accurate medical records for each employee with occupational exposure must be maintained for at least the
duration of employment plus 30 years and shall include at least the following:
• Employee's name, Social Security number and Pro -Soil employee number.
• Employee's Hepatitis B vaccination status, including vaccination dates.
• All results from examinations, medical testing and follow-up procedures, including all health care
• professional's written opinions.
• Information provided to the health care professional.
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• Any Hepatitis B Vaccine Declinations.
Training records shall be maintained for 3 years from the date on which the training occurred and shall include
at least the following:
• Outline of training program contents.
• Name of person conducting the training.
• Names and job titles of all personnel attending the training.
• Date of training.
Information provided to our employees includes:
• The Biohazards Standard itself.
• The epidemiology and symptoms of bloodborne diseases.
• The modes of transmission of bloodborne pathogens.
• Our facility's Exposure Control Procedure (and where employees can obtain a copy).
• Appropriate methods for recognizing tasks and other activities that may involve exposure.
• A review of the use and limitations of methods that will prevent or reduce exposure.
• Selection and use of personal protective equipment.
• Visual warnings of biohazards within our facility include labels, signs and "color -coded" containers.
• Information on the Hepatitis B Vaccine.
• Actions to take and people to contact in an emergency involving potentially infectious material.
• The procedure to follow if an exposure incident occurs, including incident reporting.
• Information on the post -exposure evaluation and follow-up, including medical consultation.
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Attachment 8-1 - Vaccination Declination Form
Date:
Employee Name:
I understand that due to my occupational exposure to blood or other potential infectious materials I may be at
risk of acquiring Hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with
Hepatitis B vaccine, at no charge to myself. However, I decline the Hepatitis B vaccination at this time. I
understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If,
in the future, I continue to have occupational exposure to blood or other potentially infectious materials and I
want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.
Emplovee Signature:
Facility Representative Signature
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Date:
Date:
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Job Hazard Analysis
Purpose
The purpose of the Hazard Analysis is to provide a method for a supervisor and his/her crew to inspect an
upcoming job, identify potential hazards related to that job, and to arrive at agreement on the development of
a Safe Work Plan for completing their assignment.
Policy
It is each LSHR employee's responsibility to ensure that the Safe Work Plan for the work he/she is about to do
is properly developed. Before starting a job, each crew shall review the scope of work and perform a thorough
Hazard Analysis. The Hazard Analysis process serves as LSHR Safe Work Plan. As such, by completing the process
and signing on the back of the form, employees are indicating that they are prepared to accomplish the assigned
task efficiently and safely.
In the event conditions change, the Hazard Analysis Form must be updated. Potential hazards, including those
specific to the task and those general to the work area, must be discussed and a plan formulated to eliminate
or minimize identified hazards. Each person on the crew must understand his/her role relating to the tasks at
hand. When a new worker is assigned to a job in progress, the Hazard Analysis must be reviewed with this
person, and he/she must sign the form before beginning work.
Procedure
Once the client/owner work permit has been issued, the assigned crew shall conduct a thorough Hazard Analysis
session at the job site, which includes, but is not limited to:
• Walking the job and reviewing all elements of the assignment. The supervisor shall identify all the equipment
that is to be worked on.
• Identifying existing and/or potential hazards and taking appropriate action to eliminate or minimize
identified hazards; reaching agreement on the safest plan to complete the assigned task. Each person on
the crew must thoroughly understand their role in the upcoming tasks.
• Evaluating PPE requirements and upgrading permit required PPE or providing additional PPE whenever
necessary to provide maximum level of employee protection.
• Ensuring that all workers know and are properly trained for their assignment(s).
• Posting the completed form(s) along with the work permit in a conspicuous place in the work area. In the
event it is not possible to post the form(s), they shall be kept readily available at the job site. The forms shall
be kept in a manner that protects them from weather damage.
Whenever possible the supervisor shall be involved in the Hazard Analysis Session. However, there are times
when this is not possible. Should the supervisor find that he/she will not be available, he/she shall assign a
competent person to lead the session. As soon as practical following the beginning of a job, the supervisor shall
review all Hazard Analysis Forms of crews assigned to him/her and sign the back of the form in the section
provided.
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General Instructions
• Print and make sure the form is legible/readable. The only place you do not print the required information
is when you place your signature on the back of the form.
• Involve the entire crew in the process. The more eyes and experience used to identify hazards, the better.
• Whenever possible, the completed Site Safety Plan should be reviewed for proper completion and signed
by the designated lead person, foreman, supervisor or Safety dept. representative before the work is
started. If this is not possible, the form should be reviewed as soon as practical.
• When the form (s) is completed, it must be posted & readily available at the job site.
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Activity:
Sequence of Steps
Job Hazard Analysis (JSA)
Potential Hazards w/step
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The Leader in Emergency Response
Hazard mitigation
actions/procedures
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Site -Specific Health and Safety Plan
Site -specific health and safety plans (SSHASPs) are necessary for complex and/or multi -day projects and should
include a variety of information designed to protect not just workers, but subcontractors, visitors, and members
of the public from potential safety risks presented on -site.
An effective SSHASP should ensure that general contractors and their employees are aware of:
• The types of hazards that may be associated with work being done on the site
• Procedures and measures needed to avoid or control exposure to hazards
• How to contact the contractor, subcontractor, or staffing agency with safety concerns or to report an
injury or illness
• Previous work done at the site and hazards that may already be present
The plan should include guidelines for when and where personal protective equipment (PPE) — such as hard
hats, respiratory protection, hearing protection, gloves, chemical splash goggles, and face shields — should be
worn on the job site.
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LONE STAR HAZMAT
The Leader in Emergency Response
Site Specific Health and Safety Plan
LSHR Project Number
Date
Client / RP
Site Location
LSHR Response Manager
LSHR Site Safety Officer
Scope / Objective of Work:
Involved Product Information
Shipping Name
UN/NA Number
Hazards Identification
Health
Flammability
Reactivity
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Physical and Chemical Properties
Form (circle): Solid
Liquid
Appearance:
Odor Threshold & Description:
Flash Point:
Boiling Point:
LE L:
U E L:
Specific Gravity:
Vapor Density:
Threshold Limit Values (TLVs):
ppm
Exposure Information
Route(s) of Exposure
Symptoms of Acute Exposure
First Aid Procedures
Evacuation Distance(s)
Gas
mg/ma
Note: Attach Safety Data Sheet to this document, as available
Site Description & Unusual Features
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Site Sketch — Include hot, cold and CRZ zones, ingress and egress routes, assembly point(s), command post, wind
direction, roadways, water bodies, etc.
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Nearest Medical Facility:
Address:
Phone Number:
Sketch route to facility:
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Air Monitoring
Contaminant of Interest Type of Sample Monitoring Equipment Frequency of Sampling
(perimeter, work zone,
personal)
Action Levels
Exceedance(s) require all personnel to withdraw from
the work zone pending reassessment of conditions.
PPE Oxygen
Flammability
Unknown Organic Vapor
Particulates Other
A >22.5%
>10% LEL
>500 ppm
> mg/m3
B >22.5%
>10% LEL
>500 ppm
> mg/m3
C <19.5% or>22.5%
>10% LEL
>5 ppm
> mg/m3
D <19.5% or>22.5%
>10% LEL
Above background
> mg/m3
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Activity:
Sequence of Steps
Job Hazard Analysis (JSA)
Potential Hazards w/step
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LONE STAR HAZMAT
The Leader in Emergency Response
Hazard mitigation
actions/procedures
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Spill Contingency Plan
A. Immediately report the discharge to the Response Manager, providing the following information:
• Exact location;
• Material involved;
• Quantity involved;
• Topographic and environmental conditions;
• Circumstances that may hinder response; and
• Injuries, if any.
B. Turn off all sources of ignition.
C. Locate the source of the spillage and stop the flow if it can be done safely.
D. Investigate the discharge to assess the actual or potential threat to human health or the environment:
• Location of the discharge relative to receiving waterbodies;
• Quantity of spilled material;
• Ambient conditions (temperature, rain);
• Other contributing factors such as fire or explosion hazards; and
• Sensitive receptors downstream.
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LONE STAR HAZMAT
The Leader in Emergency Response
Acknowledgement
All personnel have received the appropriate safety training in accordance with 29 CFR 1910.120(q) and are currently
under medical surveillance in accordance with 29 CFR 1910.120(f).
By signing this document, I acknowledge that I have read, understand, and agree to adhere to the requirements of this
Plan for the duration of the project.
Printed Name Signature
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LONE STAR HAZMAT
Tailgate Safety Briefing The Leader in Emergency Response
Project: Job Number: Date and Time:
Presenter / Speakers:
Tasks
Chemical, Physical, Biological Hazards:
PPE Requirements:
Participants
Name (Print) Signature Company
REMEMBER: SMOKING IS PROHIBITED AT ALL JOB SITES
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Personal Protective Equipment Policy
Protective equipment, including personal protective equipment for eyes, face, head, and extremities,
protective clothing, respiratory devices, and protective shields and barriers, shall be provided, used, and
maintained in a sanitary and reliable condition if necessary because of hazards of processes or environment,
chemical hazards, radiological hazards, or mechanical irritants encountered in a manner capable of causing
injury or impairment in the function of any part of the body through absorption, inhalation, or physical
contact.
Employee -owned equipment is not allowed.
Personal Protective Equipment Training
LSHR employees expected to wear Personal Protective Equipment (PPE) will be trained as follows:
• Exposures and how to identify them
• Types of PPE to wear as protection from each exposure
• When to wear them
• How to wear PPE properly
• How to care for, clean and properly store PPE.
An employer shall verify that each affected employee has received and understood the required training
through a written certification that contains all of the following information:
• The name of each employee trained.
• The date of training.
• The subject of certification.
Personal Protective Equipment Use
Head Protection
Approved hard hats must be worn if employees could be struck by falling objects, are in danger of striking
their heads on fixed objects, or if there is a shock hazard from working near exposed electrical conductors.
Do not drill holes in the hard hat for ventilation; it destroys the integrity to protect you from blows to the
head.
Hard hats shall comply with ANSI Z89.1-1986, Class A or B. Class B is required for exposure to high voltage
shocks, above 600 volts.
Where there is risk of injury from hair entanglements in moving parts of machinery, combustibles, or toxic
contaminants, employees shall confine their hair with nets, or other suitable restrictive devices to eliminate
the hazard.
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Eye and Face Protection
Employees working in locations where there is a risk of receiving eye injuries such as punctures, abrasions,
contusions, or burns as a result of coming in contact with flying particles, hazardous substances, projections,
or injurious light rays which are inherent to the work or environment shall be safeguarded by means of face
or eye protection.
Suitable screens or shields isolating the hazardous exposure may be considered adequate safeguarding for
nearby employees, i.e. welding screens.
Where eye protection is required and the employee requires vision correction, the following eye protection
shall be provided:
• Safety glasses with suitable corrected lenses, or
• Safety goggles designed to fit over glasses, or
• Protective goggles with corrective lenses mounted behind the protective lenses.
The wearing of contact lenses is prohibited in working environments having harmful exposure to materials,
or light flashes, except with medically approved devices.
Side shields shall be worn whenever the hazard of flying objects is angular as well as frontal.
Body Protection
Protection such as rubber aprons or sleeves may be necessary in certain environments where splashing of
Hazardous materials or other common substances such as water would pose a risk to the employee. Flying
metal particles or molten metal are examples of hazards that could penetrate normal clothing and injure the
employee, requiring leather protective sleeves and/or vests.
In all cases, clothing appropriate for the work being done shall be worn. Loose sleeves, tails, ties, lapels,
cuffs, or other loose clothing which can become entangled in moving machinery will not be worn.
Clothing containing flammable liquids, corrosive substances, pesticides, irritants, or oxidizing agents shall be
removed and not worn until properly laundered.
Hand Protection
There are many types of gloves made of many different types of materials, each with a specific application.
Gloves will be worn as precaution from the following exposures:
• Chemicals - check the Safety Data Sheets (SDS) for listed PPE required for safe handling
• Cuts
• Hot work
No glove can protect against all hazards so select the appropriate glove for the job.
Where there is risk of injury from glove entanglement in moving parts of machinery, employees shall not
wear gloves and use other methods to protect their hands from injury exposure.
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Jewelry, such as rings, has caused the loss of many fingers. Be aware that wrist watches, and other jewelry
can be caught in moving machinery, or caught on a protruding hook or nail. Never wear metallic jewelry or
other objects when working around electrically energized equipment.
Foot Protection
For work in areas where feet are in danger of:
• Being struck by falling or heavy rolling objects and crushed or penetrated, steel -toed shoes, or steel
covers are recommended.
• Working around boards with nails, or scrap metal, you need protection from punctures.
Hearing Protection
Hearing protection will be made available to all employees exposed to sources of noise 85 dB or greater, as
measured by a sound level meter or identified by the contracting company. In general, anytime someone
must elevate their voice to be heard, hearing protection will be worn.
Hearing protector equipment consists of earplugs (various NRR) or muffs (industriall.
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Hearing Conservation Program
LSHR has established a Hearing conservation Program to protect worker from the hazards of noise on the job.
OSHA regulations require that each employer implement a hearing conservation program when workers are
exposed to noise levels exceeding 85 dB. It is not hard to exceed this level of noise on many of the job sites.
Typically, noise levels exceeding 85 dB are experienced when working with any type of pneumatic chipper or
hammer, metal saw, and grinders. See Attachment 11-1 for a list of some common noise levels.
Responsibility
The Manager of Operations is responsible for developing a written Hearing Conservation Procedure and
overseeing the training of all employees in the company. The Manager of Operations is also responsible for the
monitoring and administering this procedure.
Introduction
The OSHA Standard on Occupational Noise Exposure, 29 CFR 1910.95, established the permissible limit of noise
as 85 dB(A) (decibels), expressed as an eight -hour (8-hours), time -weighted average, (TWA). This standard
allows short-term unprotected noise exposure up to a maximum of 115clB (A), peak sound.
The noise standard requires the identification by personnel monitoring of employees who may be exposed
above the 85 db (A), 8-hour, TWA. Hearing protection is also required for specific activities or using certain types
of equipment.
Procedures
LSHR has taken a conservative approach to this noise hazard by establishing this program. The following
elements establish the program:
• An Audiometric Testing Program when required
• An Employee Education and Training Program
• Monitoring and Analysis of Workplace Noise Levels
• Providing Suitable Engineering Controls when appropriate
• Providing Hearing Protectors when required
• Maintain required records for the above.
Audiometric Testing
Each new employee whose work exposes them to noise levels above the "OSHA action level" will receive an
Audiometric test as part of a pre-screening physical examination to establish a baseline audiogram against
which subsequent audiograms can be compared as required by the OSHA Standard.
Annually, all employees who are exposed to noise levels exceeding the 85-dB standard will be given a follow-
up Audiometric examination to monitor for any significant changes in their hearing ability.
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Employees will be formally notified if there is any change in their hearing as the result of the testing. The
Standard has defined this shift as a change in hearing threshold relative to the baseline audiogram of an
average of 10 dB or more at 200, 3000 and 4000 Hz in either ear.
When audiometric testing is required, each affected employee must not be exposed to any workplace noise
for at least 14 hours prior to his/her test. This requirement may be met by wearing hearing protectors which
will reduce the employee's exposure to a sound level of 80 db (A) or below.
Audiometric tests shall be performed by a licensed or certified audiologist, otolaryngologist, or other
physician, or by a technician who is certified by the Council of Accreditation in Occupational Hearing
Conservation, or who has satisfactorily demonstrated competence in administering audiometric
examinations, obtaining valid audiograms, and properly using, maintaining, and checking calibration and
proper functioning of the audiometers being used. A technician who operates microprocessor audiometer
does not need to be certified. A technician who performs audiometric tests must be responsible to an
audiologist, otolaryngologist, or physician.
An audiologist, otolaryngologist, or physician will review problem audiograms and shall determine whether
there is a need for further evaluation. The company will provide to the person performing this evaluation
the following information:
• A copy of the 29 CFR 1910.95 Hearing Conservation.
• The baseline audiogram and most recent audiogram of the employee to be evaluated.
• Measurement of background sound pressure in the audiometric test room as required in 29 CFR 1910.95
Appendix D.
• Records of audiometric calibrations as required by 20 CFR 1910.95 Appendix E.
If a comparison of the annual audiogram to the baseline audiogram indicates a standard threshold shift as
defined by OSHA, the employee will be informed of this fact, in writing, by the company within 21 days of
determination.
Unless a physician determines that the standard threshold shift is not work related or aggravated by
occupational noise exposure, the company will ensure that the following steps are tank when a standard
threshold shift occurs:
• An employee hot using hearing protectors will be fitted with hearing protectors, trained in their use and
care, and required to use them; and
• An employee already using hearing protectors shall be refitted and retrained in the use of hearing
protectors and provided with hearing protectors offering greater attenuation if necessary.
• Refer the employee for a clinical audiological evaluation or an ontological examination, as appropriate,
if additional testing is necessary or if the company suspect that a medical pathology of the ear is caused
or aggravated by the wearing of haring protectors.
• Inform the employee of the need for an ontological examination if a medical pathology of the ear which
is unrelated to the use of hearing protector is suspected.
If subsequent audiometric testing of an employee whose exposure to noise is less than an 8-hour TWA
average of 90 decibels indicates that a standard threshold shift is not persistent the company:
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• Will inform the employee of the new audiometric interpretations: and
• May stop the required use of hearing protectors for that employee.
See Attachment 11-2
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Employee Education and Training
LSHR employees must be trained in the use of personal hearing protection equipment. Also, each employee
must know how to clean and maintain the hearing protection equipment. The training will cover the following:
• Training will be for all employees who are exposed to noise at or above the 8-hour TWA of 85 dB.
• The training will be repeated annually for each employee included in the hearing conservation program.
• The effects of noise on hearing
• The purpose of hearing protectors, the advantages, disadvantages, and the attenuation of various types and
instruction on selection, fitting, use and care
• The purpose of audiometric testing, and an explanation of the test procedures.
• Access to information and training materials.
Monitoring and Analysis of Workplace Noise Levels
LSHR will periodically or as necessary, conduct noise level surveys of the workplace. The results of these surveys
will be made available to employees upon request.
Any job area or company location found to be in excess of the allowable designated noise levels that cannot be
brought into compliance with the noise standard will be designated as an area where hearing protectors are to
be worn. When signs are posted employees must wear hearing protection. The signs may read as follows:
NOTICE
EAR PROTECTION
REQUIRED
IN THIS AREA
Provide Suitable Engineering Controls
Where appropriate, LSHR will provide engineering controls to reduce noise exposure. Due to the complexity of
most job sites, it is difficult, if not possible, to institute effective engineering controls for most noise exposures.
Should this be the case, then employees will be required to wear suitable hearing protection.
Provide Hearing Protectors Where Required
LSHR will provide and required employees with hearing protectors if his/her 8-hour TWA is above the 85clB (A).
LSHR will also make hearing protectors available to all employees exposed to a TWA above 85clB (A) at no cost
to the employee. Any employee who may have a significant threshold shift of hearing level will be required to
wear hearing protection if they are exposed to noise TWA of 85dB. LSHR will provide workers with a choice of
at least one type of ear plug and one type of earmuff (earmuffs cannot be used when anything prevents the seal
of the earmuff, such as safety glasses) On some job site there will be a choice of two different ear plugs.
LSHR will make a concerted effort to find the right protector for each employee, one that offers the right
attenuation, is accepted on the terms of comfort, and is used by the employee.
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Responsibilities
A Client Will:
• Determine all sources of noise at or above 85dD.
• Determine if personnel have 8-hour TWA exposures at or above fifty percent (50%) of the OSHA
allowable.
• Review noise exposures annually for all job classifications with TWA
• Exposure at or above fifty percent (50%)
• Ensure that audiograms are made annually for personnel whose TWA exposures are at or above fifty
percent (50%) of the OSHA allowable.
Job Site Supervision Will:
• Will require hearing protection in all areas with noise levels at or above 85dB(A) and for all tasks which
generate such noise level (i.e., grinding, hammering).
• Ear plugs shall be required in an area and/or on tasks with sound levels exceeding 105dB.
• To alert employees to possible hazardous noise exposures, Signs shall be posted in work areas in which
the sound levels may exceed 85dB. These signs will be posted by the client.
• Evaluate the need for engineering and/or administrative controls to reduce the noise levels below 85 dB
and, where feasible, develop a plan to reduce all personnel exposures to less than fifty percent (50%) of
the OSHA allowable.
• Make hearing protection available and enforce its use by all employees with TWA exposures at or above
the fifty percent (50%) of the OSHA allowable and/or by those who must enter or work in areas where
the noise level is 85clB or above.
Remember - The client determines if a unit or work area is classified as a high noise area. After the
determination is made, LSHR employees will be instructed to wear the appropriate hearing protection.
Recordkeeping
All record -keeping for this program will be maintained in the office. Records will include:
• Audiometric tests
• Noise surveys
• Employee training
• Engineering controls implemented
• Record of purchase of hearing protector
Work Requiring Hearing Protectors
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There are many jobs or types of work that generally produce noise levels that intermittently or for short
durations exceed the permissible TWA. It is the policy of LSHR to require all workers who are engaged in these
jobs to wear hearing protectors.
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Hearing Protectors
Employees may choose the type of hearing protection that best suits their assignment and personal preference
among those listed below. Each employee required to wear hearing protection is responsible for carrying
hearing protection on his/her person. Hearing protection is furnished at no cost to employees.
Ear Plugs
Most ear plugs, when worn properly, have a noise reduction rating (NRR) on the package. Most ear plugs
have NRR of about 30.
Earmuffs
Adjustable muffs can be worn in three positions:
Position
Over the Head
Under the Chin
Behind the Head
Computing the Hearing Protection Level
NRR
24 (depends on the NRR of Earmuff)
20
20
To compute the actual hearing protection level under the protector, subtract 7dB(A) from the Noise
Reduction Rating (NRR), divide the number by 2, and subtract the remainder form the measured noise level dB
(A).
For example: NRR of 29 -7 = 22 dB(A)
22 Db(A) - 2 = 11 dB(A)
Noise level of 95 dB(A) —11 = 84 dB(A)
Therefore, this device offers a protection level of 11 dB(A).
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Attachment 11-1 - Common Noise Levels
The following list represents some work activities and equipment which will require the use of hearing
protection:
Activities and/or Equipment
Typically Resulting in
High Noise Level
Air Arc Gouging
Air Compressor
Chain Saw
Electric Disc Grinder
Forklift Inside a Trailer
Heavy Equipment Working
Impact Tools
Pneumatic Chipping Hammer
Abrasive Blasting
Welding Machines
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Estimated Average Noise
Level
dB(A)
115
95
107
100
98
100
108
110
100
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Attachment 11-2 - Follow Up Training Record
FROM:
Manager or Supervisor
The employee listed below recently was found to have a confirmed significant shift in the hearing threshold (as defined
by OSHA). An investigation and additional training are required. When this form is completed and reviewed with the
employee, please file it in the office.
EMPLOYEE NAME:
Print or type First, MI, Last Name
Social Security Number or Employee Number Reported Date
JOB CATEGORY
Current Assignment
The Potential for noise exposure and specific requirements for using hearing protection in their area should be reviewed
with this employee within 2 weeks. If hearing protection requirements have not been established in this work area, it
must be done as soon as possible.
The retraining for this employee should include:
• The temporary and permanent effects of noise on hearing
• Established hearing protection requirements
• Any questions the employee may have on the use of hearing protection
• The proper use of hearing protection
• Comments the employee has on potential off -the -job noise exposure
Comments on discussion held:
I have discussed the above items with this employee:
Manager or Supervisors Name (print) Signature
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Date of Discussion
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Respiratory Protection
Purpose
Improper use of or failure to wear respiratory protection when required can have devastating effects on the life
and/or health of workers. Lack of a respirator, early removal of a respirator and improperly fitting respirators
has resulted in needless worker injury and death.
The purpose of this policy is to establish a respiratory protection program that ensures that workers are
provided with the necessary information, training, and equipment to protect themselves from respiratory
hazards in the workplace, and complies with OSHA, ANSI and other applicable standards and regulations.
Policy
It is management's responsibility to implement this program at no cost to the employees and it is the employee's
responsibility to comply with all aspects of this program. Any voluntary use of respiratory protection equipment
by employees shall be governed by the provisions of this program, also at no expense to the employees.
Procedure
Responsibilities
Management
Has the responsibility of overseeing the implementation of this policy and assigning program
administrators for each site. These administrators must be suitably trained and have the appropriate
accountability and responsibility to fully manage the site respiratory program. The program
administrator will report, at least annually, on the effectiveness of the program to management, and be
authorized to make appropriate changes to the site program. The administrators will be identified by
name in the specific site program.
Supervisory
It is the responsibility of the supervisor to ensure that all personnel under their control are completely
knowledgeable of the respiratory requirements of this program. Supervisors are to ensure that
employees have been trained and are medically fit to use respiratory equipment safely. It is the
supervisors' duty to monitor the employees' diligence in following procedures and take appropriate
action when deficiencies are observed.
Employees
It is the responsibility of the employee to be aware of and practice the information presented in the
training. Specifically, employee responsibilities are to report equipment malfunctions, seal check their
respirator before every use, and to report medical or physical changes that could affect respirator use.
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Hazard Assessment
Respiratory hazard determination starts at the planning stage of a job. The responsible party is to identify
all known hazards as required by the hazard communication standard. Evaluation of the hazards consists of
exposure duration, potential for contact, and known or potential concentrations. When the hazard is a
federally controlled substance, that hazard shall be assessed and monitored as dictated by that specific
standard. A respiratory hazard may not have an established OSHA permissible exposure limit documented;
however, all provisions of this program will be enforced to protect the health of the employees.
Acceptable methods for estimating respiratory hazards include:
• Personal exposure monitoring is the most reliable and accurate method to determine exposure.
• Use of objective data — This is the use of data obtained from industry studies, trade associations or from
tests conducted by chemical manufacturers. The objective data shall represent the highest contaminant
exposures likely to occur under reasonably foreseeable conditions of processing, use or handling. If
objective data is used for assessment, the data must be documented as part of the written program.
• Mathematical Approach — The use of physical and chemical properties of air contaminates, combined
with information on room dimensions, air exchange rates, contaminant release rates, and other
pertinent data including exposure patterns and work practices to estimate maximum exposure levels in
the workplace.
• Where employee exposure cannot be identified or reasonably estimated, the atmosphere will be
considered immediately dangerous to life and health (IDLH). Also, atmospheres that are oxygen deficient
will be treated as IDLH conditions.
• Accidental release or emergency response must be a consideration when estimating hazard exposure.
Hazard Control
Engineering Controls
This should be the first consideration when evaluating hazard exposure.
• Substitution of a less or non -toxic substance to replace a more harmful one. Example: Sandblasting
with black grit instead of silica sand.
• Isolation or encapsulation of the process. Example: To spray asbestos insulation with glue, paste to
lessen exposure levels.
• Ventilation to remove contamination from the work area before exposure. Example: Mechanical dust
collection system installed to capture contaminants and reduce buildup.
Administrative Controls
• Especially effective for repetitive stress and heat stress control, crew rotation could increase
productivity in contaminated atmospheres.
• Adjust the length of the work shift. Instead of two 12-hour shifts, it may be more effective to have
three 8-hour shifts.
• Change scheduled work to limit the number of employees exposed. The scheduling of other work
near the exposure area could be limited until exposure is gone.
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Personal protective devices for the control of respiratory hazards are to be used as a last resort, and only
when other means of control are not practical or feasible. Respiratory protection may be required while
implementing engineering controls, or in conjunction with other control methods. Engineering controls may
only lessen the exposure but are required to be implemented along with personal protective devices.
Respirator Selection
Selecting the proper respirator can be very complex and is critical in having an effective respiratory program.
The program administrator must solicit information from all available professional resources concerning
exposure controls.
Factors that must be considered include:
• The nature of the hazardous operation or process
• The type of respiratory hazard (including physical properties, oxygen deficiency, physiological effects on
the body, concentration of toxic material or airborne radioactivity level, established exposure limits for
the toxic materials, established permissible airborne concentration for radioactive material, and
established immediately dangerous to life or health concentration for toxic material)
• The location of the hazardous area in relation to the nearest area having respirable air
• The period of time for which respiratory protection must be worn
• The activities of workers in the hazardous area
• The physical characteristics and functional capabilities and limitations of the various types of respirators
• Respirator -assigned protection factors listed in Attachment 12-1, Table 1
Respirators for use under IDLH conditions:
The required respiratory protection for IDLH conditions caused by the presence of toxic materials, or a
reduced percentage of oxygen, is a combination full face piece pressure demand supplied air respirator (SAR)
with auxiliary self-contained air supply. For rescue applications, a full -face piece pressure demand SCBA
certified by NIOSH for a minimum service life of thirty minutes is acceptable.
When respirators are worn under IDLH conditions, at least one standby person shall be present in a safe
area. The standby person shall have the proper equipment available to assist the respirator wearer in case
of difficulty. Communications (visual, voice, signal line, radio, or other suitable means) shall be maintained
between the standby person and the wearer. While working in the IDLH atmosphere, the wearer shall be
equipped with safety harness and safety lines to permit removal to a safe area, if necessary. Provisions for
rescue other than safety harness and lines may be used, if equivalent.
Breathing Air Quality
Workers using supplied breathing air equipment shall be thoroughly trained in its use.
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Breathing air is typically supplied from cylinders or via a compressor. Appropriate measures shall be taken
to ensure that all compressed breathing air meets at least the requirements for Grade D breathing air
described in ANSI/Compressed Gas Association Commodity Specification for Air, G-7.1-1989, to include:
• Oxygen content (v/v) of 19.5-23.5%;
• Hydrocarbon (condensed) content of 5 milligrams per cubic meter of air or less;
• Carbon monoxide (CO) content of 10 ppm or less;
• Carbon dioxide content of 1,000 ppm or less; and
• Lack of noticeable odor.
Suppliers of breathing air cylinders shall provide the company with a certificate of analysis with each delivery
certifying that the breathing air meets the requirements for Grade D breathing air; and that the moisture content
in the cylinder does not exceed a dew point of -50 deg. (F) (-45.6 deg. (C) at 1 atmosphere pressure. The certificate
shall have the name of the breathing air supplier, the testing technician and date of test.
Breathing air cylinders shall be tested and maintained as prescribed in the Shipping Container Specification
Regulations of the Department of Transportation (49 CFR part 173 and part 178).
Breathing Air Compressors
Compressors used to supply breathing air to respirators shall be constructed and situated so as to:
• Prevent entry of contaminated air into the air -supply system;
• Minimize moisture content so that the dew point at 1 atmosphere pressure is 10 degrees F (-5.56
deg. (C) below the ambient temperature;
• If required to ensure delivery of Grade D air to the user, provide suitable in -line air -purifying
sorbent beds and filters. All filters, cartridges and canisters shall be labeled, and color coded with
the NIOSH approval label and the label shall remain legible. Sorbent beds and filters shall be
maintained and replaced or refurbished periodically following the manufacturer's instructions. A
tag containing the most recent change date and the signature of the person authorized by the
employer to perform the change shall be attached to the equipment.
• For compressors that are not oil -lubricated, the company shall ensure that carbon monoxide levels
in the breathing air do not exceed 10 ppm.
• For oil -lubricated compressors, the company shall use a high -temperature or carbon monoxide
alarm, or both, to monitor carbon monoxide levels. If only high -temperature alarms are used, the
air supply shall be monitored at intervals sufficient to prevent carbon monoxide in the breathing air
from exceeding 10 ppm.
• The air shall be routinely tested to ensure that it meets Grade D requirements.
In addition, a stand-by attendant should be on watch anytime workers are using breathing air supplied
directly by a compressor.
Breathing air couplings shall be incompatible with outlets for non -respirable worksite air or other gas
systems. No asphyxiating substance shall be introduced into breathing airlines.
Training
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To protect employees from exposure to respiratory hazards using OSHA and ANSI standards as minimum
guidelines, all employees who will wear respiratory protection will be trained on this policy. Training will be
provided prior to job assignment where respirator equipment is required, and annually thereafter.
Additional training is required when there are deficiencies in the employee's knowledge/skills or when there
is a change in the workplace or respiratory equipment that renders previous training obsolete. The training
will include the following:
• Responsibilities of employees and supervisors
• How, why and for what jobs we use respirators
• Hazard assessment including limitations of respirators
• Hazard control
• Respirator selection
• Medical evaluation
• Respirator fit test
• Maintenance, care, and storage
• Medical surveillance
• Program evaluation
All training shall be conducted in a way that is understandable to the employee and is documented.
Whv use respiratory protection
• The nature, extent, and effects of respiratory hazards
• Consequences of improper fit, usage and maintenance on respirator effectiveness
Limitations and capabilities of the respirator
• Air purifying respirators that filter either particles, or absorbing vapors and gases
• Air supplying respirators that supply air from an uncontaminated source
• Limitations of respirators in IDLH atmospheres and for emergency use only
How respirators are inspected, donned, removed, seal checked and worn
• What to do if respirators have defects
• Who to report problems to during use
• Proper technique for donning and removing the respirator, and how to store when not in use
• How to seal check using the positive and/or negative pressure method
Methods of maintenance and storage
• Visual inspection of parts for worn or defective items
• How to keep the issued respirator clean and sanitary
• Requirement to disinfect and sanitize before reissue to other employees
• Proper storage in a cool, clean, and dry location, placing them in a clean, sealed plastic bag after
drying
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Medical signs and svmotoms that may limit or prevent the effective use of respirators
• An awareness of physical conditions that may indicate warning signs
• An obligation to report signs and symptoms and the opportunity for medical reevaluation
• Changes in weight (gain or loss)
• Physical changes in facial structure
• Changes in endurance, stability or general health
• Medication for illness
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Medical Evaluation
All employees whose job classification may require use of respiratory protection shall be evaluated and
certified by a physician or a licensed health care professional (PLHCP) as being "medically fit" to wear a
respirator. For new hires, the medical evaluation shall be made before any use of respiratory equipment.
Thereafter, the evaluation shall occur at a minimum annually. The medical evaluation consists of, at a
minimum, the administration of a health questionnaire meeting federal guidelines or provisions for a
physical examination by a PLHCP that elicits the same information as the questionnaire. The PLHCP shall be
provided with supplemental information by the employer on the description of the job classification,
possible work conditions and any additional P.P.E. that may be required of the employee while using
respiratory equipment. A copy of this program will be given to the PLHCP for reference along with the OSHA
standard.
The administration of the health questionnaire will be done during work hours and at no cost to the
employee. The information on the questionnaire shall remain confidential between the PLHCP and the
employee. The employee must have access to the PLHCP for discussion and asking questions concerning
their medical evaluation. The company will only receive a recommendation regarding the employee's ability
to wear respiratory equipment.
If an employee is restricted by the PLHCP from wearing a negative pressure respirator, but otherwise
physically able to perform duties with a powered air respirator, then reasonable accommodations will be
made by the program administrator not to have this restriction limit the employee's ability to perform his
job.
Respirator Fit Test
Respirator fit testing is required of all employees prior to using a positive or negative tight -fitting respirator.
The fit test will be specific for respirator manufacturer, model and size. This test is to be repeated annually,
or if there is a change in the respiratory equipment. Some substance specific standards may call for more
frequent testing and dictate a specific protocol, which would take precedence over this program. A change
in the employee's physical appearance can affect the seal of a respirator and may require re -testing. If the
respirator is unacceptable to the employee due to comfort, irritation, or inability to get a seal, the employee
will be offered a reasonable selection for an alternate choice of respirators.
The employee will be asked to wear the proposed respirator for a period of time to become familiar with
the feeling and fit. No obstacles can be between their face and the sealing surface of the respirator, including
facial hair of 24 hours or more growth, sideburns that extend into the sealing surface or hair that is long
enough to prevent proper function of the respirator. Jewelry, caps, hats, scarves and certain safety gear
must be evaluated as part of the fitness test if the employee is permitted or required to wear them during
work. OSHA did not restrict the use of contact lens with respirators but did mandate that the use of
corrective lens shall not interfere with the seal of the respirator. Any adaptive devices for vision correction
with respiratory equipment will be supplied at no cost to the employee. The employee will be instructed on
how to field check respiratory equipment. The positive and negative seal check methods of verifying a good
seal shall be required before each and every entry into a respiratory hazard area. These seal checks are not
to be considered a fit test.
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Positive Seal Check
A positive seal check is accomplished by effectively sealing the exhalation valve and slowly exhaling. This
should create a slight, positive pressure inside the face piece for a short period of time. The participant
must be careful not to exhale too fast or small leaks can be nullified and/or large leaks artificially created.
Negative Seal Check
A negative seal check is accomplished by effectively sealing the inhalation ports of the respirator and
inhaling slowly. The participant should be able to create a negative pressure inside the respirator and
hold it for a short period of time. Inhaling too fast may nullify small leaks and/or artificially create other
leaks.
Fit Test (See Attachment 12-5, Table 2 for "Acceptable Fit -Testing Methods")
• Qualitative fit test — a pass/fail test that relies on the subject to detect a challenge agent and is
predicated on an individual's sensory response.
• Quantitative fit test — uses an instrument to measure the challenge agent inside the respirator and
gives a numerical value to the test data.
If qualitative testing is used, the employee should be informed of the exposure limitations. A limit of 10
times the permissible exposure level for an 8-hour duration is the maximum exposure for either a half
mask, or full -face piece negative pressure respirator.
For OSHA guidelines, refer to Attachment 12-5, Table 2 for Acceptable Fit Test Methods.
Irritant Smoke Protocol
Irritant smoke protocol for qualitative fit testing is very effective, since it is the only challenge agent that
does not rely on a voluntary response. This type of test requires that the tester be well trained in the
correct and safe use of the irritant smoke tubes. The smoke tubes can be a health hazard if not used
properly and in a well -ventilated room. Specific step by step procedures are referenced in Attachment
10-3.
Maintenance and Care
The company will provide for the cleaning and disinfecting, storage, inspection and repair of respirators that
are issued to their employees. There are specific guidelines to follow in Attachment 12-4 to ensure the
respirators are clean and disinfected. Respirators designated for the exclusive use of an employee shall be
the responsibility of that employee to maintain and keep in a sanitary condition. Respirators issued to more
than one employee shall be cleaned and disinfected before being worn by different individuals. Respirators
maintained for emergency, training, or fit testing use shall be cleaned and disinfected after every use.
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Storage
Respirators shall be stored to protect them from damage, contamination, dust, sunlight, extreme
temperatures, excessive moisture and damaging chemicals. They shall be packed or stored to prevent
deformation of the face piece. Emergency respirators shall, in addition, be kept accessible to the work
area and stored in easily identifiable coverings. Reference manufacturer's instructions for other
recommendations.
Inspection
Respirators are inspected on a regular basis and employees are instructed on how to inspect their
respirator. All respirators used on a routine basis shall be inspected before each use and during cleaning.
All emergency respirators shall also be inspected at least monthly. Respirator inspection shall include
the tightness of connections and the condition of various parts including, but not limited to, the face
piece, head straps, valves, gaskets, connecting tubes, cartridges, canisters, and filters. Also, check all
elastic parts for deterioration and pliability. Inspection of self-contained breathing apparatus shall be
done only by trained technicians competent with that specific brand, make and model of respiratory
equipment. The technician conducting the inspection shall certify the inspection by attaching a signed
and dated tag or label to the equipment.
Repairs
Equipment that is defective, broken or otherwise in need of repair shall be identified immediately by
attaching a red tag and stating the reason it is out of service. Repairs to respirator equipment shall be
made by competent employees and only with the manufacturers' recommended replacement parts.
Absolutely no substitution of parts is allowed that is not authorized by the NIOSH approval.
Medical Surveillance
Employees should be aware of medical conditions that would prevent or limit their use of respiratory
equipment. Supervisors shall be informed when employees experience medical difficulties that may affect
or be a result of respiratory use. Substance specific hazards may require a specific medical monitoring
procedure that requires biological testing. Employees will be required to complete a medical questionnaire
initially, and then further evaluation at the frequency determined by the medical evaluator.
Program Evaluation
The supervisor will monitor the work site for acceptance of and compliance with the written respiratory
program. The supervisor will address issues where employees have had deficient respiratory issues, i.e.
cartridge breakthrough and the respirator effectiveness. Employees will be asked questions about the
effectiveness of the program and encouraged to offer suggestions for improvement including how the fit
test protocol was performed, the maintenance procedures for care and storage of respirators and overall
program. Periodic audits will be documented and reviewed by the program administrator. The program
administrator will report, at least annually, to the management on the effectiveness of the total program.
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Attachment 12-1 - Assigned Protection Factors
Table 1— Assigned Protection Factors
Respiratory inlet covering
Type of respirator
Air purifying
Atmosphere supplying
SCBA (demand) 1)
Airline (demand)
Half Mask 1)
10
10
10
Respiratory inlet covering
Full Facepiece
100
100
100
Half Full Helmet/ Loose -fitting
Type of respirator mask hood facepiece
Face
Powered air purifier 50 10001) 10001) 25
Atmosphere supplying airline
Pressure demand 50 1000 - -
Continuous flow
50 1000 1000 25
Self-contained breathing
apparatus
Pressure demand - 4) - -
Open/closed circuit
1) Includes % mask, disposable half masks, and half masks with elastomeric facepieces.
2) Demand SCBA shall not be used for emergency situations such as firefighting.
3) Protection factors listed are for high -efficiency filters and sorbents (cartridges and canisters).
With dust filters, an assigned protection factor of 100 is to be used due to the limitations of
the filter.
4) Although positive -pressure respirators are currently regarded as providing the highest level
of respiratory protection a limited number of recent simulated workplace studies concluded
that all users may not achieve protection factors of 10,000. Based on this limited data, a
definitive assigned protection factor could not be listed for positive -pressure SCBA's. For
emergency planning purposes where, hazardous concentrations can be estimated, an
assigned protection factor of no higher than 10,000 should be used.
NOTE: Assigned protection factors are not applicable for escape respirators. For combination
respirators, e.g., airline respirators equipped with an air -purifying filter, the mode of
operation in use will dictate the assigned protection factor to be applied.
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Attachment 12-2 - Respirator Selection
Logic Guide: Reference ANSI 288.2 —1992 7.2.2.
Respirator selection involves reviewing each operation to (a) determine what hazards may be present (hazard
determination) and (b) select which type or class of respirators can offer adequate protection.
Hazard Determination Steps
The nature of the hazard shall be determined as follows:
• Determine what contaminant(s) may be present in the workplace.
• Determine whether there is a published Threshold Limit Value, Permissible Exposure Limit, or any other
available exposure limit or estimate of toxicity for the contaminant(s). Determine if the IDLH
concentration for the contaminant is available.
• Determine if there is a comprehensive health standard (e.g., lead, asbestos) for the contaminant(s). If
so, there may be specific respirators required that influence the selection process.
• If the potential for an oxygen -deficient environment exists, measure the oxygen content.
• Measure or estimate the concentration of the contaminant(s).
• Determine the physical state of the contaminant. If an aerosol determines or estimates the particle size.
• Determine if vapor pressure of the aerosol is significant at the maximum expected temperature of the
work environment.
• Determine whether the contaminant(s) present can be absorbed through the skin, produce skin
sensitization, or be irritating or corrosive to the eyes or skin.
• Determine for a gas or vapor contaminant(s) if a known odor, taste, or irritation concentration exists.
Selection Steps
The proper respirator shall be selected as follows:
• If unable to determine what potentially hazardous contaminant may be present, the atmosphere shall
be considered IDLH.
• If no exposure limit or guideline is available and estimates of the toxicity cannot be made, the
atmosphere shall be considered IDLH.
• If a specific standard exists for the contaminant, follow those guidelines/requirements.
• If there is an oxygen -deficient atmosphere, the type of respirator selected depends on the partial
pressure and concentration of oxygen and the concentration of the other contaminant(s) that may be
present.
• If the measured or estimated concentration of the contaminant(s) is considered IDLH, reference
"Respirators for use under IDLH conditions" at the end of this guide.
• Divide the measured or estimated concentration of each contaminant by the exposure limit or guideline
to obtain a hazard ratio. When two or more substances are present, consideration needs to be given if
there is a synergistic or combined effect of exposure rather than considering each substance individually.
Select a respirator with an assigned protection factor greater than the value of the hazard ratio, as listed
in Attachment 12-1, Table 1.
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• If the contaminant(s) is a gas or vapor only, select a device with an assigned protection factor that is
greater than the hazard ratio. The concentration shall also be less than the maximum use concentration
of the cartridge/canister.
• If the contaminant is a paint, lacquer, or enamel, select a respirator approved specifically for paint mists
or an atmosphere -supplying respirator. (Approval label or regulatory provision may preclude use for
some paints.)
• If the contaminant is a pesticide, select a respirator and filtration system specifically approved for
pesticides or an atmosphere -supplying respirator. (Approval label may preclude use for some pesticides.)
• If the contaminant is an aerosol with an unknown particle size, or less than 2 ums (MMAD), a high -
efficiency filter shall be used.
• If the contaminant is a fume, use a filter approved for fumes or a high -efficiency filter.
• If the contaminant is an aerosol with a particle size greater than 2 ums (MMAD), any filter type (dust,
fumes, mist, or high efficiency) may be used.
• If the contaminant is a gas or vapor and has poor warning properties, the use of an atmosphere -supplying
respirator is generally recommended.
When atmosphere -supplying respirators cannot be used because of the lack of a feasible air supply, or the
need for worker mobility, air -purifying devices should be used only if:
The air -purifying respirator has a reliable end -of -service -life indicator that will warn the user prior to
contaminant breakthrough or,
A cartridge change schedule is implemented based on cartridge service data including desorption studies
(unless cartridges are changed daily), expected concentration, pattern of use, duration of exposure, and
the chemical does not have a ceiling limit.
Respirators for use under IDLH atmospheres:
• The required respiratory protection for IDLH conditions caused by the presence of toxic materials, or a
reduced percentage of oxygen, is a combination full face piece pressure demand supplied air respirator
(SAR) with auxiliary self-contained air supply. For rescue applications, a full -face piece pressure demand
SCBA certified by NIOSH for a minimum service life of thirty minutes is acceptable.
• When respirators are worn under IDLH conditions, at least one standby person shall be present in a safe
area. The standby person shall have the proper equipment available to assist the respirator wearer in
case of difficulty. Communications (visual, voice, signal line, intercom, radio or other suitable means)
shall be maintained between the standby person and the wearer. While working in the IDLH atmosphere,
the wearer shall be equipped with a safety harness and lifeline to permit removal to a safe area, if
necessary. Provisions for rescue other than harness and lifeline may be used, if equivalent.
Special considerations for confined space entry into IDLH conditions are not addressed in this policy.
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Use and duration of cartridges
Contaminant (1) Maximum Concentration
Maximum Use Time (2)
(Hours)
1,3 Butadiene 50
1
Ammonia 100
4
Benzene 10
8
Benzene 50
4
Chemicals not specified (3) NA
1
Naphtha 100
4
Naphtha 500
2
Particulates (including dusts, NA
8
mists, welding fumes)
Sulfur Dioxide 50
8
Total Hydrocarbons (as n- 100
4
hexane)
Total Hydrocarbons (as n- 500
1
hexane)
• If more than one contaminant is present, use the lowest maximum
use time.
• Cartridges should be changed out if the contaminant can be detected
inside the respirator mask,
regardless of the maximum use time.
• Cartridges for chemicals not listed should be used for only 1 hour. This will err on the side of safety. If
specific information is needed on a particular chemical, consult with the SDS or your supervisor.
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Attachment 12-3 - Fit Testing
If the test subject is not familiar with using a particular respirator, the test subject shall be directed to don the
face piece several times and to adjust the straps to become adept at setting the proper tension on the straps.
Assessment of comfort shall include a review of the following points with the test subject and allowing the
test subject adequate time to determine the comfort of the respirator:
• Position of the mask on the nose
• Room for eye protection
• Room to talk
• Position of mask on face and cheeks
The following criteria shall be used to help determine the adequacy of the respirator fit:
• Chin properly placed
• Adequate strap tension, not overly tightened
• Fit across nose bridge
• Respirator of proper size to span distance from nose to chin
• Tendency of respirator to slip
• Self-observation in mirror to evaluate fit and respirator position
The test subject shall conduct a user seal check, utilizing the negative and positive pressure seal check
methods. Before conducting the negative and positive pressure checks, the subject shall be told to seat the
mask on the face by moving the head from side -to side and up and down slowly while taking a few slow
deep breaths. Another face piece shall be selected and retested if the test subject fails the user seal check
tests.
The test shall not be conducted if there is any hair growth between the skin and the face piece sealing
surface, such as stubble beard growth, beard, mustache or sideburns which cross the respirator sealing
surface. Any type of apparel, which interferes with a satisfactory fit, shall be altered or removed.
If the employee finds the fit of the respirator unacceptable, the test subject shall be given the opportunity
to select a different respirator and to be retested.
Exercise regimen
Prior to the commencement of the fit test, the test subject shall be given a description of the fit test and the
test subject's responsibilities during the test procedure. The description of the process shall include a
description of the test exercise that the subject will be performing. The respirator to be tested shall be worn
for at least 5 minutes before the start of the fit test
The fit test shall be performed while the test subject is wearing any applicable safety equipment that may
be worn during actual respirator use, which could interfere with respirator fit.
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Test exercises
The following test exercises are to be performed for all fit testing methods. The test subject shall perform
exercises, in the test environment, in the following manner:
• Normal breathing: In a normal standing position, without talking, the subject shall breathe normally.
• Deep breathing: In a normal standing position, the subject shall breathe slowly and deeply, taking
caution so as not to hyperventilate.
• Turning head side to side: Standing in place, the subject shall slowly turn his/her head from side to side
between the extreme positions on each side. The head shall be held at each extreme momentarily so
the subject can inhale at each side.
• Moving head up and down: Standing in place, the subject shall slowly move his/her head up and down.
The subject shall be instructed to inhale in the up position (i.e., when looking toward the ceiling).
• Talking: The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test
conductor. The subject can be read from a prepared text such as the Rainbow Passage, count backward
from 100, or recite a memorized poem or song.
Rainbow Passage
When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a
division of white light into many beautiful colors. These take the shape of a long round arch, with its path
high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of
gold at one end. People look, but no one ever finds it. When a person looks for something beyond reach, his
friends say he is looking for the pot of gold at the end of the rainbow.
• Bending over: The test subject shall bend at the waist as if he/she were to touch his/her toes. Jogging in
place shall be substituted for this exercise in those test environments that do not permit bending over
at the waist.
• Normal breathing: In a normal standing position, without talking, the subject shall breathe normally.
Each test exercise shall be performed for one minute. The test subject shall be questioned by the test
conductor regarding the comfort of the respirator upon completion of the protocol. If it has become
unacceptable, another model of respirator shall be tried. The respirator shall not be adjusted once the fit
test exercises begin. Any adjustment avoids the test, and the fit test must be repeated.
Irritant Smoke Protocol
This qualitative fit test uses a person's response to the irritating chemicals released in the "smoke" produced
by a stannic chloride ventilation smoke tube to detect leakage into the respirator.
General Requirements and Precautions
• The respirator to be tested shall be equipped with high efficiency particulate air (HEPA) or P100 series
filter(s).
• Only stannic chloride smoke tubes shall be used for this protocol.
• No form of test enclosure or hood for the test subject shall be used.
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• The smoke can be irritating to the eyes, lungs, and nasal passages. The test conductor shall take
precautions to minimize the test subject's exposure to irritant smoke. Sensitivity varies, and certain
individuals may respond to a greater degree to irritant smoke. Care shall be taken when performing
the sensitivity screening checks that determine whether the test subject can detect irritant smoke to
use only the minimum amount of smoke necessary to elicit a response from the test subject.
• The fit test shall be performed in an area with adequate ventilation to prevent exposure of the person
conducting the fit test, or the build-up of irritant smoke in the general atmosphere.
Sensitivity Screening Check
• The test operator shall break both ends of a ventilation smoke tube containing stannic chloride and
attach one end of the smoke tube to a low flow air pump set to deliver 200 milliliters per minute, or
an aspirator squeeze bulb. The test operator shall cover the other end of the smoke tube with a short
piece of tubing to prevent potential injury from the jagged end of the smoke tube.
• The test operator shall advise the test subject that the smoke can be irritating to the eyes, lungs, and
nasal passages and instruct the subject to keep his/her eyes closed while the test is performed.
• The test subject shall be allowed to smell a weak concentration of the irritating smoke before the
respirator is donned to become familiar with its irritating properties, and to determine if he/she can
detect the irritating properties of the smoke. The test operator shall carefully direct a small amount
of the irritant smoke in the test subject's direction to determine that he/she can detect it.
Irritant Smoke Fit Test Procedure
• The person being fit tested shall don the respirator without assistance and perform the required user
seal check(s).
• The test subject shall be instructed to keep his/her eyes closed.
• The test operator shall direct the stream of irritant smoke from the smoke tube toward the face seal
area of the test subject, using the low flow pump or the squeeze bulb. The test operator shall begin
at least 12 inches from the face piece and move the smoke stream around the whole perimeter of
the mask. The operator shall gradually make two more passes around the perimeter of the mask,
moving to within six inches of the respirator.
• If the person being tested has not had an involuntary response and/or detected the irritant smoke,
proceed with the test exercises.
• The exercises identified in section H of this attachment shall be performed by the test subject while
the respirator seal is being continually challenged by the smoke, directed around the perimeter of
the respirator at a distance of six inches.
• If the person being fit tested reports detecting the irritant smoke at any time, the test is failed. The
person being retested must repeat the entire sensitivity check and fit test procedure.
• Each test subject passing the irritant smoke test without evidence of a response (involuntary cough,
irritation) shall be given a second sensitivity screening check with the smoke from the same smoke
tube used during the fit test, once the respirator has been removed, to determine whether he/she
still reacts to the smoke. Failure to evoke a response shall void the fit test.
• If a response is produced during this second sensitivity check, then the fit test is passed.
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Attachment 12-4 - Respirator Cleaning Procedures
These procedures are provided as a guideline when cleaning respirators. They are general in nature, and the
administrator as an alternative may use the cleaning recommendations provided by the manufacturer of the
respirators used by their employees, provided such procedures are as effective as those listed here. Equivalent
effectiveness simply means that the procedures used must accomplish the objectives set forth (i.e., must ensure
that the respirator is properly cleaned and disinfected in a manner that prevents damage to the respirator and
does not cause harm to the user).
• Remove filters, cartridges, or canisters. Disassemble face pieces by removing speaking diaphragms, demand
and pressure -demand valve assemblies, hoses, or any components recommended by the manufacturer.
Discard or repair any defective parts.
• Wash components in warm water (110' F maximum), with mild detergent or cleaner recommended by the
manufacturer. A stiff bristle (not wire) brush may be used to facilitate the removal of dirt.
• Rinse components thoroughly in clean, warm (110' F maximum), preferably running water. Drain.
• When the cleaner used does not contain a disinfecting agent, respirator components should be immersed
for two minutes in one of the following:
o Hypochlorite solution (50 ppm of chlorine) made by adding approximately one milliliter of laundry bleach
to one liter of water at 110' F, or,
o Aqueous solution of iodine (50 ppm iodine) made by adding approximately 0.8 milliliters of tincture of
iodine (6-8 grams ammonium and/or potassium iodide/100cc of 45% alcohol) to one liter of water at
110°F, or,
o Other commercially available cleansers of equivalent disinfectant quality when used as directed, if their
use is recommended or approved by the respirator manufacturer.
• Rinse components thoroughly in clean, warm (110° F maximum), preferably running water. Drain. The
importance of thorough rinsing cannot be overemphasized. Detergents or disinfectants that dry on face
pieces may result in dermatitis. In addition, some disinfectants may cause deterioration of rubber or
corrosion of metal parts if not completely removed.
• Components should be hand -dried with a clean lint -free cloth or air-dried.
• Reassemble face piece, replacing filters, cartridges, and canisters where necessary.
• Test the respirator to ensure that all components work properly.
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Attachment 12-5 - Acceptable Fit -Testing Methods
Table 2
QLFT
QNFT
Half -Face, Negative Pressure, APR (<100 fit factor)
Yes
Yes
Full -Face, Negative Pressure, APR (<10 fit factor)
Yes
Yes
Used in atmospheres up to 10 times the PEL
Full -Face, Negative Pressure, APR (>100 fit factor)
No
Yes
PAPR
Yes
Yes
Supplied -Air Respirators (SAR), or SCBA used in Negative Pressure
No
Yes
(Demand Mode) (>100 fit factor)
Supplied -Air Respirators (SAR), or SCBA used in Positive Pressure
Yes
Yes
(Pressure Demand Mode)
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Attachment 12-6 - Site Specific Respiratory Protection Plan
Purpose
Because site facilities, equipment and procedures are not standard, OSHA requires that each worksite develop
and maintain a Site -Specific Respiratory Protection Plan. The Site Respiratory Protection Program Administrator
will utilize the Respiratory Protection Program and this attachment to develop site specific procedures
governing the administration, selection, use, and care of respirators.
Scope and Application
This procedure applies to all sites or projects where employees are required to wear respirators during normal work
operations and during certain non -routine or emergency operations.
Site Respirator Program Administrator
The Site Respirator Program Administrator (Administrator) is responsible for overseeing the respiratory protection
program at (worksite). The Administrator will report, at least annually, on the effectiveness of the
program to management, and be authorized to make appropriate changes to the Site Program. The person designated
as the Administrator for this worksite is
Administrators are responsible for ensuring that the respiratory protection program is implemented at their
site. In addition, all site supervisors shall be knowledgeable about the program requirements for their own
protection, supervisors must ensure that the program is understood and followed by the employees under
his/her supervision.
Duties include:
Administrator/Supervisor
• Ensuring that employees under their supervision (including new hires) have received appropriate and
current training, fit testing, and medical evaluation.
• Ensuring the availability of appropriate respirators and accessories.
• Being aware of tasks requiring the use of respiratory protection.
• Enforcing the proper use of respiratory protection when necessary.
• Ensuring that respirators are properly cleaned, maintained, and stored according to the site respiratory
protection plan.
• Ensuring that respirators fit well and do not cause discomfort.
• Identifying work areas, processes or tasks that require workers to wear respirators, and evaluating
hazards.
• Monitoring respirators is used to ensure that respirators are used in accordance with their certifications.
• Ensuring proper storage and maintenance of site respiratory protection equipment.
• Conducting qualitative/quantitative fit testing.
• Updating the Site Program as necessary to reflect workplace changes that affect respirator use.
• Coordinating with management on how to address respiratory hazards or other concerns regarding the
Site Program.
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Emplovees
Each employee has the responsibility to wear his or her respirator when and where required and in the way
they were trained. Employees must also:
• Care for and maintain their respirators as instructed and store them in a clean and sanitary location.
• Inform their supervisor if the respirator no longer fits well and request a new one that fits properly.
• Inform their supervisor or the Program Administrator of any respiratory hazards that they feel are not
adequately addressed in the workplace and of any other concerns that they have regarding the program.
• Notify their supervisor or the Program Administrator of any other problems associated with using their
respirator.
Hazard Determination/Respirator Selection
The Administrator shall utilize Attachment 12-2 — Respirator Selection to ensure that the respirator selected
will be adequate to effectively reduce exposure to the respirator user under all conditions of use including
reasonably foreseeable emergency situations.
• When necessary, exposure monitoring will be conducted to measure potential hazardous exposures.
Monitoring will be conducted by
The results of the hazard evaluation are summarized in Table 1.
TABLE 1: HAZARD EVALUATION SUMMARY
Work Activity Contaminants Exposure Permissible Controls
Asbestos Insulation Work Asbestos
Opening equipment
containing Benzene
Opening equipment
containing Butadiene
Lead paint work
Activities covered:
• Dry abrasive blasting
• Burning, flame -torch
cutting & welding
• Grinding, sanding or
buffing with power
tools
Opening equipment
containing 112S
Benzene
Monitoring Exposures
Sample prior 0.1 f/cc TWA Not in excess of 1 f/cc - % mask APR w/ high efficiency
to start of filters
work Not in excess of 5 f/cc — FF APR w/high efficiency filters
Not in excess of 10 f/cc — PAPR w/high efficiency filters
Prior to 1 ppm < 1 ppm — No respirator.
opening Less than or 10 ppm %: mask APR w/ organic vapor
cartridge
Less than or 50 ppm FF APR w/organic vapor cartridge
Less than or 100 ppm FF PAPR w/ organic vapor cartridge
Less than or 1000 ppm supplied air FF respirator
> 1000 ppm SCBA
Butadiene Prior to
1ppm (TWA)
Same a Benzene
opening
Lead Sample prior
50 Ug/M3
Airborne concentration of Lead
to start of
(TWA)
Not in excess of 0.5 mg/M3 — % APR w/high efficiency
work
filters
Not in excess of 2.5 mg/M3 — FF APR w/high efficiency
filters
Not in excess of 50 mg/M3 PAPR w/high efficiency filters
H2S Sample prior
10 ppm
< 10 ppm No respirator
to start of
work
Vendor Services Agreement Lone Star Hazmat Response, LLC 159 of 257
Site Hazard Evaluation Update
The Administrator is responsible to revise and update the hazard evaluation as needed (i.e., any time work
process changes may potentially affect employee exposure). If an employee feels that respiratory protection
is needed during a particular activity, she/he is to notify their immediate supervisor.
Medical Evaluation
The Administrator will ensure that the Medical Evaluation of this policy is followed.
Fit Testing
Refers to Respirator Fit Test section of the Respiratory Protection Program.
Procedures for Immediately Dangerous to Life and Health (IDLH) Situations
All employees are prohibited from entering and working in known IDLH areas, unless they are specifically
trained and certified for such work i.e. inert entry. Whenever workers are assigned to work in potentially
IDLH areas, task specific procedures including training requirements shall be developed and strictly adhered
to.
The Administrator has identified the following areas or job duties as presenting the potential for IDLH
conditions:
(List areas/iob duties/non-routine activities)
Cleaning and Disinfecting
Respirators will be cleaned and disinfected by , the Administrator ensures the
procedures in Attachment 12-4: Respirator Cleaning Procedures are strictly adhered to.
Storage
Respirators will be stored so that they are protected against damage, contamination, dust, sunlight,
temperature extremes, excessive moisture, and damaging chemicals. When respirators are packed or
stored, the facepiece and exhalation valve will be stored in a manner that prevents deformation. Each
respirator should be positioned so that it retains its natural configuration.
Respirators will be readily available for use will be stored at
The Administrator will ensure that an adequate number and type of respirators are provided for each work
area where they are needed.
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Inspection
Respirators used in routine situations will be inspected during cleaning, prior to issue and prior to use.
Inspection information for respirators will be maintained until it is replaced following subsequent
certification.
Repair
Repairs or adjustments to respirators will be done by Only NIOSH-
approved manufacturer's replacement parts designed for that respirator will be used. Repairs will be made
in accordance with the manufacturer's recommendations and specifications regarding the type and extent
of repairs to be performed.
Because components such as reducing and admission valves, regulators, and alarms are complex and
essential to the safe functioning of SCBAs, they are required to be adjusted and repaired only by the
manufacturer or a technician trained by the manufacturer. Maintenance on SCBAs will be done by
SCBA's air and oxygen cylinders will be maintained in a fully charged state and recharged when the pressure
falls to 90% of the manufacturer's recommended pressure level. Cylinders will be recharged by sending them
out to or recharged on site by
SCBA air and oxygen cylinders will be hydrostatically tested according to the manufacturers recommended
frequency. Hydrostatic testing will be conducted by
Composite -wrapped aluminum cylinders will be taken out of service after 15 years regardless of the last
hydrostatic test date.
Breathing Air Qualitv
The Administrator will ensure that breathing air for atmosphere -supplying respirators will be of high purity,
meets quality levels for content, and does not exceed OSHA contaminant levels and moisture requirements.
For supplied -air respirators (SARs), only Grade D breathing air shall be used in cylinders. The Program
Administrator or designee will coordinate deliveries of compressed air with and require
certification that the air in the cylinders meet the specifications of Grade D breathing air. All breathing gas
containers must be marked in accordance with the NIOSH respirator certification standard, 42 CFR part 84.
Compressors
Compressors used for supplying breathing air must be constructed and situated so contaminated air cannot
enter the air -supply system. Compressors must meet the requirements of this policy.
Only non -oil -lubricated compressors will be used at . The Administrator
shall ensure that the compressor intake will not allow the introduction of carbon monoxide greater than 10
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parts per million (ppm) into the system. Note: This could be from sources other than the compressor such as
forklifts/vehicles or other gas -powered equipment. Where this is not possible or feasible, it maybe necessary
to combine the use of a carbon monoxide alarm with a carbon monoxide sorbent bed when conditions are
such that a reliable carbon monoxide -free area for air intake cannot be found.
Training and Information
will provide training to respirator users, supervisors, and any person issuing
respirators on the contents of the Respiratory Protection Program the proper care and use of site -specific
equipment and their responsibilities. All training records will include the manufacturer, type and model of
respiratory protection equipment.
Recordkeer)ing
The Administrator shall retain copies of all respiratory protection program documents, including fit test and
training records.
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Attachment 12-7 - SUPPLIED AIR PRE -JOB CHECKLIST
Date: Location:
Unit: Equipment:
Supervisor: Crew:
Bottle watch: Safety standby:
Supplied Air Equipment Checklist (Are the following in good working condition?)
Cylinders & Associated Equipment Yes No Hoses and Fittings Yes No
Pressure: All bottles, i.e. 6 packs must be Serviceable condition
changed at 500 psi (SCBAs will be full for Connected properly
rescue or standby work 2000 psi) No leaks
Gauges
Valve and check valve Facepiece and Regulator Yes No
Cylinder Valve Cover(s) Lens is clean
Alarm Tearoff Lens Present
Regulator -coupling secured Face seal (fit check)
Head straps
SCBA Frame and Harness Assembly Yes No Purge valve
Waist belt Exhalation valve & diaphragm
Shoulder straps Adequate air flow
Snaps, buckles, clips
Task Related Checklist ✓
Proper permits at location and displayed
Hazard analysis completed and displayed
Safe work and emergency plans understood by all crew members
Personnel certified to perform supplied air work
Standby attendant trained and procedures reviewed
Bottle watch trained and procedures reviewed
Area barricaded with red tape and tagged "supplied air being used"
Emergency bypass off
Damaged equipment tagged and removed from service
Backup cylinder determined
Note:
• Cylinders which show evidence of exposure to high heat or impact damage shall be removed from service and
retested prior to recharging.
• Do not use tools to open or close the purge valve (finger -tight only).
• Route hose lines in a manner that does not restrict access/egress.
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• Make sure your work does not endanger others in your immediate area or downwind.
• Do not remove the facepiece if product exposure obstructs your vision. Use tear off lens or wipe it off and
move safely out of the hazardous environment.
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Owl*
LONE STAR HAZMAT
The Leader in Emergency Response
Individual Respiratory Fit Test Record
Location:
Instructor(s):
Date:
Test Type: Qualitative /
Quantitative
Respirator Information: Test Method:
Make:
Model:
Style
Size:
Print Employee's Name
Employee's Signature
105
Social Security Number
Date Entered
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Ladder Safety Policy
The Ladder Safety Policy is intended to provide employees with safe guidelines for the use of portable ladders,
while complying with applicable OSHA and other Regulatory Compliance Standards. This policy is designed to
meet or exceed ANSI requirements.
Policy
Except where either permanent or temporary stairways or suitable ramps or runways are provided, employees
are to only use manufactured portable ladders that are labeled as being designed and manufactured in
accordance with the provisions of the American National Standards Institute. Under no circumstances are
portable ladders to be used unless conditions are considered safe, secure and in compliance with OSHA and
company procedures and safe work practices.
Procedures
• The use of ladders with broken or missing rungs or steps, broken or split side rails, or other faulty or defective
construction is prohibited. All rungs, cleats, and steps will be parallel, level and uniformly spaced when the
ladder is being used. All ladders will be inspected prior to use by a competent person. When ladders with
such defects are discovered, they must be immediately removed from service and tagged as such.
• Employees will face the ladder and will not carry material or tools in their hands while ascending or
descending.
• Ladders will not be loaded beyond the maximum intended load for which they were built or beyond the
manufacturer's rated capacity.
• All ladders shall be placed on secure footing, and the area around the top and bottom will be kept clear of
work materials, tools, and debris.
• Planks will not be used on the top step of stepladders.
• Portable ladders will be placed and used at a pitch that places the horizontal distance, from the top support
to the foot of the ladder, at about one -quarter of the working length of the ladder. Ladders will not be used
in a horizontal position as a platform, runway, or scaffold.
• Ladders shall not be placed in front of doors, unless the door is blocked open, and/or a barricade or guard
is provided.
• Ladders shall not be placed on scaffold, boxes, boards, barrels, or other unstable bases.
• Ladders shall not be spliced together.
• Employees will not stand on the top cap or the step below the top cap of a stepladder.
• Any ladder splashed with caustic or acid shall not be used until thoroughly cleaned and inspected for possible
corrosive damage.
• There shall be ample clearance and clear access at the top and bottom of portable ladders.
• Portable rung ladders shall only be used with metal supports on the underside.
• No ladder shall be used to gain access to a roof unless it extends at least 3 feet above the point of highest
support with the building. Side rails must extend not less than 36" above any landing. When this is not
practical, grab rails will be provided to facilitate employee movement to and from the point of access.
• Portable metal ladders will not be used for electrical work or where they may contact electrical conductors.
• All ladders shall be equipped with non -slip bases when a hazard of slipping exists.
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• All ladders will be tied off on top, blocked or otherwise secured to prevent positive movement before work
is performed from them.
• All ladders must have a minimum width of 12 inches. All ladders must have a distance of 12" between rungs.
• The company prefers not to use or issue chain ladders, however if a client provides or mandates chain ladder
usage, a thorough pre -use inspection of the ladder(s) must be performed. When there is a need for this type
of ladder, wire rope ladders are preferred.
• Stepladders shall not exceed 20 feet in length.
• Extension ladders should be equipped with stops.
• Ladders shall be maintained in good condition.
• Only one employee is to work on or climb a ladder at the same time.
• All work done from a ladder shall be within an individual's normal reach and with no overextending allowed.
• All work done from a ladder that exposes a worker to a fall potential of 6 feet or more requires the worker
to wear a harness and be tied off per the Fall Protection Policy. Employees are not permitted to stand or
work off of the top three rungs or cleats of a ladder unless there are members of the structure that provide
a firm handhold, or the employee is protected by personal fall protection
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Fall Protection Policy
Work activities where employees may be subject to falls and/or falling objects shall be conducted safely with
associated hazards eliminated and/or controlled.
This policy covers minimum performance standards applicable to all LSHR employees and locations. Local
practices requiring more detailed or stringent rules, or local, state, or other federal requirements regarding this
subject can and should be added as an addendum to this procedure as applicable.
Purpose
To ensure that employees are protected from the hazards associated with falls and falling objects.
Scope
Applies to all LSHR work sites, i.e., LSHR offices, client job sites, etc., where field construction related activities
involve exposure to heights greater than or equal to six (6) feet and/or falling objects exist. In general industry
(e.g. offices, shops, warehouses, etc.) exposure to heights greater than or equal to four (4) feet shall be in
place of all references to the construction six (6) foot reference.
Definitions
Anchorage means a secure point of attachment for lifelines, lanyards, or deceleration devices that is capable of
supporting 5,000 lbs. per employee or two times the intended impact load, whichever is greater, or for a
positioning system, 3,000 lbs. without failure.
Approved means, for the purpose of this section, authorized by the Safety Officer, tested and certified by the
manufacturer or any recognized national testing laboratory to possess the strength requirements specified in this
section.
Catenary Line — see Horizontal Lifeline.
Competent Person means an individual knowledgeable (through experience and/or training) of fall protection
equipment, including the manufacturer's recommendations and instructions for the proper use, inspection, and
maintenance; who is capable of identifying existing and potential fall hazards; who has the authority to take
prompt corrective action to eliminate those hazards; and who is knowledgeable of the rules contained in this
section regarding the erection, use, inspection, and maintenance of fall protection equipment and systems.
Controlled Access Zone means an area in which certain work may take place without the use of guardrail systems,
personal fall arrest systems, or safety net systems and access to the zone is controlled.
Deceleration Device means a device manufactured (fall) shock -absorbing device whereby the forces of the fall are
rapidly reduced to meet acceptable levels.
Drop Line means a vertical lifeline secured to an upper anchorage for the purpose of attaching a lanyard or device.
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Employee means every laborer regardless of title or contractual relationship.
Fall Arrest System (Personal) means the use of multiple, approved safety equipment components such as body
harnesses, shock absorbing lanyards, deceleration devices, droplines, horizontal and/or vertical lifelines and
anchorages, interconnected and rigged to ones body as to arrest a free fall.
Fall Protection Work Plan means a written planning document in which the employer identifies areas in the work
area where a fall hazard of 6 feet or greater exists, wherebv conventional Fall Restraint and Fall Arrest Svstems
cannot be utilized.
Fall Restraint System means an approved device and any necessary components that function together to restrain
an employee in such a manner as to prevent that employee from falling to a lower level.
Fall Distance means the actual distance from the employee's work platform (area) to the level where a fall would
stop (ground level or otherwise).
Full Body Harness means a configuration of connection straps to distribute a fall arresting force over at least the
thighs, shoulders and pelvis, with provisions for attaching a lanyard, lifeline, positioning rings, or deceleration
devices.
Full Body Harness System means a Class III full body harness and shock absorbing lanyard attached to an
anchorage or attached to a horizontal or vertical lifeline which is properly secured to an anchorage(s) capable of
withstanding the forces specified in the applicable sections.
Hardware means snap hooks, D-rings, buckles, carabiniers, and adjusters used to attach the components of a fall
protection system together.
Holes (floor, roof or walking surface) means any opening in the floor greater than two inches whereby falling
objects or an employee fall equal to, or greater than six foot is possible.
Holes (wall) — see Wall Opening.
Horizontal Lifeline means an approved rail, rope, or synthetic cable installed in a horizontal plane between two
anchorages and used for attachment of a employee's lanyard or lifeline device while moving horizontally.
Lanyard means a flexible line of webbing, rope or cable (usually in two, four or six foot lengths) used to secure a
harness to a lifeline or an anchorage point.
Leading Edge means the advancing edge of a floor or roof, where a fall of more than six foot is possible to the
ground or to another level.
Lifeline (vertical or horizontal) means an approved vertical line from a fixed overhead anchorage or horizontal
line between two horizontal anchorages, independent of walking or working surfaces, to which a lanyard or device
is secured.
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Restraint Line means a line from a fixed anchorage or between two anchorages to which an employee is secured
in such a way as to restrict the employee from reaching a point where falling to a lower level is possible.
Safety Line — see Lifeline.
Shock Absorbing Lanyard means a flexible line of webbing or rope used to secure a harness to a lifeline or
anchorage point that has an integral shock absorber of either a rip -stitch or retractable configuration.
Snaphook — means a 'locking' hook at the end of a lanyard or restraining/positioning line that has a double -action
locking mechanism intended to eliminate unintentional unhooking from the D-ring of a body harness. Non -locking
snaphooks are prohibited.
Standard Guardrail means a toprail at 42 inches high (plus or minus three inches), a midrail installed midway the
top edge of the guardrail system and the surface.
Static Line — see Lifeline.
Toeboard means a barrier at the base of the guardrail system to prevent material and objects from falling off the
surface. They are at least four (4) inches of nominal height with no less than one (1) inch clearance from the
surface.
Unprotected Sides and Edges means any side or edge (except at entrances to points of access) of a floor, roof,
ramp, or runway where there is no wall or guardrail system.
Walking/Working Surface means for the purpose of this section, any area whose dimensions are 45 inches or
greater in all directions through which employees pass or conduct work, and can include scaffolding and aerial lifts
regardless of surface dimensions.
Wall Opening means a gap in a wall where the outside bottom edge is 6 feet or more above lower levels, and the
inside bottom edge (e.g. parapit wall) is less than 39 inches above the walking/working surface.
Work Area means that portion of a walking/working surface where work activities are being performed.
Requirements
Training
Fall Protection training requirements shall include:
• New employees with work responsibilities requiring the use of fall protection will be oriented to the
LSHR Fall Protection Program (and any local addendums) as part of the 'new employee orientation
program'.
• At new worksites, i.e., office, client job sites, etc., during the pre -job meeting to describe specific fall
protection requirements of the job.
• Thereafter, every foreseeably exposed employee will be trained at least annually, and include the
following:
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o The nature of fall hazards in the typical work area
o The correct procedures for erecting, maintaining, disassembling, and inspecting fall protection
systems
o The use and operation of conventional and non -conventional fall protection systems
o The role of each employee in the safety monitoring system when such a system is in use
o The limitations on the use of mechanical equipment during the performance of roof work on low -
slope roofs
o The correct procedures for equipment and materials handling and storage, and the erection of
overhead protection
o The correct fit, maintenance and use of (personal) fall arrest system components, as determined by
the manufacturer(s)
o Rescue procedures in the event an individual falls
o All other details in this section (and local addendums)
Toolbox talks for related issues of this manual section shall be covered periodically. Retraining shall also
occur whenever deficiencies in the training program are identified, standard requirements change or are
modified or new fall protection systems are introduced. Any employee who has not received orientation or
annual training (as previously outlined) shall not be allowed to work at heights identified by this section.
Training provided shall be documented and maintained in a training file at the Branch Office. Training will
include dates of training, instructor's name, toAvetta / material covered and attendee names.
Conventional Fall Arrest and Fall Restraints Svstems
Conventional Fall Arrest and Fall Restraint Systems shall be utilized where the exposure to falls greater than
6 foot and from falling objects as is reasonably foreseen. The following systems shall be utilized:
Guardrail Svstem (fall restraint and potentially from falling obiects)
• Toprails and midrails of guardrail systems constructed of wood shall be at least % inch diameter or
thickness to prevent cuts and lacerations.
• If wire rope is used for toprails, it shall be flagged at not more 6 feet intervals with high -visibility
material. Steel and plastic banding are prohibited for use as toprails or midrails.
• The top edge height of toprails, or (equivalent) guardrails shall be 42 inches, plus or minus 3 inches,
above the walking/working level.
• When employees are using ladders in distance proximity equivilent to the maximum use -length of
the ladder, the top edge height of the top rail, or equivalent member, shall be increased an amount
equal to the maximum use -length height of the ladder, or see Special Control Procedures portion
(for ladders) of this manual section for other options.
• Screens, midrails, mesh, intermediate vertical members, or equivalent intermediate structural
members shall be installed between the top edge of the guardrail system and the walking/working
surface when there are no walls or parapet walls at least 21 inches high. When midrails are used,
they shall be installed at a height midway between the top edge of the guardrail system and the
walking/working level. When screens and mesh are used, they shall extend from the top rail to the
walking/working level. Intermediate members, such as balusters, when used between posts, will not
be more than 19 inches apart.
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• The guardrail system shall be capable of withstanding a force of at least 200 pounds of force applied
within 2 inches of the top edge in any outward or downward direction. When the 200 pounds is
applied in a down -ward direction, the top edge of the guardrail shall not deflect to a height less than
39 inches above the walking/working level.
• Midrails, screens, mesh, intermediate vertical members, solid panels, and equivalent structural
members will be capable of withstanding a force of at least 150 pounds of force applied in any
downward or outward direction at any point along the midrail or other member.
• Guardrail systems shall be free of sharp edges and burrs to protect against punctures or lacerations
and to prevent clothing from snagging.
• The ends of top rails and midrails shall not overhang terminal posts, except where such an overhang
does not constitute a projection hazard.
• When guardrail systems are used at hoisting areas, a chain, gate or removable guardrail section shall
be placed across the access opening between guardrail sections when hoisting operations are not
taking place.
• At uncovered holes, guardrail systems shall be set up on unprotected sides or edges. When holes are
used for the passage of materials, the hole shall have not more than two sides with removable
guardrail sections. When the hole is not in use, it shall be covered or provided with guardrails along
unprotected sides/edges.
• If guardrail systems are used around uncovered holes that are used as access points (such as
ladderways), gates shall be used or the guardrail shall be offset at a 45 degree angle to prevent
accidental walking into the hole. Toeboards shall be utilized around the edges not utilized as the
actual access point.
• If guardrails are used at unprotected sides or edges of ramps and runways, they shall be erected on
each unprotected side/edge.
• When guardrail systems, in combination with netting, is used to prevent materials from falling from
one level to another, openings shall be small enough to prevent passage of potential falling objects.
Covers for Holes (fall restraint and from falling obiects)
• Covers (or a guardrail system with toe boards ... see Guardrail Systems within this section) shall be
installed over holes equal to or greater then 2" in floors, roofs and walkways that are more than 6
feet above lower levels.
• Hole covering material shall support at least two times the potential weight that will cross over it. If
plywood is chosen as the cover material, it shall be of at least 3/ inch in thickness.
• Hole covers shall be secured in place in such a manner as to not easily be displaced. Examples of
securing methods include, but are not limited to: nailing, attached cleats, wire, etc.
• Such covers shall have the word 'HOLE' or'COVER' predominately marked on the top surface. Where
covers are too small for such marking, they shall be painted or significantly marked in the color
orange.
Restraining/Positioning Svstem (fall restraint)
• Only full body harness systems with positioning rings are to be utilized with any
restraining/positioning system.
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• Restraint line (rope) length shall not exceed the distance to fall exposure, and shall be secured to an
anchorage capable of supporting at least twice the potential impact load of an employee's fall or
3,000 pounds, whichever is greater.
• Requirements for body harness systems, snaphooks, D-rings, and other connectors used with
positioning device systems shall meet the same criteria as those for fall arrest systems of this section.
• No makeshift fall protection equipment may be utilized.
Body belts are prohibited.
(Personal) Fall Arrest Svstem (fall arrest)
(Personal) Fall Arrest Systems shall do all of the following:
• Limit maximum arresting force on an employee to 1,800 pounds. Note: total body weight including
tools cannot exceed 310 lbs. to stay under arresting force limit
• Be rigged so that an employee can neither free fall more than 6 feet nor contact any lower level
• Bring an employee to a complete stop and limit maximum deceleration distance an employee travels
to 3.5 feet
• Have sufficient strength to withstand 5000 lbs. (excluding horizontal lifelines which require a safety
factor of at least two times the potential impact energy)
• All components of the (personal) fall arrest system (lanyards, body harness and attached hardware,
and shock -absorbing devices) shall meet the design specifications of OSHA 1926.502 Subpart M
The following items/actions are prohibited for use with (personal) fall arrest systems:
• body belts
• non -locking snaphooks
• lanyards without shock absorbers
• tying back to the lanyard (once around another object) for a means of an anchorage point, unless
the lanyard was designed for this purpose by the manufacturer, the object tied around can support
the anticipated fall force and the object does not have sharp edges or burrs
(Personal) fall arrest systems shall be utilized in the following manner:
Pre -Use Inspection
All components shall be inspected prior to each use for wear damage, and other deterioration in
accordance with manufacturer's requirements (see equipment inspection and maintenance
procedures of this section).
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General Proper Body Harness Fit Guidelines
• Two employees are usually required to completely fit each other
• The body harness type and size shall meet the physical needs of its user (male/female or small,
medium, large, etc.).
• Follow the manufacturer's guidelines on proper fit.
• Shoulder, thigh, button and chest straps shall be fit snugly whereas it is slightly difficult to slide
the hand underneath.
• Loose straps ends shall be folded back under.
• D-ring placement should be between the shoulder -blades.
• Chest straps should be positioned across the mid -chest area.
Sufficient Anchorage Points Utilized
Anchorages shall be used under the supervision of a competent person, as part of a complete
(personal) fall arrest system that maintains a safety factor of at least two (i.e., capable of supporting
at least twice the weight expected to be imposed upon it).
Anchorages used to attach (personal) fall arrest systems will be independent of any anchorage being
used to support or suspend platforms and shall be capable of supporting at least 5,000 pounds of
force per person attached.
Anchorage points can include:
• Lifelines (horizontal and vertical)
• Designed anchorage points on aerial lifts
• Eye -bolts listed for use by the manufacturer
• Specially designed anchorage tools specifically designed to meet fall force requirements,
including:
• Wrap -around lanyards as approved by the manufacturer
• I-beam clamps designed specifically as an anchorage point
Prohibited anchorage points include, but are not limited to:
• Standard guardrails and railing
• Ladders/rungs
• Scaffolding, unless approved by the manufacturer for/with anchorage points
• Light fixtures, ductwork, conduit, pipe vents, wiring/duct/piping harnesses, other roof stacks,
vents or fans
• C-clamps
• Piping (unless capable of meeting the criteria of an anchorage point)
• To a lanyard (around a solid object), unless the lanyard and hardware is manufactured for that
purpose
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Lifeline/Lanyard Applications
Lanyards shall only be attached to anchorage points sufficient to meet the fall force requirements.
Shock -absorbing lanyards are required to limit the fall force to less than 1800 pounds.
Self -retracting lanyards (retractables) capable of withstanding the tensile load of 3,000 lbs. that limit
the free fall distance to two (2) feet or less are always recommended and are required when the fall
distance is less than ninteen and one-half (19.5) feet.
Lanyards that do not limit free fall distance to 2 feet or less, such as ripstitch lanyards and
tearing/deforming lanyards will be capable of sustaining a minimum tensile load of 5,000 pounds
applied to the device with the lifeline or lanyard in the fully extended position.
Horizontal lifelines will be designed, installed, and used under the supervision of a Competent
Person, as part of a complete (personal) fall arrest system. Lifelines shall be protected against being
cut or abraded. Horizontal lifelines cannot exceed sixty feet in length.
Vertical lifelines shall be utilized with leading edge work, shall reach the ground, and the method of
anchorage attachment shall be of proper design (i.e. no knots).
Safety Net System (fall arrest and potentially from falling objects)
When utilized, safety nets shall be installed as close as practicable under the walking/working surface on
which employees are working and never more than 30 feet below such levels.
Safety nets will be inspected at least once a week for wear, damage, and other deterioration. The
maximum size of each safety net mesh opening will not exceed 36 square inches nor be longer than 6
inches on any side, and the openings, measured center -to -center, of mesh ropes or webbing, will not
exceed 6 inches.
Defective/unfit nets are not to be used and are to be taken from service and immediately destroyed by
cutting into unuseful sizes and properly disposed.
Mesh crossings will be secured to prevent enlargement of the mesh opening. Each safety net or section
will have a border rope for webbing with a minimum breaking strength of 5,000 pounds. Connections
between safety net panels will be as strong as integral net components and be spaced no more than 6
inches apart.
Safety nets shall extend outward from the outermost projection of the work surface as follows:
Vertical distance from working level
Minimum required horizontal distance
to horizontal plane of net surface of outer edge of net from edge of
working surface
Up to 5 feet
8 feet
More than 5 feet up to 10 feet 10 feet
More than 10 feet 13 feet
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Safety nets shall be tested at the beginning of each workday and shall be capable of absorbing an impact
force of a drop test consisting of a 400-pound bag of sand 30 inches in diameter dropped from the
highest walking/working surface at which workers are exposed, but not from less than 42 inches above
that level. Employees shall not be allowed in work areas controlled with safety nets until this test is
complete.
If safety nets are utilized for the dual purpose of employee fall protection and the protection of other
workers from fall objects, the net webbing opening shall be small enough to prevent passage of potential
falling objects.
Items that have fallen into safety nets, such as materials, scrap, equipment, and tools, shall be removed
as soon as possible and at least before the next work shift.
Non -conventional Methods
Where conventional fall restraint and fall arrest methods cannot be utilized (or utilized safely), the following
non -conventional methods can be utilized:
• A written work plan shall be developed when a project or task possesses a fall exposure whereby these
systems are utilized. A sample written plan format can be found in 29 CFR 1926 Subpart M Appendix E.
• A Competent Person will develop and implement a written Fall Protection Work Plan including each area
of the work place where the employees are assigned and where fall hazards of 6 feet or more will exist.
The Risk Assessment for this project/task should be reviewed for this document.
The written Fall Protection Work Plan shall include:
• Identification of fall hazards in the work area
• Describe the non -conventional method (or in combination with conventional method) of fall protection
to be provided
• Describe the correct procedures for the assembly, maintenance, inspection, and disassembly of any fall
protection system to be used
• Describe the correct procedures for the handling, storage, and securing of tools and materials
• Describe the method of providing overhead protection for workers who may be in or pass through the
area below the work site
• Describe the method for prompt, safe removal of injured workers
• Describe the method for destruction of personal fall arrest system equipment subjected to the forces of
any fall
• Be available at all times on the jobsite
Controlled Access Zone Svstem
Controlled access zone systems shall be set up as follows:
• Zone shall be established no closer than six (6) feet or further than twenty-five (25) feet from any
leading edge
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• Control line shall extend parallel along the entire length of the unprotected or leading edge
• Only trained employees are allowed in the Zone
• The Zone shall have signage marking it as a 'Controlled Access Zone'
Warning Line System (pitches of <4:12 and flat surfaces only)
Warning line systems consist of ropes, wires, or chains, and supporting stanchions and are set up as
follows:
• Flagged at not more than 6-foot intervals with high -visibility material
• Rigged and supported so that the lowest point including sag is no less than 34 inches from the
walking/working surface and its highest point is no more than 39 inches from the walking/working
surface
• Stanchions, after being rigged with warning lines, will be capable of resisting, without tipping over, a
force of at least 16 pounds applied horizontally against the stanchion, 30 inches above the
walking/working surface, perpendicular to the warning line and in the direction of the floor, roof, or
platform edge
• The rope, wire, or chain will have a minimum tensile strength of 500 pounds, and after being attached
to the stanchions, shall support without breaking the load applied to the stanchions as prescribed
above
• Line will be attached to each stanchion in such a way that pulling on one section of the line between
stanchions will not result in slack being taken up in the adjacent section before the stanchion tips
over
• Warning lines will be erected around all sides of roof work areas. When mechanical equipment is
being used, the warning line will be erected not less than 6 feet from the roof edge parallel to the
direction of mechanical equipment operation, and not less than 10 feet from the roof edge
perpendicular to the direction of mechanical equipment operation
When mechanical equipment is not being used, the warning line shall be erected not less than 6 feet
from the roof edge.
The warning line system shall be used in conjuction with one of the following:
• safety monitoring system (most common); or
• (personal) fall arrest system; or
• safety net system; or
• guardrails
Safety Monitoring System
A competent person will appoint the 'safety monitor' and will ensure that the safety monitor:
• Is competent in the recognition of fall hazards
• Is capable of warning workers of fall hazard dangers and in detecting unsafe work practices
• Is operating on the same walking/working surfaces of the employees and can see them
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• Is close enough to work operations to communicate orally with the employees and has no other duties
but the monitoring function
• Has the authority to stop work
Only employees engaged in roof/surface work and the safety monitor shall be allowed in an area where an
employee is being protected by a safety monitoring system.
Specific Fall Hazard Procedures
Aerial Personnel Lifts
Employees utilizing aerial personnel lifts (e.g. scissor lifts, genie lifts, cherry -pickers, boom -lifts, etc.) shall
use a restraint/positioning system or (personal) fall arrest system, even though a guardrail system is in
place.
Attachment points for these systems shall be capable of withstanding 5,000 pounds and shall be
maintained in the floor of the lift or where designed by the manufacturer.
Rails of such lifts shall not to be used as attachment points unless designed for that purpose by the
manufacturer.
Excavations
Employees who work at the edge of an excavation 6 feet or more deep will be protected from falling
into the excavation by guardrail systems or covers.
Where walk -ways are provided to permit employees to cross over excavations, guardrails are required
on the walkway if the fall would be 6 feet or more to the lower level.
Hoist Areas
Each employee in a hoist area will be protected from falling 6 feet or more by guardrail,
restraint/positioning or (personal) fall arrest systems.
If guardrail systems (or chain gate or guardrail), or portions thereof, must be removed to facilitate
hoisting operations, as during the landing of materials, and a worker shall lean through the access
opening or out over the edge of the access opening to receive or guide equipment and materials, that
employee shall be protected by a (personal) fall arrest system.
Falling Obiects (additional protection from)
Except for scaffolding and aerial lifts, no materials or equipment shall be stored within 6 feet of working
edges.
When canopies are used as protection from falling objects, canopies shall be strong enough to prevent
collapse and to prevent penetration by any objects that may fall onto them.
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When toeboards are used as protection from falling objects, they shall be erected along the edges of the
overhead walking or working surface for a distance sufficient to protect persons working below.
Toeboards will be capable of withstanding a force of at least 50 pounds of force applied in any downward
or outward direction at any point along the toeboard. Toeboards will be a minimum of four (4) inches
tall from their top edge to the level of the walking/working surface, have no more than one (1) inch
clearance between its bottom and the surface.
Ladders
(where work height (due to leaning out) exposure is equal to, or exceeds six foot and/or the maximum
ladder height is within the distance to a leading edge)
If work is performed outside the rails of a ladder equal to, or exceeding 6' ; or if three-point contact on
the ladder cannot be maintained, a (Personal) Fall Arrest Systems shall be utilized if anchorage points
are available.
If anchorage points are not available or other traditional fall control systems are not feasible, a non -
conventional system can be utilized.
Leading Edge Work
Employees working near a leading edge 6 feet or more above lower levels shall be protected by guardrail,
safety net, restraint/positioning, or (personal) fall arrest systems.
Roadwav/Vehicular Passage Covers
Covers located in roadways and vehicular aisles shall be able to support at least twice the maximum axle
load of the largest vehicle to which the cover might be subjected, and secured/marked.
Roofs (work from or on)
Low -sloped (<4:12 pitch)
Employees engaged in roof activities on low -slope roofs with unprotected sides and edges 6 feet or
more above lower levels will be protected from falling by guardrail systems, safety net systems,
(personal) fall arrest systems or a combination of a warning line system and guard-rail system, warning
line system and safety net system, warning line system and (personal) fall arrest system, or warning
line system and safety monitoring system.
Steep Roofs (>4:12 pitch)
Employees on a steep roof with unprotected sides and edges 6 feet or more above lower levels will be
protected by either guardrail systems with toeboards, a safety net system, or a (personal) fall arrest
systems.
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Wall Openings
Employee working on, at, above, or near wall openings (including those with chutes attached) shall be
protected from falling by the use of either a guardrail system, a safety net system, or a (personal) fall
arrest system.
Equipment Inspection and Maintenance Procedures
Inspection, Replacement and Destruction
All equipment hereafter noted shall be visually inspected before each use, replaced immediately if any
of the defective conditions are found, tagged 'out of service' and sent back to the Branch for destruction.
Bodv Harness Inspection
Beginning at one end, holding the body side of the harness toward you, grasp one area of the harness with
your hands six to eight inches apart. Bend the strap in an inverted "U". Follow this procedure the entire
length of the belt or harness. Watch for frayed edges, broken fibers, pulled stitches, cuts, burn marks or
chemical damage. Special attention should be given to the attachment of buckles and D-rings to strap
webbing. Inspect for frayed or broken strands. Broken webbing strands generally appear as tufts on the
webbing surface.
Rivets should be tight and unmovable with fingers. Body -side rivet base and outside rivet burr should be
flat against the material. Bent rivets will fail under stress. Especially note condition of D-ring rivets and D-
ring metal wear pads (if applicable). Discolored, pitted, or cracked rivets indicate chemical corrosion.
The tongue or billet of bolts receives heavy wear from repeated buckling and unbuckling. Inspect for loose,
distorted, or broken grommets. Harnesses using punched holes without grommets should be checked for
torn or elongated holes causing slippage of the tongue buckle.
Hardware (Buckles, D-Rings, Snaps and Thimbles)
Buckle tongues should be free of distortion in shape and motion. They should overlap the buckle frame
and move freely back and forth in their socket. Roller should turn freely on frame. Check for distortion
or sharp edges.
Inspect the friction buckle for distortion. The outer bars and center bars must be straight. Pay special
attention to corners and attachment points of the center bar.
Inspect the sliding bar buckle frame and sliding bar for cracks, distortion, or sharp edges. The sliding bar
should move freely. Knurled edge will slip if worn smooth. Pay special attention to corners and ends of
sliding bar.
Inspect the forged steel D-ring for cracks or other defects. Inspect the assembly of the D-ring to the body
pad or D-saddle. If the D-ring can be moved vertically independent of the body pad or D-saddle, the
harness should be replaced. Check D-Rings and D-Ring metal wear pad (if any) for distortion, cracks,
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breaks, and rough or sharp edges. The D-Ring bar should be at a 90 degree angle with the long axis of
the belt and should pivot freely.
Inspect closely for hook and eye distortions, cracks, corrosion, or pitted surfaces. The keeper (latch)
should seal into the nose without binding and should not be distorted or obstructed. The keeper spring
should exert sufficient force to firmly close the keeper.
The thimble must be unmovable in the eyes of the splice, and the splice should have no loose or cut
strands. The edges must be free of sharp edges, distortion, or cracks.
Lanyard (shock -absorbing)
Begin at one end and work to the opposite end. Slowly rotate the lanyard so the entire circumference is
checked. Factory spliced ends require particular attention.
Lanyard (Webbing) Retractable
Bend the webbing over a non -lacerating edge, observe each side of the webbed lanyard. This will reveal
any cuts or breaks. Swelling, discoloration, cracks, and charring are obvious signs of chemical or heat
damage. Closely observe for any breaks in the stitching.
Rope
Rotation of the rope lanyard while inspecting from end to end will bring to light any fuzzy, worn, broken,
or cut fibers. Areas weakened by extreme loads will appear as noticeable change in original diameter.
The rope diameter should be uniform throughout, following a short break-in period. Strands should be
separated and inspected since the rope may wear on the inside if grit or moisture becomes embedded.
Storage/Cleaning
Storage areas shall be maintained as clean, dry and free of exposure to fumes or corrosive elements.
Cleaning methods established by the manufacturer shall be followed for all components. Generally, the
following applies for body harnesses:
• Wipe off surface dirt with a sponge dampened in plain water. Squeeze the sponge dry. Dip the sponge
in a mild solution of water and commercial soap or detergent. Work up a thick lather with a vigorous
back and forth motion
• Wipe the belt dry with a clean cloth. Hang freely to dry but away from excessive heat
• Bolts and other equipment should dry thoroughly without close exposure to heat, steam, or long
periods of sunlight
• Mildly dirty cotton may be cleaned normally. For heavy dirt or grease, soak belts in a solution of one
tablespoon of grease cutter to one gallon of water. DO NOT USE A STRONGER SOLUTION. After
soaking, rinse again, then hang to dry
• Fall protection, which is not in the original package, shall be stored in a clean, dry area
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Post -Fall or Near -Miss Incidents
Fall incidents and near -misses shall be thoroughly investigated to determine root causes and facilitate
corrective measures to prevent reoccurences.
Employees involved in a fall equal to, or greater then 6' shall be required to receive an immediate medical
evaluation.
All components of a (personal) fall arrest system involved in any fall with a fall distance of over six feet shall
be immediately and completely replaced. Such equipment shall be tagged 'out of service' and sent back to
the Branch for destruction.
References
OSHA 29 CFR 1926 Subpart M
OSHA 29 CFR 1910 Subpart D
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Electrical Policy - General
This procedure establishes requirements to minimize potential hazards encountered when work activities
involve general electrical hazards.
Scope
This procedure applies to all employees and contractors working at LSHR
Definitions
Approved means acceptable to the authorities
Authorized Person means a person approved or assigned by LSHR to perform a specific duty or duties or to be at
a specific location or locations at the jobsite.
Cabinet means an enclosure designed either for surface or flush mounting.
Competent Person means one who is capable of identifying existing and predictable hazards in the surroundings
or working conditions which are unsanitary, hazardous or dangerous to employees, and who has the authorization
to take prompt corrective measures to eliminate them.
Conductor (bare) means a conductor having no covering or electrical insulation whatsoever.
Conductor (insulated) means a conductor encased within material of composition and thickness that is
recognized as electrical insulation.
Defect means any characteristic or condition that tends to weaken or reduce the strength of the tool, object, or
structure of which it is a part.
Disconnect means a device, or group of devices or other means by which the conductors of a circuit can be
disconnected from their source of supply.
Enclosed means surrounded by a case, housing, fence or walls which shall prevent persons from accidentally
contacting energized parts.
Enclosure means the case or housing of apparatus, or the fence or walls surrounding an installation to prevent
personnel from accidentally contacting energized parts, or to protect the equipment from physical damage.
Exposed (as applied to live parts) means capable of being inadvertently touched or approached nearer than a safe
distance by a person. It is applied to parts not suitably guarded, isolated, or insulated.
Guarded means covered, shielded, fenced, enclosed, or otherwise protected by means of suitable covers, casings,
barriers, rails, screens, mats, or platforms to remove the likelihood of approach to a point of danger or contact by
persons or objects.
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Isolated means not readily accessible to persons unless special means for access are used.
Labeled means equipment or materials to which has been attached a label, symbol or other identifying mark of a
qualified testing laboratory which indicates compliance with appropriate standards or performance in a specified
manner.
NEC stands for National Electric Code.
Qualified means persons who are capable of working safely on equipment and are familiar with electrical
properties, the proper use of special precautionary techniques, personal protective equipment, insulating and
shielding materials, and insulated tools.
Receptacle means a contact device installed at the outlet for the connection of a single attachment plug. A single
receptacle is a single contact device with no other contact device on the same yoke. A multiple receptacle is a
single device containing two or more receptacles.
Requirements
General
Feasible engineering and administrative controls shall be applied to mitigate or minimize the risk of injury and illness
from exposure to electrical hazards. Where such hazards still exist after application of these controls, local 'hot
work' procedures (see local addendum to this section) shall apply and personal protective equipment shall be
utilized. Such addenda shall comply with NFPA 70E.
Where feasible, employees shall not perform live electrical work. Branches that engage in live work are required to
provide applicable safe work procedures, PPE, and equipment in Addendum to this manual section.
In existing installations, no changes in circuit protection shall be made to increase the load in excess of the load
rating of the circuit wiring.
Worn or frayed electric cords or cables shall be removed from work areas for repair or disposal. Plugs equipped with
a grounding prong must have the prong in place. Damaged plugs must be repaired. Repairing cords shall be limited
to shortening only by an authorized person, as determined by the Branch Safety Officer.
Working spaces, walkways, and similar locations must be kept clear of cords to eliminate hazards.
Extension cords shall not be fastened with staples, hung from nails, or suspended by wire.
Control equipment, utilization equipment, and busways approved for use in dry locations only shall be
protected against damage from the weather during building construction.
Metal raceways, cable armor, boxes, cable sheathing, cabinets, elbows, couplings, fittings, supports, and
support hardware shall be of materials appropriate for the environment in which they are to be installed.
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Electrical switches shall be labeled to indicate the system, equipment, service, or tool they control. This
includes switch boxes, cabinets, motor control cabinets, stationary equipment, control panels, and other
such switches or disconnects.
Persons who perform electrical work shall wear hard hats that are proof tested to 20,000 volts and shall not wear
clothing with or without PPE that could increase injury (100% cotton is better than blended materials).
In work areas where the exact location of underground electric power lines is unknown, employees using
jackhammers, bars, or other hand tools that may contact a line shall be provided with insulated protective gloves.
Gloves must be rated to (or exceed) the voltage for which they may be exposed. The gloves shall be inspected
before use and replaced as per the manufacturer's specifications.
Wiring components and equipment in hazardous environments shall be maintained in a condition consistent with
NEC requirements (i.e. no loose or missing screws, gaskets, threaded connections, seals, or other impairments to
a tight condition).
Hazardous locations are those locations where flammable vapors, liquids or gases, or combustible dusts or
fibers may be present. There are six "classifications" for these types of locations, as follows:
• Class I Division 1 and Division 2
• Class II Division 1 and Division 2
• Class III Division 1 and Division 2
Equipment, wiring methods, and installations of electrical equipment in hazardous (classified) locations must
be designated as "intrinsically safe" or be approved for the classification location.
Energized Electrical Parts and Systems
This section does not apply to power distribution or transmission lines. Refer to CFR Subpart "R" 1910.269
(servicing) and/or CFR Subpart "V" 1926.950 (construction) for overhead power transmission and
distribution line requirements.
Safety -related work practices shall be employed to prevent electric shock or other injuries resulting from
either direct or indirect electrical contacts, when work is performed near or on equipment or circuits which
are or may be energized. The specific safety -related work practices shall be consistent with the nature and
extent of the associated electrical hazards.
Live parts to which an employee may be exposed shall be deenergized before the employee works on or
near them, unless it can be demonstrated that deenergizing introduces additional or increased hazards or is
infeasible due to equipment design or operational limitations. Live parts that operate at less than 50 volts
to ground need not be deenergized if there will be no increased exposure to electrical burns or to explosion
due to electric arcs.
If the exposed live parts are not deenergized (i.e., for reasons of increased or additional hazards or
infeasibility), other safety -related work practices shall be used to protect employees who may be exposed
to the electrical hazards involved. Such work practices shall protect employees against contact with
energized circuit parts directly with any part of their body or indirectly through some other conductive
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object. The work practices that are used shall be suitable for the conditions under which the work is to be
performed and for the voltage level of the exposed electric conductors or circuit parts.
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Working on or near exposed deenergized parts
This section applies to work on exposed deenergized parts near enough to expose employee/s to an
electrical hazard.
While an employee is exposed to contact with fixed electrical equipment or circuits which have been
deenergized, the circuits energizing the parts shall be locked out in accordance with the Energy Control
(lockout).
The circuits and equipment to be worked on shall be disconnected from electrical energy sources (and
locked out). Control circuit devices, such as push buttons, selector switches, and interlocks, shall not be
used as the sole means for deenergizing circuits or equipment.
Procedures for the release of stored electric energy shall be covered in the Addendum to this policy
section (as hot work).
When capacitors or associated equipment are handled, they shall be treated as energized.
Stored non -electrical energy in devices that could reenergize electrical parts shall be blocked or relieved
to the extent that the parts could not be accidentally energized by the device.
Working on or near exposed energized parts
Every effort shall be made to preclude work on energized electrical parts. When this is not possible, the
requirements of this section shall apply. Potential contact with live energized parts includes work
performed on exposed live parts (involving either direct contact or contact by means of tools or
materials) or near enough to them for employees to be exposed to any hazard they present.
Only qualified persons shall work on electrical equipment that has not been deenergized.
If work is to be performed near overhead lines, the lines shall be deenergized and grounded, or other
protective measures shall be provided before work is started.
If the lines are to be deenergized, arrangements shall be made with the person or organization that
operates or controls the electric circuits involved to deenergize and ground them. If protective measures,
such as guarding, isolating, or insulating are provided, these precautions shall prevent employees from
contacting such lines directly with any part of their body or indirectly through conductive materials,
tools, or equipment.
Overhead electrical lines
While conducting site activities near overhead lines, field personnel need to be aware of the location of
the lines so as not to use conductive equipment (e.g., metal equipment to include drill rigs; hand auger
extensions; Geo probe units; excavators, etc.) in close proximity to power lines.
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OSHA 29 CFR 1926.550 requires that any vehicle or mechanical equipment (i.e., drill rigs) capable of
having parts of its structure elevated near energized overhead lines shall be operated so that a clearance
distance of at least 10 feet is maintained.
When calculating the clearance distances for a drill rig consider both the length of the derrick and the
length of the rods. Position the rig such that if rods are ever fully extended from the top of the derrick,
the rods will still be at least 10 feet away from the power lines. Note that rods can lean or sway when
elevated so it may be necessary to maintain more than a 10-foot distance on the ground to ensure that
there is a 10-foot horizontal distance between the rods and the power line.
Higher voltages require greater clearance distances. Contact the electrical utility company to verify line
voltage. If the voltage is higher than 50kV, the clearance shall be increased 4 in. for every 10kV over that
voltage.
Table 15-1
Voltage I Required Clearance
0-50 kV
10 feet
50-200 kV
15 feet
200-350 kV
20 feet
350-500 kV
25 feet
500-750 kV
35 feet
750-1000 kV
45 feet
Under any of the following conditions, OSHA allows the required clearance to be reduced:
• If a vehicle is in transit with its structure lowered, the clearance shall be reduced to 4 ft. If the voltage
is higher than 50kV, the clearance shall be increased 4 in. for every 10kV over that voltage
• If insulating barriers (boots) are installed to prevent contact with the lines, and if the barriers are
rated for the voltage of the line being guarded and are not a part of or an attachment to the vehicle
or its raised structure, OSHA allows the clearance to be reduced to a distance within the designed
working dimensions of the insulating barrier. However, while this is permissible according to OSHA,
some utility companies are recommending that safe distances, as described previously, be
maintained in addition to the insulating barrier.
• If the equipment is an aerial lift insulated for the voltage involved, and if the work is performed by a
qualified person, the clearance (between the uninsulated portion of the aerial lift and the power line)
may be reduced to the distance given in Table 15-2.
When an unqualified person is working in an elevated position near overhead lines, or working on the
ground in the vicinity of overhead lines, the location shall be such that the person and the longest
conductive object he or she may contact cannot come closer to any unguarded, energized overhead line
than the clearance distances indicated in Table 15-1.
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For voltages normally encountered with overhead power lines, objects which do not have an insulating
rating for the voltage involved shall be considered to be conductive.
When a qualified person is working in the vicinity of overhead lines, whether in an elevated position or
on the ground, the person shall not approach or take any conductive object without an approved
insulating handle closer to exposed energized parts than the clearance distances indicated in Table 15-
2, unless:
• The person is insulated from the energized part (gloves, with sleeves if necessary, rated for the
voltage involved are considered to be insulation of the person from the energized part on which work
is performed), or
• The energized part is insulated both from other conductive objects at a different potential and from
the person, or
• The person is insulated from conductive objects at a potential different from that of the energized
pa rt
Table 15-2
Approach Distances for Qualified Employees - Alternating Current
Voltage range (phase to phase) Minimum approach distance
300V and less
Avoid contact
Over 300V, not over 750V
1 ft. 0 in.
Over 750V, not over 2kV
I ft. 6 in.
Over 2kV, not over 15kV
2 ft. 0 in.
Over 15kV, not over 37kV
3 ft. 0 in.
Over 37kV, not over 87.5kV
3 ft. 6 in.
Over 87.5kV, not over 121kV
4 ft. 0 in.
Over 121kV, not over 140kV
4 ft. 6 in.
If the equipment is an aerial lift insulated for the voltage involved, and if the work is performed by a
qualified person the clearance (between the uninsulated portion of the aerial lift and the power line)
may be reduced to the distance indicated in Table 15-2. However, employees standing on the ground
shall not contact the vehicle or mechanical equipment or any of its attachments, unless:
• The employee is using protective equipment rated for the voltage or the equipment is located so
that no uninsulated part of its structure (that portion of the structure that provides a conductive
path to employees on the ground) can come closer to the line than permitted in this section
• If any vehicle or mechanical equipment capable of having parts of its structure elevated near
energized overhead lines is intentionally grounded, employees working on the ground near the point
of grounding shall not stand at the grounding location whenever there is a possibility of overhead
line contact. Additional precautions, such as the use of barricades or insulation, shall be taken to
protect employees from hazardous ground potentials, depending on earth resistivity and fault
currents, which can develop within the first few feet or more outward from the grounding point
Illumination
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Employees shall not enter spaces containing exposed energized parts, unless illumination is provided
that enables the employees to perform the work safely. Where lack of illumination or an obstruction
precludes observation of the work to be performed, employees shall not perform tasks near exposed
energized parts. Employees shall not reach blindly into areas which may contain energized parts.
Confined Space or enclosed space work
When an employee works in a confined or enclosed space (such as a manhole or vault) that contains
exposed energized parts, protective shields, protective barriers, or insulating materials shall be used as
necessary to avoid inadvertent contact with these parts. Doors, hinged panels, and the like shall be
secured to prevent swinging into an employee and causing the employee to contact exposed energized
parts (reference the Confined Spaces section of this manual).
Conductive materials and equipment
Conductive materials and equipment that are in contact with any part of an employee's body shall be
handled in a manner that will prevent them from contacting exposed energized conductors or circuit
pa rts.
For instance, an employee should measure the length of a sledge hammer and the expected radius of his
swing prior to using the hammer near an energized circuit. If such a circuit is present, a sign must be posted
to warn the employees. The job supervisor must inform the employees of the location of the lines, the
hazards involved, and the protective measures to be taken.
Portable ladders
Portable ladders shall have nonconductive siderails if they are used where the employee or the ladder
could contact exposed energized parts (reference Ladder section of this manual).
Conductive apparel
Conductive articles of jewelry and clothing (such as watch bands, bracelets, rings, key chains, necklaces,
metalized aprons, cloth with conductive thread, or metal headgear) shall not be worn if they might
contact exposed energized parts. However, such articles may be worn if they are rendered
nonconductive by covering, wrapping, or other insulating means.
Housekeeping duties
Where live parts present an electrical contact hazard, employees shall not perform housekeeping duties
at such close distances to the parts that there is a possibility of contact, unless adequate safeguards
(such as insulating equipment or barriers) are provided.
Electrically conductive cleaning materials (including conductive solids such as steel wool, metalized cloth,
and silicon carbide, as well as conductive liquid solutions) shall not be used in proximity to energized
parts unless procedures are followed which will prevent electrical contact.
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Interlocks
Only a qualified person following the requirements of this section may defeat an electrical safety
interlock, and then only temporarily while working on the equipment. The interlock system shall be
returned to its operable condition when this work is completed.
Grounding, GFCIs and Assured Grounding Procedures
Equipment, tools and cord sets shall be provided and utilized so as to protect employees from electrical
shock and to prevent fire.
Equipment and tools
Note: Portable equipment which is "double insulated" and endorsed by a nationally recognized testing
facility need not have a grounding conductor but is subject to the inspection requirements of this section.
Tools and equipment subject to inspection and testing include:
• Portable Electrical Tools such as grinders, drills and stapling guns
• Stationary tools such as table saws, drill presses, and jig saws
• Portable electrical extension cords
• Portable and Temporary lighting systems and cords
Receptacles shall be of the grounding type and their contacts shall be grounded by connection to the
equipment grounding conductor of the circuit supplying that receptacle in accordance with the NEC.
Visual inspections
Visual inspection of tools and equipment are required prior to each use and shall include:
• General condition
• Plugs and caps, and presence of ground prong
• Electrical cord sets
• External defects, and missing parts
Defective tools shall be tagged, taken out of service and placed in a secured location until they are
repaired or destroyed.
Testing
The following tests shall be performed on all applicable equipment:
• Equipment grounding conductors shall be tested for continuity and shall be electrically continuous
• Receptacle and attachment cap or plug shall be tested for correct attachment of the equipment -
grounding conductor. The equipment -grounding conductor shall be connected to its terminal
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Required tests should be performed as indicated below:
• Before first use
• Before being returned to service following any repairs
• Before being used, after any incident that can be reasonably suspected to have caused damage (for
example, when a cord set is run over)
• At intervals not to exceed 3 months
Test equipment must be evaluated for proper operation immediately before and after tests are
conducted.
Removal from service
Any equipment failing any test shall be taken out of service, shall be tagged with a "Danger, Do Not Use"
tag, secured and repaired or destroyed.
Ground Fault Circuit Interrupters (GFCI's)
Ground Fault Circuit Interrupters (GFCI's) shall be used on receptacles >15 amps up to and including 30
amps for tool and equipment used in construction applications and potentially wet environments (either
indoors or outdoors). Receptacles of temporary wiring systems and portable generators shall be
protected with a GFCI.
The minimum requirements relative to the use of Ground Fault Circuit Interrupters are:
• Prior to use, and periodically thereafter, verify that the GFCI is in good working order. (e.g., Plug
the GFCI in to an outlet, plug a power tool or light in to the GFCI, hit the "test" button and verify
that it interrupts current flow). Periodically re -test the GFCI to ensure continued effectiveness.
• Remove from service any GFCI that has insufficient load capacity, is damaged or is ineffective for any
reason. Affix a "Danger, Do Not Use" tag and store the GFCI in a secure location until it can be
replaced or repaired. Destroy and discard any GFCI that cannot be repaired or re -used.
• Train employees in the provisions of this section as related to safe us of GFCIs. This training should
include:
o Double insulated tools
o Defective cords and plugs
o Heavy moisture, and wet conditions
o Operation, selection, and use of GFCI's
Assured Grounding Program
When this is not possible (feasible) to use GFCI's, the Assured Grounding procedures in this section shall
apply and the Branch Office shall include as the Addendum to this policy section an Assured Grounding
Program. It is best to avoid situations where an Assured Grounding Program is required because it is very
labor intensive to comply. If unavoidable, the elements of this program shall include as a minimum:
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• Written description of program
• Program coordinator
• Inspections
• Documented Testing
• Availability of Equipment
• Integrity of testing equipment (repairs/testing of test equipment)
• Handling of defective tools and equipment
• Who will perform tests, and repairs
• Recordkeeping
• How receptacles will be provided with GFCI's
Only qualified persons shall perform inspection and "color code" labeling of tools and equipment.
The color code scheme for labeling tools and equipment, as indicated in the following table, shall be
used in the Addendum color scheme. This color code scheme is consistent with guidance from the
Association of General Contractors. Tools and equipment shall be color coded on a quarterly basis when
inspected and marked according to the Quarterly Code. If inspections are conducted monthly, the
Monthly Code should be used. For example, "Red & Blue" means the inspection was conducted in the
first quarter during February.
Tape Color Coding System
Month
Monthly Color Code
Quarterly Code
January
Red
Red
February
Red & Blue
March
Red & White
April
Blue
Blue
May
Blue & White
June
Blue & Green
July
White
White
August
White & Green
September
White & Red
October
Green
Green
November
Green & Red
December
Green & Blue
Temporary Wiring
This section applies to temporary electrical power and lighting wiring methods that may be of a class less
than would be required for a permanent installation.
Temporary wiring shall be removed immediately upon completion of work and when the purpose for which
the wiring was installed no longer applies.
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General requirements for temi)orary wiring
Feeders shall originate in a distribution center. The conductors shall be run as multi -conductor cord or
cable assemblies or within raceways.
Branch circuits shall originate in a power outlet or panel board. Conductors shall be run as multi -
conductor cord or cable assemblies or open conductors or shall be run in raceways. Conductors shall be
protected by over -current devices at their ampacity.
Receptacles shall be of the grounding type. Unless installed in a complete metallic raceway, each branch
circuit shall contain a separate equipment -grounding conductor, and receptacles shall be connected to
the grounding system. Receptacles shall not be connected to the same ungrounded conductor of multi -
wire circuits that supply temporary lighting.
Disconnecting switches or plug connectors shall be installed to permit the disconnection of ungrounded
conductors of each temporary circuit.
Lamps for general illumination shall be protected from accidental contact or breakage. Metal -case
sockets shall be grounded.
The electric cords shall not be used to suspend temporary lights unless cords and lights are designed for
this means of suspension. Temporary lighting shall be properly supported.
Portable electric lighting used in wet and/or other conductive locations. Examples are drums, tanks, and
vessels, shall be operated at 12 volts or less. However, 120-volt lights may be used if protected by a
ground -fault circuit interrupter.
A mounted box (with a cover) shall be used wherever a change is made to a raceway system or a cable
system that is metal clad or metal sheathed. Non-metallic wiring system joints below seven feet (T) shall
have mounted boxes and be covered. Exposed temporary joints shall have the wire nuts or other
mechanical devices taped with black (electrical) tape to prevent them from falling off. Temporary joints
including the ground wire shall have a mechanical connection.
Flexible cords and cables shall be protected from damage. Sharp corners and projections shall be
avoided. Flexible cords and cables may pass through doorways or other pinch points, if protection is
provided to avoid damage. Cords and temporary wiring passing through walls should be properly
protected (e.g. sleeved).
Extension cord sets used with portable electric tools and appliances shall be of three -wire type and shall
be designed for hard or extra -hard usage. Flexible cords used with temporary and portable lights shall
be designed for hard or extra -hard usage. See the NEC, ANSI/NFPA 70, in Article 400, Table 400-4 that
lists various types of flexible cords, some of which are noted as being designed for hard or extra -hard
usage. Note: SEU, SER or other similar cables cannot be laid on the floor despite their rating.
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For temporary wiring over 600 volts, nominal, fencing, barriers, or other effective means shall be
provided to prevent access of other than authorized and qualified personnel.
Batteries
General
Batteries of the unsealed type shall be in enclosures with outside vents or in well -ventilated rooms and shall be
arranged so as to prevent the escape of fumes, gases, or electrolyte spray into other areas.
Ventilation shall be provided to ensure diffusion of the gases from the battery and to prevent the accumulation
of an explosive mixture.
Appropriate face shields, aprons, goggles, and rubber gloves shall be provided for workers handling acids or
batteries. Contact lenses are prohibited while working with batteries, unless using a type of goggle that will not
allow the transference of gases.
Facilities for quick drenching of the eyes and body shall be provided within 25 feet of battery handling areas.
Facilities shall be provided for flushing and neutralizing spilled electrolyte and for fire protection in the areas of
battery use.
Battery charging installations shall be in areas designated for that purpose. When batteries are being charged,
the vent caps shall be kept in place to avoid electrolyte spray. Vent caps shall be maintained in a functioning
condition.
Battery manufacturer guideline specifics of this policy section shall be met.
Smoking, eating or drinking in areas where batteries are being stored, charged or worked with is prohibited.
Handling and Transporation
Packaging, markings and transportation of batteries shall be in accordance with Federal, State and local
laws, regulations and standards.
After the packaging is removed, batteries shall be inspected for defect, including, but not limited to:
• Bulging
• Cracking
• Leaking
Batteries shall not be forced into equipment/locations.
Where feasible, old and new batteries shall not be intermixed.
Storage
• Batteries shall be kept in their original packaging until they are ready to be used.
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• New and used batteries shall be kept separate for distinguishment.
• Batteries should be stored separate from combustibles and flammables and protected from being
crushed, punctured or exposed to incompatible environmental conditions.
• Used batteries, not intended for re -use, shall be properly disposed.
Disposal
Batteries being disposed of shall be done so in accordance with Federal, State and local laws,
regulations and standards. When possible, batteries should be recycled.
Clearances in the Workplace
Employees shall not be permitted to work in such proximity to any part of an electric power circuit that the
employee could contact the electric power circuit in the course of work, unless the employee is protected against
electric shock by deenergizing the circuit and grounding it (if appropriate) or by guarding it effectively by insulation
or other means.
Supervisors and/or Competent Person(s) shall ascertain by inquiry, direct observation, or by instruments,
whether any part of an energized electric power circuit, exposed or concealed, is so located that the
performance of the work may bring any person, tool, or machine into physical or electrical contact with the
electric power circuit. The supervisor/Competent Person shall post and maintain proper warning signs
where such a circuit exists. The supervisor/Competent Person shall advise employees of the location of such
lines, the hazards involved, and the protective measures to be taken.
Barriers or other means of guarding shall be provided to ensure that workspace for electrical equipment will not
be used as a passageway during periods when energized parts of electrical equipment are exposed.
Fuses
Installing or removing fuses shall be considered as work with live electrical energy and shall be covered in the
Addendum to this policy section for operations conducting such activities.
Persons who perform work on high voltage fuses (over 600 volts) shall wear appropriate head, face, body
flash suits, protective footwear and insulated gloves.
Insulating electrical gloves, sleeves, aprons, and other protective electrical clothing shall be tested for leaks and
integrity prior to initial use and periodically. These tests shall meet the requirements of OSHA Standard 29 CFR
1910.137.
Protector gloves shall be worn over insulating gloves, except as defined in the above referenced standard.
Only manufacturer -qualified personnel shall inspect and make repairs to electrical insulating protective
clothing.
Workspace Clearances - 600 Volts, nominal, or less
Working space about electric equipment
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Sufficient access and working space should be provided and maintained for electric equipment to permit ready
and safe operation and maintenance of such equipment.
Working clearances
Except as required or permitted elsewhere in this section, the dimension of the working space in the
direction of access to live parts operating at 600 volts or less and likely to require examination,
adjustment, servicing or maintenance while live shall not be less than indicated in the table below.
In addition to the dimensions shown in the following table, the workspace shall not be less than 30 inches
wide in front of the electric equipment. Distances shall be measured from the live parts if they are
exposed or from the enclosure front or opening if the live parts are enclosed. Walls constructed of
concrete, brick, or tiles are considered to be grounded.
Working space is not required behind assemblies such as dead -front switchboards or motor control
centers where there are no renewable or adjustable parts such as fuses or switches on the back and
where connections are accessible from locations other than the back.
Minimum Depth of Clear Working Space in Front of Electric Equipment
(feet)
Nominal voltage to ground conditions* (a)* (b)* (c)*
0-150 3 3 3
151-600 3 31/2 4
*Conditions (a), (b), and (c) are as follows: (a) Exposed live parts on one side
and no live or grounded parts on the other side of the working space or
exposed live parts on both sides effectively guarded by insulating material.
Insulated wire or insulated bus bars operating at not over 300 volts are not
considered live parts. (b) Exposed live parts on one side and grounded parts on
the other side. (c) Exposed live parts on both sides of the workspace [not
guarded as provided in Condition (a)] with the operator between.
Note: For International System of Units (SI): one foot=0.3048m.
The working space required by this in this section shall not be used for storage. When normally enclosed
live parts are exposed for inspection or servicing, the working space, if in a passageway or general open
space shall be guarded.
At least one entrance should be provided to give access to the working space for electrical equipment.
Where there are live parts normally exposed on the front of switchboards or motor control centers, the
working space in front of such equipment shall not be less than 3 feet.
The minimum headroom for working spaces for service equipment, switchboards, panel boards, or
motor control centers shall be 6 feet 3 inches.
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Guarding of live parts
Except as required or permitted live parts of electrical equipment operating at 50 volts or more shall be
guarded against accidental contact by cabinets or other forms of enclosures, or by any of the following
means:
• By location in a room, vault, or similar enclosure that is accessible only to qualified persons
• By partitions or screens so arranged that only qualified persons will have access to the space within
reach of the live parts. Any openings in such partitions or screens shall be so sized and located in a
manner that persons are not likely to come into accidental contact with the live parts or to bring
conducting objects into contact with them
• By location on a balcony, gallery, or platform so elevated and arranged as to exclude unqualified
persons
In locations where electric equipment could be exposed to physical damage, enclosures or guards should be
so arranged and of such strength to prevent damage.
Entrances to rooms and other guarded locations containing exposed live parts shall be marked with
conspicuous warning signs forbidding unqualified persons to enter.
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Workspace Clearances - over 600 volts, nominal
Conductors and equipment used on circuits exceeding 600 volts, nominal, shall comply with all applicable
provisions of this section and with the following provisions that supplement or modify those requirements.
Enclosure for electrical installations
Electrical installations in a vault, room, closet or in an area surrounded by a wall, screen, or fence, access
to which is controlled by lock and key or other equivalent means, are considered to be accessible to
qualified persons only.
A wall, screen, or fence less than 8 feet in height is not considered adequate to prevent access unless it
has other features that provide a degree of isolation equivalent to an 8-foot fence. The entrances to
buildings, rooms or enclosures containing exposed live parts or exposed conductors operating at over
600 volts, nominal, shall be kept locked or shall be under the observation of a qualified person at all
times.
Installations accessible to qualified persons only
Electrical installations having exposed live parts shall be accessible to qualified persons only and shall
comply with the requirements of this standard and applicable regulatory standards.
Installations accessible to unqualified Person(s)
Electrical installations that are open to unqualified persons shall be made with metal -enclosed equipment or
shall be enclosed in a vault or in an area, access to which is controlled by a lock. Metal -enclosed switchgear,
unit substations, transformers, pull boxes, connection boxes, and other similar associated equipment shall be
marked with appropriate caution signs. If equipment is exposed to physical damage from vehicular traffic,
guards shall be provided to prevent such damage. Ventilating or similar openings in metal -enclosed
equipment shall be designed so that foreign objects inserted through these openings will be deflected from
energized parts.
Workspace about equipment
Sufficient space shall be provided and maintained for electric equipment to permit the ready and safe
operation and maintenance of such equipment. Where energized parts are exposed, the minimum clear
workspace shall not be less than 6 feet 6 inches high (measured vertically from the floor or platform), or
less than 3 feet wide (measured parallel to the equipment). The depth shall be as required in the table
below. The workspace shall be adequate to permit at least a 90-degree opening of doors or hinged
panels.
The minimum clear working space in front of electric equipment such as switchboards, control panels,
switches, circuit breakers, motor controllers, relays, and similar equipment shall not be less than
specified in the following table, unless otherwise specified. Distances shall be measured from the live
parts if they are exposed or from the enclosure front or opening if the live parts are enclosed.
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However, working space is not required in back of equipment such as dead front switchboards or control
assemblies where there are no renewable or adjustable parts (such as fuses or switches) on the back and
where connections are accessible from locations other than the back. Where rear access is required to
work on de -energized parts on the back of enclosed equipment, a minimum working space of thirty (30)
inches horizontally shall be provided.
Minimum Depth of Clear Working Space in Front of Electric Equipment (feet)
Nominal voltage to ground conditions* (a)* (b)* (c)*
601 to 2,500 3 4 5
2,501 to 9,000 4 5 6
9,001 to 25,000 5 6 9
25,001 to 75 kV 6 8 10
Above 75kV 8 10 12
*Conditions (a), (b), and (c) are as follows: (a) Exposed live parts on one side and no live or
grounded parts on the other side of the working space or exposed live parts on both sides
effectively guarded by insulating materials. Insulated wire or insulated bus bars operating at not
over 300 volts are not considered live parts. (b) Exposed live parts on one side and grounded parts
on the other side. Walls constructed of concrete, brick, or tiles are considered to be grounded
surfaces. (c) Exposed live parts on both sides of the workspace [not guarded as provided in
Condition (a)] with the operator between.
Note: For International System of Units (SI): one foot=0.3048m.
Lighting outlets and points of control
The lighting outlets shall be so arranged that people changing lamps or making repairs to the lighting system
will not be endangered by live parts or other equipment. The points of control shall be so located that people
are not likely to come in contact with any live part or moving part of the equipment while turning on the lights.
Elevation of unguarded live parts
Unguarded live parts above working spaces shall be maintained at elevations not less than specified in
the following table.
Elevation of Unguarded Energized Parts Above Working Space
Nominal voltage between Minimum elevation
phases
601-7,500 8 feet 6 inches
7,501-35,000 9 feet. -'q6;,
Over 3SkV 9 feet+0.37 inches per kV above 35kV
Note: For SI units: one inch=25.4 mm; one foot=0.3048 m.
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Entrance and access to workspace
At least one entrance not less than 24 inches wide and 6 feet 6 inches high shall be provided to give
access to the working space for electrical equipment. On switchboard and control panels exceeding 48
inches in width, there shall be one entrance at each end of such board where practicable. Where bare
energized parts at any voltage or insulated energized parts above 600 volts are located adjacent to such
entrance, they shall be guarded.
References
OSHA 29 CFR 1910 Subpart R
OSHA 29 CFR 1910 Subpart S
OSHA 29 CFR 1926 Subpart K
OSHA 29 CFR 1926 Subpart V
National Electric Code
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Energy Control (Lockout/Tagout)
Work activities associated with energized equipment or processes shall be controlled prior to initiating by
verifying a zero -energy state.
This policy covers minimum performance standards applicable to all LSHR employees. Local practices requiring more
detailed or stringent rules, or local, state or other federal requirements regarding this subject can and should be added
as an addendum to this procedure as applicable.
Purpose
To establish safe practices associated with equipment or processes that involve hazardous energy sources.
Scope
Applies to all LSHR work sites, i.e., offices, client job sites, etc., that perform activities such as, but not limited
to, erecting, installing, constructing, repairing, adjusting, inspecting, cleaning, operating or maintaining
equipment/machines/processes whereby hazardous energy sources are involved such as accessing tanks, air
handlers, etc.
Note special exception to policy: equipment/machines that have an electrical plug as the sole hazardous energy
source and can reach a zero -energy state by simply being unplugged are exempt from this policy, as long as
control of the plug can be maintained at all times.
Definitions
Affected Employee means any LSHR employee who is not an Authorized Employee but is required to work
around equipment/machine/processes where Lockout procedures are being implemented.
Authorized Employee means any LSHR employee who utilizes Lockout procedures on
equipment/machines/processes.
Control Mechanism means any lock or combination of locks, multi -lock hasps and/or other types of special
mechanisms (chains, valve covers, breaker covers, etc.) applied to an energy -isolating device to ensure that it
cannot be moved/operated.
Energy Isolating Device means a mechanical device that physically prevents the transmission or release of
hazardous energy, including, but not limited to the following: a manually operated electrical circuit breaker; a
disconnect switch; line valve; slide gate; similar device used to block or isolate energy.
Hazardous Energy Source means any type of energy that could injure anyone working on or near the
equipment/machine/process if released because of work activities. Examples of hazardous energy sources
include but are not limited to the following: electrical; hydraulic (fluid/liquids); pneumatic (air); chemical;
radiation; thermal; mechanical (from stored energy, like in flywheels and springs); and mechanical (from
gravity).
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Lockout means the placement of a control mechanism on an energy -isolating device that ensures that the
equipment/machine/process being worked on cannot be operated/initiated until the control mechanism is
removed.
Other Personnel means non-LSHR personnel or visitors to any work area where LSHR authorized employees are
utilizing processes outlined in this Policy.
Operation Device means any switch, button, leaver, valve, etc. that is expressly intended for the starting or
initiation of the equipment/machine/process.
Zero Energy State means the equipment/machine/process has been purged of and blocked from hazardous
energy sources, that is no hazardous energy is present.
Requirements
Identifying Applicable Equipment/Machines/Processes
The following shall be documented:
• Owned and common/typical equipment/machine/processes where this Policy applies
• Owned and known/common/typical energy isolating devices for applicable procedures related to the
identified equipment/machine/processes
• Applicable lockout mechanisms necessary for applicable energy control procedures related to the
identified equipment/machine/processes
• Applicable energy control procedures related to the identified equipment/machine/processes.
This information shall be developed by the Safety Officer, posted on/near machine and kept on file, utilized
within the training required for Authorized employees, and updated as equipment/machines/processes and
lockout mechanisms are introduced. A sample format is found in Attachment 16-1 (Energy Control
Procedure Form).
Training
Initial Training
Each affected employee shall receive training during orientation on the procedures of this Policy Section
for the expressed purpose of ensuring awareness of the prohibition of removing control mechanisms
and/or operation/initiation of applicable equipment/machines/processes.
Each authorized employee shall receive special training in the recognition of hazardous energy sources,
the specific and/or common equipment/machines/ processes within respective work areas, types of
necessary control mechanisms, and the procedures of this Policy Section.
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Annual Refresher Training
Both affected and authorized employees shall receive annual re-training.
Other Re-training
Any affected or authorized employee shall be immediately re-trained if their actions during related work
activities violated any portion of this Policy.
Lockout Procedures (in order of action)
Preparation
Authorized employees shall verbally notify affected employees (LSHR-employed or anyone considered
as Other Personnel) of the procedures to be used BEFORE commencing other work activities.
Lockout Application
Perform the actions BEFORE commencing other work activities, in the following order:
• Identify known operation devices for the equipment/machine/process, and commit all of them to
the 'off' or 'neutral' position
• Identify known energy controlling devices for the equipment/machine/process, commit all of them
to the 'off' or 'neutral' position following established machine shutdown procedures, and utilize a
lockout device to secure them in the 'off' or 'neutral' position
Note 1: tag the lockout mechanism if multiple authorized employees are present or if the work will
not be completed within the normal work shift. In such cases, mark the tag with your name and
contact information.
Note 2: If the proper lockout procedures or a hazardous energy source is unknown, authorized
employees shall not conduct further work activities and shall immediately contact their supervisor
for assistance/instructions on proceeding.
• Identify and neutralize all potential stored energy sources such as gravity, springs, electrical
capacitors, hydraulic pressure and compressed gases.
• Visually inspect the equipment/machine/process and/or use electronic or mechanical means to
verify that a zero -energy state has been reached
• Ensure that affected and authorized employees are clear of the equipment/machine/process, then
try to activate the equipment/machine/process by initiating identified operation devices to ensure
that a zero -energy state has been reached. Apply additional lockouts to any energy controlling
devices having unprotected energy sources and repeat this procedure point until a zero -energy state
is obtained. Proceed with the required work activities for the equipment/machine/process when the
zero -energy state is obtained
• If a zero -energy state cannot be reached, contact your supervisor for instructions
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Release from Lockout
Authorized employees shall visually inspect the equipment/machine/ process to ensure that personnel
and tools have been cleared and/or removed.
Then, only the authorized employee who placed the lockout mechanism into use can remove it. See
Emergency Lock Removal Procedures.
Testing/Diagnosis/Re-positioning Procedures During Lockout
Perform the actions, in the following order:
• Clear the equipment/machine/process of tools, materials, and personnel
• remove the applicable lockout mechanisms from the energy isolating device
• Energize the applicable portion of the equipment/machine/process
• Proceed with the test/diagnosis/re-positioning
• De -energize the equipment/machine/process
• Re -apply the applicable lockout mechanisms to the energy isolating device
• Re -test operation devices to ensure a zero -energy state is in place
• Continue work and repeat this procedure as necessary
Emergencv Lock Removal Procedures
Attachment 16-2 Lock Removal Procedures shall be utilized for documentation.
Every effort shall be made to personally contact authorized employees prior to their lock being removed.
The direct supervisor of an authorized employee is the first person allowed to remove their lock. If the
applicable supervisor is not physically capable, only another authorized employee can be provided with the
authority, directly by the applicable supervisor only.
In either event, the direct supervisor of the authorized employee who originally placed the lockout
mechanism(s) to be removed shall inform that employee of the removal BEFORE that employee returns to
that work area. This communication shall be documented on Attachment 16-2. Messages (oral, written, or
forwarded) are prohibited.
Lockout Control Mechanisms
Locks
Each authorized employee shall be issued a lock (for locks) individually keyed and manufactured of a
standard size, shape and/or color. Each Branch shall identify this as an Addendum to this manual section.
Each Branch shall require a list of employees and corresponding lock numbers maintained at the work
site. Such lists shall be maintained by the Safety Officer or Manager.
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Multi -lock Hasps
The following steps shall be followed to accommodate multiple authorized employees on a single
project:
• A multi -lock hasp shall be utilized when more than one authorized employee is performing work on
the equipment/machine/process.
• The senior LSHR authorized employee working on the specific project shall be responsible for
assuring that other authorized employees working on the project attach their personal lockout
device prior to work being performed.
• The senior LSHR authorized employee working on the specific project shall also be responsible for
assuring the continuity of the lockout device during shift changes and/or personnel changes unless
formally relieved of that responsibility by the Project Manager. At which time, the Project Manager
will obtain the responsibility for the integrity of the lockout device.
• When a traditional multi -lock hasp will not provide enough attachment points for authorized
employees, another method shall be established (e.g. adding another multi -lock hasp, lockout box,
lockout cabinet, etc.) as per the direction of the senior LSHR employee working on the specific
project.
Other Specialized Equipment
Tags (when necessary) shall be durable, standardized in type and have areas to indicate the employee's
name and contact information.
Multi -Contractor Site/Subcontractor
Authorized employees shall inform the supervision of other employers in a multi -employer work site of all
aspects covered by this manual section.
Subcontractors for LSHR are required to meet or exceed all aspects covered by this manual section.
Policv Review and Certification
Annually, this manual section (and applicable addendums and related training programs) shall be reviewed
and documented (certified) by the Safety Officer for updating and verifying the use of these procedures.
Inspections verifying that these procedures are being followed shall be a component of this review.
References
OSHA 29 CFR 1910.147
OSHA 29 CFR 1926.417
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LONE STAR HAZMAT
The Leader in Emergency Response
Department:
Equipment Identification:
Person Completing This Form:
Location and Type of Energy Sources
Electrical:
Mechanical:
Pneumatic:
Hydraulic:
Other:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Special Hazards
Energy Control Procedure Form
Date:
Specific Steps to Follow to Complete Lockout
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LONE STAR HAZMAT
The Leader in Emergency Response
Lock Removal Procedure Form
Equipment/Machine/Process:
Lock Number:
Authorized Employee Name:
Location:
Consistent with LSHR Policy Section 16 — Energy Control — Lockout, only the direct Supervisor of an Authorized
Employee shall remove an Energy Control Device (Lock) after all efforts have been made to assure the area in question
is clear, the Authorized Employee is not available to remove the lock themselves and this Procedure has been
completed.
Check each item that applies and sign prior to Energy Control Device Removal
❑ It is necessary that the equipment/machine/process be re-engaged before the authorized employee can
return to personally remove the lock.
❑ Every attempt has been made to locate the Authorized Employee so they can remove their Energy
Control Device (Lock).
❑ The direct supervisor of the Authorized Employee or a direct designee has personally reviewed the
equipment/machine/process to assure the area is clear of people, tools or obstructions.
❑ The Energy Control Device (Lock) will be removed by the Authorized Employee's direct supervisor or a
direct designee only.
Direct Supervisor or (direct) Designee
❑ The Authorized Employee acknowledges the lock removal.
Authorized Employee (whose lock was removed) Ko j' Date
Direct Supervisor or (direct) Designee
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Date of Removal
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Hazard Communication Program
It is the policy of LSHR that all employees are entitled to be informed of the known health hazards of any hazardous
chemical used in the workplace.
This policy covers minimum performance standards applicable to all LSHR employees and locations. Local
practices requiring more detailed or stringent rules or local, state or other federal requirements regarding this
subject can and should be added as an addendum to this procedure as applicable.
Purpose
The following information represents the written Hazard Communication Program for LSHR as required by the
Occupational Safety and Health Administration Standards 29 CFR 1910.1200 and 29 CFR 1926.59. The purpose of
this written program is to establish LSHR's policy, procedures, and responsibilities for dissemination of information
to employees regarding the safe use and handling of hazardous chemicals to which they are exposed or potentially
exposed.
Scope
This Hazard Communication Program shall apply to all LSHR employees who are exposed or potentially exposed to
hazardous chemicals. This includes employees who may be exposed under normal conditions of use or in a
foreseeable emergency.
This manual section and its Addendum shall serve as the LSHR written Hazard Communication program.
Note: The following items are excluded from this program and the requirement to inventory:
• Any hazardous waste defined by the Solid Waste Disposal Act, as amended by the Resource Conservation
and Recovery Act of 1976
• Tobacco or tobacco products
• Wood or wood products
• Articles, defined as:
o A manufactured item which is formed to a specific shape or design during manufacturing, and
o Which has end use function(s) dependent in whole or in part upon its shape or design during end use,
and
o Which does not release, or otherwise results in exposure to a hazardous chemical during normal use.
• Food, drugs, cosmetics, or alcoholic beverage in a retail establishment which are packaged for sale to
consumers and food, drugs, cosmetics intended for personal consumption by employees in the workplace.
• Any consumer product or hazardous substance, as those defined in the consumer Product Safety Act and
Federal Hazardous Substances Act where the product is used in the workplace in the same manner as normal
consumer use, and which is not a greater exposure than experienced by consumers.
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Definitions
Acute health hazard means a hazard that usually occurs rapidly following a brief exposure, such as a skin rash
or eye irritation.
Article means a manufactured item which:
• is formed to a specific shape and design during manufacture
• has end use functions dependent upon its shape or design during end use, and
• under normal use conditions, does not release more than trace amounts of a hazardous chemical and does not pose
a physical hazard or health risk to employees
Chemical means any element, chemical compound or mixture of elements and/or compounds.
A chemical manufacturer means an employer with a workplace where chemicals are produced for use or
distribution.
Chemical name means a name that will clearly identify the chemical for the purpose of hazard evaluation.
Chronic health hazard means a hazard that is continuous and follows repeated long-term exposure - such as
lung cancer or kidney disease.
Common name means a brand name used to identify a chemical by other than its chemical name.
Container means a bag, barrel, bottle, box, can, cylinder, drum, reaction vessel, storage tank, or the like that
contains a hazardous chemical.
Employee means a worker who may be exposed to hazardous chemicals under normal operating conditions or
in foreseeable emergencies.
Employer means a person engaged in a business where chemicals are used, distributed, or produced for use or
distribution, including a contractor or subcontractor.
Foreseeable emergency means any potential occurrence that could result in an uncontrollable release of a
hazardous chemical in the workplace.
Hazardous chemical means any chemical that is a physical hazard or a health hazard.
Hazard warning means any words, pictures, symbols or combination or words, pictures, or symbols appearing
on a label or other appropriate form of warning which convey the specific physical or health hazards.
Health hazard means a chemical for which there is statistically significant evidence based on at least one study
conducted in accordance with established scientific principles that acute or chronic health effects may occur to
exposed employees.
Label means any written, printed, or graphic material displayed on or affixed to containers of hazardous
chemicals.
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Safety Data Sheet (SDS) means written or printed material concerning a hazardous chemical.
Physical Hazards means a chemical that acts outside the body to produce a dangerous situation. Flammable or
explosive chemicals pose physical hazards.
Responsible party means someone who can provide additional information on hazardous chemicals and
appropriate emergency procedures, if necessary.
Use means to package, handle, react, emit, extract, generate a byproduct, or transfer.
Requirements
Responsibilities
The Safety Officer is responsible for implementing the Hazard Communication Program. Specifically, the Safety
Officer will:
• Assemble and maintain the master inventory of chemicals.
• Develop and conduct appropriate training and information programs to promote methods for the safe use
and handling of hazardous chemicals for current and new employees.
• Provide technical guidance to supervisors and personnel at all levels of responsibility on matters pertaining
to health and safety.
• Inspect laboratories, garages, and other work areas semi-annuallyto assess compliance with policies for the
safe conduct of work involving hazardous chemicals.
• Investigate reported accidents which result in the exposure of personnel or the environment to hazardous
chemicals and recommend corrective action to reduce the potential for recurrence.
• Supervise decontamination operations where accidents have resulted in significant contamination of
laboratory and general work areas.
• Verify that each Branch and Division Manager is meeting labeling and Safety Data Sheet requirements as
specified in this program.
• Investigate and report to the Regional Safety Coordinator any problems pertaining to the operation and
implementation of safe work practices and this Hazard Communication Program.
• Maintain appropriate documentation for the Hazard Communication Program.
Operations Manager is responsible for ensuring compliance with requirements of the Hazard Communication
Program as it relates to their areas of operational responsibility. Specifically, he or she is responsible for:
• Acquiring the knowledge and information needed to recognize and control chemical hazards in the
workplace.
• Ensuring that inventory, training, labeling, and SIDS requirements of the program are met.
• Selecting and employing work practices and engineering controls that reduce the potential for exposure to
hazardous chemicals to the lowest practical level.
• Ensuring that employees, for whom the supervisor is responsible, receive training as described in this
section. This shall include instructing employees in the use of site- or task -specific work practices,
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engineering controls, and procedures for prevention of, and response to, accidents and exposures involving
hazardous chemicals.
• Supervising the safety performance of his or her staff to ensure that the required work practices and
engineering controls are employed.
• Arranging for appropriate medical attention and reporting to the Safety Officer any incident which results
in potential overexposure or injury from a hazardous chemical.
• Investigating and reporting to the Safety Officer any problems pertaining to the operation and
implementation of safe work practices and this Hazard Communication Program.
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Chemicals - Handling, Storage, Transport & Disposal
Because of the toxicity, flammability, reactivity, and corrosivity hazards of some of the chemicals that LSHR
personnel utilize, it is importantthat usage guidelines be followed. Not only must chemicals be carefully handled
for safety reasons, but also very strict regulatory and legal protocols dictate that LSHR store, transport, and
dispose of such chemicals in a very specific manner.
The following section applies to all employees who utilize chemical substances, collect chemically contaminated
samples, and generate chemical waste.
Handling
General
• When handling any chemical, contaminated sample, or waste material, LSHR employees must utilize
appropriate protective equipment. The type and amount of equipment will vary depending upon
the substance. Specific recommendations can be obtained by consulting Safety Data Sheets,
reference books, or by contacting the Safety Department. More details regarding the protective
equipment policy can be found in section 2 of this manual.
• When working with or around any chemical substance, become familiar with the chemical and the
hazards associated with it. This information can be obtained from Safety Data Sheets.
• When using any chemical, ensure that its container is properly labeled per this policy.
• Large bottles of liquid chemicals (e.g. 4-liter bottles of acetone) should be placed in a non -breakable
protective caddy when in use.
• When using chemicals in the laboratory, etc., only keep the amount of chemicals at hand that are
necessary to complete the task.
• Volatile and/or toxic chemicals should be handled only in a well -ventilated area. Preferably this
should be a chemical fume hood exhausted outside the building.
• Emergency equipment such as first aid kits, fire extinguishers, eyewash, and emergency showers
must be readily available within close proximity.
Chemical Storage
Chemicals should be stored by their reactive class with incompatibles physically separated from one
another. The following sections cover some of the major chemical classifications and specific requirements.
Storage Areas
Hazardous chemical substances must be stored in specifically designated storage areas or cabinets
which meet the following safety criteria:
• Storage areas/cabinets must be marked or identified as such.
• Storage areas/cabinets should be secured whenever not in use and must be available only to
authorized personnel.
• Storage areas must be well illuminated and well -ventilated with exhaust air leaving the building.
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• Open flames, smoking, and localized heating units are not permitted in storage areas.
• Cleanliness and order must be maintained in the storage areas. Packing material and empty cartons
should be removed promptly from the stockroom.
• A class ABC -rated fire extinguisher must be mounted within 50 feet of the chemical storage area. If
there are chemicals for which an ABC fire extinguisher is not effective, an additional fire extinguisher
of the appropriate rating must also be mounted within 50 feet.
• No chemical storage is permitted on the floor or above eye level.
• Chemical containers must not be crowded onto storeroom shelves. Containers must not protrude
over the shelf edges.
• All shelving must be level and stable.
• Laboratory fume hoods must not be used for chemical storage.
Storage Containers
• All chemical containers must be labeled as specified under the labeling section of this policy.
• Storage containers must be inspected periodically for rust, corrosion, or leakage.
• Damaged containers must be removed or repaired immediately.
• Chemicals must be kept in airtight containers. Beakers or open vessels are not acceptable for
storage.
Corrosives
• Acids and caustics must be physically separated in storage.
• Oxidizing acids (e.g. nitric, perchloric, sulfuric) must be segregated from organic acids (e.g. acetic,
butyric, citric, oleic, oxalic, stearic), flammable, and combustible materials.
• Acids must be separated from active metals such as sodium, magnesium, and potassium.
• Segregate acids from chemicals which can generate toxic gases on contact (e.g. sodium cyanide, iron
sulfide, etc.).
• Corrosives should be stored in glass or polyethylene containers rather than metal, wood, or other
potentially reactive containers.
• Bottle carriers should be used when carrying corrosives from the storage area.
Flammables
• OSHA/NFPA-specified safety cabinets with FM or UL approval should be used for the storage of
flammable liquids. This includes cans of gasoline, mineral spirits, etc.
• Only approved refrigerators should be used for storing highly volatile flammable liquids.
• In areas with highly volatile flammable atmospheres, all electrical service equipment must be
explosion proof for the appropriate class and group of flammable material.
• Flammable and combustible liquids shall be stored in approved containers [refer to 29 CFR
1910.106(d)(2) for details]. Containers shall be kept closed when not in use.
• Flammable liquids in large quantities (over 4 liters) should be kept in UL or FM approved safety cans
with flash arresters. This includes portable gasoline containers.
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• Extreme care must be exercised when transferring flammable Iiquidsfrom one container to another.
To prevent static electricity discharge, bulk containers MUST be grounded. Transfer containers must
then be bonded, via a bonding cable or metal pouring spout, to the bulk container.
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Oxidizers
Many oxidizers can be extremely reactive when mixed with incompatible substances. Some oxidizers
may decompose and react on their own if exposed to heat, light, shock, or friction. Special storage
precautions and care must be exercised when using such materials.
Examples of oxidizers include many acids (e.g. nitric, perchloric, sulfuric), hydrogen peroxide, chlorine,
fluorine, nitrous oxide, and compressed oxygen. Refer to labels and SIDS to find out if a chemical is an
oxidizer.
• Store oxidizers away from flammables, combustibles, and reducing agents (e.g. zinc, alkaline metals,
etc.).
• Peroxide forming chemicals (e.g. hydrogen peroxide, ethyl ether, etc.) must be stored in airtight
containers in a dark, cool, and dry place.
• Peroxide -forming chemicals must be periodically inspected and disposed of before the date of
expected peroxide formation.
• No container should be handled if there is suspicion of peroxide contamination. Immediately
contact the Safety Officer in such circumstances.
Compressed Gases
Not only do compressed gas cylinders frequently contain hazardous substances, but the additional high-
pressure hazard warrants the need to exercise extreme caution.
• Bas cylinders (including small calibration cylinders) must be appropriately labeled.
• Gas cylinders must be securely chained to a stationary structure in an upright position. Small
calibration gas cylinders must be stored in lockable cabinets.
• Gas cylinders must be stored away from direct heat, open flames, sparks, highly flammable
substances, and corrosives.
I;1a"F-114019111A
Compressed oxygen cylinders that are in storage must be stored at least 20 feet from compressed
fuel gas cylinders and flammables (especially oil and grease) or must be physically separated by a
5' non-combustible barrier.
• Empty gas cylinders should be marked as such and stored separately from full cylinders.
• When gas cylinders are not in use, the valve cap must be securely in place to protect the valve stem
and valve.
• Use a hand truck to transport gas cylinders to and from the storage area.
Waste Chemical Storage
Chemical waste is not produced on a routine basis at LSHR. The waste materials that are produced must be
stored in a safe and secure manner until appropriate disposal can be arranged. Hazardous waste from
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project sites (e.g. drums of contaminated soil, water, gasoline, etc.) must not be taken to LSHR. Appropriate
disposal arrangements should be made for pick up from the project site.
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Transport
Waste Chemical Containers
Waste chemicals must be stored in a manner consistent with the criteria outlined in the Chemical
Storage section of this procedure.
• It is extremely important that waste containers (drums, cans, etc.) are clearly labeled as to their
contents.
• The containers themselves must be compatible and sturdy. For large volumes, glass bottles or jars
are inappropriate waste containers because of the potential for breakage.
• Safety cans should be utilized for the collection of waste flammables.
Hazardous Waste Storage Areas
The following guidelines should be utilized to safely store hazardous wastes at LSHR
• Only personnel specifically trained in the hazards of the waste material shall be allowed to handle
it.
• Personnel must be properly protected with appropriate clothing and gloves and, if necessary, a
respirator when handling or transferring hazardous waste.
• The waste storage area must be non -cluttered and spacious enough to allow safe handling and
placement of containers.
• The storage area must be well ventilated to prevent a buildup of toxic or flammable vapors. Natural
ventilation may be used (outside storage) or an explosion -proof exhaust system may be used.
• To avoid container leakage, pressure build up, hazardous polymerization, etc., wastes should be
stored out of the rain, snow, high heat, or extreme cold.
• For large quantities of hazardous waste, a secondary containment berm or tray in the storage area
is necessary to provide containment in the event of leakage or spills. The containment should be
capable of holding 10-15% of the waste's volume.
• All electrical services, including lighting, in a waste storage area which contains highly flammable
materials must be explosion proof.
• All hazardous waste storage areas must be secured to prevent unauthorized entry.
Disposal
• All waste chemicals and unneeded or outdated chemicals must be disposed of in an appropriate
manner by a qualified disposal company.
• Chemical waste or contaminated samples must not be disposed of in solid waste dumpsters or via
the sanitary sewer unless specific approval has been received from all governing state and local
regulatory agencies.
• No chemical waste must be allowed to accumulate at LSHR for longer than 90 days.
• Manifests from all chemicals being disposed of must be retained indefinitely at LSHR
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Because of safety and liability concerns, no LSHR employee shall transport hazardous waste over the road.
Appropriate arrangements must be made prior to job start up regarding the ultimate disposal of any waste
generated on site.
Quantities of chemical products needed to conduct routine operations such as gasoline, acetone, methanol,
etc. may be transported as long as the following conditions are met.
General Requirements
• Containers must be properly labeled as per the requirements of the labeling section of this policy.
• Gasoline must be transported in UL or FM approved safety cans with flash arresters.
• Chemical containers must be air -tight and placed in non -breakable protective enclosures.
• Large tanks (e.g. over 1001 lbs. or roughly 100 gallons) for gasoline, diesel fuel or other flammables
/ combustibles in support vehicles must be securely mounted and placarded with the appropriate
DOT placard information and number.
• Safety Data Sheets for the chemicals must be transported in the vehicle
Written Hazard Communications (Hazcom) Program
An evaluation of the effectiveness of the Hazard Communication Program shall be conducted annually by
the Safety Officer.
Hazard Communication (HAZCOM) Coordinator
A HAZCOM Coordinator shall be the Safety Officer or a designated person or the senior person at any work
site. The HAZCOM Coordinator shall be knowledgeable of the requirements of the OSHA Hazard
Communications Standard.
Hazard Determination and Chemical Inventories
LSHR facilities and jobsites must maintain an inventory of the chemicals known to be present in the workplace.
Each inventory shall list the hazardous chemicals/products by an identity that is referenced on the appropriate
Safety Data Sheet and indicate the location of the chemicals/products. Each Project Manager is responsible for
compiling the inventory of his or her own hazardous chemicals. Inventories are assembled by the Safety Officer
into a master inventory.
The Project Manager is responsible for notifying the Safety Officer and employees, within his or her department,
within 30 days of the receipt of a new chemical. The Safety Officer must update the master inventory as
departmental chemical inventories are updated.
The hazardous chemical inventories are to be audited annually by the Safety Officer to verify that the Division
Managers have appropriately accounted for and reported their hazardous chemicals.
Labels and other forms of warnings shall contain:
• The identity of the hazardous chemical(s)
• Appropriate hazard warnings
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• Name and address of the chemical manufacturer, importer, or other responsible party
Chemicals received by each department will be labeled by the Project Manager unless an appropriate label
exists from the manufacturer. Employees should not deface or remove existing labels.
Transfer containers (including safety cans, etc.) must also be labeled. The only exception is for portable
containers into which hazardous chemicals are transferred from labeled containers and are intended for the
immediate (within the same work shift) use by the employee who performed the transfer.
A label audit shall be performed annually by the Safety Officer to ensure that containers of hazardous materials
have been properly labeled.
Safety Data Sheets (SDS)
The most current SDS available shall be utilized.
A master set of SDSs shall be maintained at LSHR office. SDSs for a specific work area shall be established,
maintained, and made available to employees in designated locations within these areas. Such compilations
can be unique to the work area, e.g. sets for Service Technicians on vehicles, tool rooms, shop areas, long-
term service site, etc.
LSHR maintains copies of Safety Data Sheets for each hazardous chemical used. The SDS provides information
for employee and employer review including:
• Identification
• Hazard(s) Identification
• Composition/information on ingredients
• First -aid measures
• Fire -fighting measures
• Accidental release measures
• Handling and storage
• Exposure controls/personal protection
• Physical and chemical properties
• Stability and reactivity
• Toxicological information
• Ecological information
• Disposal considerations
• Transport information
• Regulatory information
• Other information
Chemical manufacturers or distributors are required by the Hazard Communication Standard to supply a
complete SDS for each hazardous chemical sent to LSHR. It is the responsibility of the Project Manager to
contact all manufacturers and distributors who do not send an SDS or who send an inadequate SDS.
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A written request for SIDS may be made to the manufacturer using the form letter found in Appendix 2-1. A
copy of any incomplete or inadequate SIDS should be attached to the request when sent to the manufacturer
or distributor. Each Project Manager is responsible for informing the Safety Officer when SIDS are added or
deleted.
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Employee Information and Training
LSHR shall provide employees with effective information and training on hazardous chemicals in their work area
at the time of their initial assignment, and whenever a new physical or health hazard the employees have not
been trained about is introduced into their work area. Information and training may be designed to cover
categories of hazards (i.e., flammability, carcinogenicity, etc.) or specific chemicals.
Chemical -specific information must always be available through labels and Safety Data Sheets. Labels and SDSs
shall be legible in English. However, for any non-English speaking employees, information and training shall be
presented in their language as well. The information and training shall consist of at least the following:
Information
Employees shall be informed of:
• The requirements of 29 CFR 1910.1200;
• Any operations in their work area where hazardous chemicals are present; and
• The location and availability of the written hazard communication program, including the required list(s)
of hazardous chemicals (inventory), and Safety Data Sheets required by 29 CFR 1910.1200.
Training
Employee training shall include at least:
• Employee's "Right to Know", and general requirements of 1910.1200;
• The physical and health hazards of the specific chemicals or classes of chemicals in the work area;
• The details of this Hazard Communication Program, including an explanation of the labeling system and
the Safety Data Sheets, and how employees can obtain and use the appropriate hazard information;
• Methods and observations that may be used to detect the presence or release of a hazardous chemical
in the work area (such as air sampling, direct reading instruments, visual appearance or odors of
hazardous chemicals when being released, etc.); and,
• The measures employees can take to protect themselves from the hazards, such as appropriate work
practices, emergency procedures, engineering controls, and personal protective equipment.
• This information and training will be conducted by the Safety Officer with input and assistance from the
employee's supervisor. Web -based or computer -based training programs are acceptable provided that
completion of the course and any supplemental site -specific training will satisfy OSHA training
requirements, and the course is approved by the Corporate Director of Health and Safety.
Training Documentation
LSHR employees trained in hazard communication must sign off on the training acknowledgment form.
Copies of this document are to be issued to the employee and the original shall be retained in the
employee's personnel file.
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Owner, Contractor and Multi -Employer Worksites
Contractors/employers entering LSHR whose employees may be exposed to chemicals controlled/owned by
LSHR will be informed by the Safety Officer or their designee of the LSHR Hazard Communication Program.
Where LSHR is working at a multi -employer workplace, the on -site individual in charge of LSHR's operations will
inform any other contractor/employer whose employees may be exposed to chemicals controlled/owned by
LSHR of the LSHR Hazard Communication Program. This information will include:
• The location and contents of the written Hazard Communication Program;
• The location of and on -site access to Safety Data Sheets;
• The precautionary measures that need to be taken to protect employees during the workplace's normal
operating conditions and in foreseeable emergencies; and,
• The labeling system used to label LSHR's chemicals.
A "Multi -Employer Workplace Hazard Communication Information Sheet" will be filled out by the Safety Officer
or on -site representative and presented to the contractor/employer for their signature.
Any employer/contractor must also alert LSHR of the hazards of chemicals brought to the office/work site
which LSHR employees may be exposed to. This may include paints, solvents, or even welding fumes. The
contractor must make readily available SDSs for these chemicals.
Non -Routine Tasks
Hazard Communication plans for non -routine tasks shall include:
• the method used to identify the hazards of non -routine tasks
• the methods used to inform employees of these hazards
• a description of special procedures required for hazardous non -routine tasks
In the event of non -routine tasks (e.g. spill clean-up, unique sampling or analytical procedures, etc.), the Project
Manager or Safety Officer must ensure that the affected employee(s) has been properly briefed regarding the
chemical hazards associated with the operation. Safety Data Sheets for the chemicals must be made available.
Due to the varied workplaces LSHR employees may occupy, there is a potential of encountering unlabeled pipes
which may contain hazardous chemicals. As a precaution, LSHR employees will consider all unlabeled pipes to
contain hazardous chemicals. If any leaks or releases from unlabeled pipes are encountered, LSHR employees
will immediately leave the work area and report the incident to the appropriate facility manager.
LSHR employees will only reenter these areas after the leak/release has been eliminated and an appropriate
clean-up conducted or if the pipe contents are verified to be non -hazardous.
References
OSHA 29 CFR 1910.1200
OSHA 29 CFR 1926.59
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Confined Space Policy
Systems shall be utilized to ensure the safety of employees who are required to enter confined spaces. Only
those LSHR employees who have received specifically required training and certification on confined space
entry shall be allowed to enter and/or attend a confined space. This program will be reviewed annually by the
Safety Officer and revised as necessary.
This policy covers minimum performance standards applicable to all LSHR employees and locations. Local
practices requiring more detailed or stringent rules, or local, state, or other federal requirements regarding
this subject can and should be added as an addendum to this procedure as applicable.
Purpose
To set forth procedures for the safe entry to confined spaces.
Scope
Applies to all work sites, i.e., LSHR office, client job sites, etc., involving confined space entry.
Definitions
Attendant means an individual stationed outside permitted confined spaces that monitors the authorized
entrants and who performs all attendants' assigned duties.
Authorized Entrant means an individual who is authorized to enter a confined space.
Blanking or blinding means an absolute closure of a pipe, line, or duct by the fastening of a solid plate (such as
a spectacle blind or a skillet blind) that completely covers the bore and that is capable of withstanding the
maximum pressure of the pipe, line, or duct with no leakage beyond the plate.
Confined space means a space that is large enough and so configured that an individual can enter and perform
assigned work; has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins,
hoppers, vaults, and pits are spaces that may have limited means of entry.); and is not designed for continuous
occupancy. A permit required confined space has one or more of the following characteristics:
• Contains or has a potential to contain a hazardous atmosphere
• Contains a material that has the potential for engulfing an entrant
• Has an internal configuration such that an entrant could be trapped or asphyxiated by inwardly converging
walls or by a floor which slopes downward and tapers to a smaller cross- section
• Contains any other recognized serious safety or health hazard
Confined Space Permit means a written or printed document that allows persons to enter into a permitted
confined space.
Double block and bleed mean the closure of a line, duct, or pipe by closing and locking or tagging two in -line
valves and by opening and locking or tagging a drain or vent valve in the line between the two closed valves.
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Emergency means any occurrence (including any failure of hazard control or monitoring equipment) or event
internal or external to the permitted confined space that could endanger entrants.
Engulfment means the surrounding and effective capture of a person by a liquid or finely divided (flowable)
solid substance that can be aspirated to cause death by filling or plugging the respiratory system or that can
exert enough force on the body to cause death by strangulation, constriction, or crushing.
Entry means the action by which a person passes through an opening into a permit -required confined space.
Entry includes ensuing work activities in that space and is considered to have occurred as soon as any part of
the entrant's body breaks the plane of an opening into the space.
Entry supervisor means the person responsible for determining if acceptable entry conditions are present at a
permitted confined space where entry is planned, for authorizing entry and overseeing entry operations, and
for terminating entry as required by this section. An entry supervisor may also be acting as an attendant.
Hazardous atmosphere means an atmosphere that may expose persons to the risk of death, incapacitation,
impairment of ability to self -rescue (that is, escape unaided from a permit space), injury, or acute illness.
Line breaking means the intentional opening of a pipe, line, or duct that is or has been carrying flammable,
corrosive, or toxic material, an inert gas, or any fluid at a volume, pressure, or temperature capable of causing
injury.
Permit -required confined space program (permit space program) means the employer's overall program for
controlling, and, where appropriate, for protecting employees from, permit space hazards and for regulating
employee entry into permit spaces.
A permit system means a written procedure for preparing and issuing permits for entry and for returning the
permit space to service following termination of entry.
Prohibited condition means any condition in a permit space that is not allowed by the permit during the period
when entry is authorized.
Oxygen deficient atmosphere means an atmosphere containing less than 19.5 percent oxygen by volume.
Oxygen enriched atmosphere means an atmosphere containing more than 23.5 percent oxygen by volume.
Rescue service means the personnel designated to rescue employees from permit spaces.
Retrieval system means the equipment (including a retrieval line, chest or full -body harness, wristlets, if
appropriate, and a lifting device or anchor) used for non -entry rescue of persons from permit spaces.
Testing means the process by which the hazards that may confront entrants of a permit space are identified and
evaluated. Testing includes specifying the tests that are to be performed in the permit space.
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Requirements
General
Employees shall be informed of identified permit required confined spaces for the work site as they are
identified.
Only authorized personnel may be permitted to enter a permit required confined space.
The Confined Space Pre -Job Assessment Form (Attachment 18-1) must be completed (in addition to the Site
Safety Plan requirements) for each potential confined space identified where entry is planned. Refer to
Definitions - Confined Space.
Danger signs or other equivalent means shall be used to warn of existing confined spaces that are accessible
by employees and others. The wording shall be "DANGER -PERMIT -REQUIRED CONFINED SPACE, DO NOT
ENTER" or other equivalent language.
Required safety equipment shall be in the confined space work area, in working order, and instruments
calibrated.
Initial Evaluation of Confined Spaces
Confined spaces shall be considered as permit required confined spaces until a competent person conducts
an initial evaluation of the work site to identify permit required confined spaces. This evaluation shall be
recorded on the Confined Space Pre -Job Assessment Form (Attachment 18-1). Confined spaces shall be
classified as follows:
• Non -Hazardous
• Hazardous due to work task
• Hazardous due to internal condition
If the work site contains permit required confined spaces, danger signs stating "DANGER CONFINED SPACE
ENTRY BY PERMIT ONLY" or equivalent shall be posted to inform employees of the existence and location of
the spaces. Bilingual signs shall be posted as necessary.
Reclassification or Canceling of Permit Required Spaces
Permit required confined spaces shall be reclassified as Non permit spaces under the following
circumstances:
• The space has no actual or potential atmospheric hazards and if hazards within the space are eliminated
without entry into the space
• If testing and inspection during entry demonstrates that the hazards within the space have been
eliminated and remain eliminated
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• If the permit required confined space is to be reclassified as a non -permit space, the basis for
determining that hazards have been eliminated shall be documented on Attachment 18-2.
• If a hazard returns, personnel shall evacuate the space and the space shall be reevaluated
• If new hazards are identified that are not part of the original permit, personnel shall immediately
evacuate the space and the confined space shall be re-evaluated
• Cancelled permits shall be kept on file for a period of at least 12 months and reviewed to determine
problems encountered.
Confined Space Entry Form
The supervisor responsible shall ensure that a Confined Space Entry Form (reference Attachment 18-3) is
completed prior to the entry of any permit required confined space. Completion of this form involves the
following activities:
• Assessing hazards
• Atmospheric testing
• Identification of qualified entrants
• Identification of attendant(s).
• Identification of entry supervisor
• Establishment of Rescue method and Rescue Service
• De -energizing systems
• Cleaning of confined spaces
• Types of equipment required
• Hazards that may be generated through work activities
• Communication methods
• Entrants are qualified
Confined Space Permits are valid for the work period or work shift and become void and shall be reissued
when:
• There is an unplanned interruption in the work process
• The surrounding conditions change that introduce a new hazard
• Personnel leave the space to perform other work
• The workspace is left unattended
• The work period (normal time a person or crew is scheduled to work during that day) ends
• When new crew assumes the work assignments of the existing work crew
Permits are not void during any single work period when crew members are added to the existing crew or
when crew members are replaced on a planned rotational basis and the provisions of the permit are met
including training and instructions.
Permits become void when the scope of work exceeds the definition of work defined on the permit, and
when work is required to be completed that is not covered by the permit.
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Confined Space Permits shall be posted at the confined space work area until the work is completed. At the
conclusion of work, the permit shall be returned to the issuer (i.e. Entry Supervisor, client, etc.).
Completed confined space permits shall be kept for a minimum of 12 months and until a review of the
confined space permit program is completed.
Atmospheric Testing
Atmospheric conditions of a confined space shall be tested with calibrated equipment prior to entry of
personnel and as identified by the Initial Evaluation of Confined Spaces. Atmospheric testing shall be
completed as indicated below and recorded on the Entry Permit:
• Oxygen content shall be tested. The acceptable range is 19.5 to 23.5 percent
• Test for combustible gas and vapors. Acceptable range is 0 to 10 percent of the Lower Flammable Limit
(or Lower Explosive Limit). Record readings on the Entry Permit
• Check for toxic gases and airborne combustibles (i.e. dusts) as identified by the initial determination of
confined spaces (5.2 of this section). Safe operating levels can be determined from the Permissible
Exposure Level (PEL) as listed in OSHA 29 CFR 1910.1000, applicable Safety Data Sheets (SDSs) or as
provided by the client
• Entrants and/or attendants may request additional monitoring at any time
Pre -Entry (occurring prior to entrvi
Only those persons receiving specifically required training and certification on confined space entry shall be
allowed to enter and/or attend a confined space. This training shall be documented at orientation and at the
required pre -job meeting (see Confined Space Pre -Job Assessment Form —Attachment 18-1) defining the specific
requirements of the confined space being entered. Annual refresher training shall be conducted for all applicable
LSHR personnel to include emergency rescue drills.
Persons who enter confined space, Attendant(s), and Entry Supervisor shall receive the following minimum
instructions concerning the confined space:
• How to recognize symptoms of the specific potential hazards of the confined space
• The consequences of exposure to potential hazards
• When to evacuate the confined space
• Adhering to instruction of the Attendant
• Evacuating when alarms sound
• How communications will be maintained
• What to do if an exposure occurs or there is a release of a substance
• Shutting off tools during an emergency
Sources of energy or contaminants shall be controlled, such as:
• Electrical energy
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• Pressurized systems such as pipelines and vessels are isolated through double blocking, blinding, bleeding,
and depressurization
• Extreme heat and extreme cold conditions
Pre -entry atmospheric testing shall be completed.
The method of ventilating the confined space shall be established.
The approved tools shall be identified and staged at or near the entry point of the confined space. Tools, electrical
tools and lighting systems shall be approved for use in confined spaces as identified by the Initial Evaluation of
confined spaces.
Depending upon the Pre -Job Assessment (see Attachment 18-1), lighting and electrical equipment may be
either low voltage (50V or less), or conventional 120V portable lamps and tools if powered by approved
ground fault circuit interrupter devices and the work is not an electrically hazardous location. Pneumatic
equipment may be used instead of electrical equipment.
Required rescue procedures and rescue equipment that shall be staged at the confined space.
The safe methods to enter, exit, and escape for personnel (including rescue personnel during retrieval)
working in a permit -required confined space shall be developed during the job planning phase, specified on,
and included, as needed, on the entry permit.
Personnel have been issued the required personal protective equipment (PPE).
Persons who enter confined spaces shall be logged using the Confined Space Pre -Job Assessment Form
(Attachment 18-1).
Ventilation of Confined Spaces
Powered ventilation shall occur before entry into the permit -required confined space and continue until
after the employees have left the space. Layout of ventilation equipment will be made in such a manner that
the air is being sent throughout the entire confined space. Forced air ventilation should come from a clean
source and may not increase hazards.
Air hoses with diffusers may not be used to provide forced ventilation.
Air sampling shall be conducted prior to personnel entry to assure the safety of the space and periodic air
sampling shall be continued thereafter in the space when forced ventilation is used.
Forced ventilation may be used to:
• To remove contaminants created by work activities such as welding
• As a method of maintaining controlling the ambient temperature of a confined space when the rise in
temperature is caused by atmospheric conditions.
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Ventilation shall occur only by forcing air into a confined space. If it is necessary to exhaust hazardous gases,
such as those produced when welding, the air being forced into the confined space shall be increased by at
least the amount that is being exhausted out of the space.
Performance of Work
The confined space attendant shall remain at the entry point of the confined space while personnel are
inside any permit required confined space.
The confined space attendant shall ensure that only authorized personnel enter the confined space.
Confined space attendants shall not perform any other work activities except that they may also serve as
the attending supervisor.
Confined space attendants shall only monitor a single confined space, unless entry points to subsequent
confined space(s) are immediately adjacent and are under the direct control of the attendant.
If an emergency or other unplanned event takes place during the course of work the Confined Space Work
Permit is void.
The Attendant and Entry Supervisor have the authority to discontinue work activities at any time.
Compressed gas cylinders other than a self-contained breathing apparatus should not be taken into a
confined space.
The hoses of gas cutting and welding tools shall be inspected for leaks prior to taking them into any confined
space.
Persons who enter confined spaces shall comply with the provisions of this standard and the confined space
permit. This includes:
• Supervisors
• Inspectors
• Surveyors
• Observers
• Scaffold Builders
• Engineers
• Vendors
• Contractors, subcontractors, and other employers
Sources of ignition (e.g., flame. arc, or spark) shall not be permitted in any confined space until tests have
ensured that the percentage of combustible/flammable gas or vapor is not more than zero (0) % of the
Lower Explosive Limit (LEL).
Emergencies
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Emergency Notification
It is the responsibility of the Entry Supervisor and/or the Entry Attendant to immediately notify the senior
LSHR employee on the worksite of a potential emergency by radio or cell phone. The senior LSHR
employee will assess the situation and contact emergency response personnel if applicable.
Only those individuals trained and certified in confined space entry procedures on the worksite may
assist in emergency rescue operations.
First Aid / Medical Services
Refer to the requirements in the First Aid section for specific worksite requirements.
Rescue / Retrieval Systems
To facilitate emergency rescue, retrieval systems or methods shall be used whenever an authorized
entrant enters a confined space, unless the retrieval equipment increases the overall risk of entry or
would not contribute to the rescue of the entrant.
The entry supervisor, prior to the initial entry of personnel into a confined space, shall ensure the rescue
equipment and retrieval system is functioning properly.
Retrieval systems shall meet the following requirements to the greatest extent possible.
• Each authorized entrant shall use a full body harness with a retrieval lifeline attached at the center
of the entrant's back near shoulder level, or above the entrant's head or safety coveralls with built
in harness, with a retrieval lifeline attached at the near shoulder level of the entrant's back, or above
the entrant's head
• Wristlets may be used in lieu of the full body harness if the entry supervisor can demonstrate that
the use of a full body harness is not feasible or creates a greater hazard and that the use of wristlets
is the safest and most effective alternative
• The other end of the retrieval line shall be attached to a mechanical device or fixed point outside the
confined space in such a manner that rescue can begin as soon as the rescuer becomes aware that
rescue is necessary. A mechanical device shall be available to retrieve personnel from vertical type
confined spaces more than 5 feet deep
• The safety harness shall be of the type that permits easy rescue of personnel from the confined space
during emergency conditions and may be either the harness type that suspends a person in an
upright position or the wrist type rescue harness. (A hoisting device or other effective means for
lifting personnel from confined spaces is preferred)
• Lifelines shall have a minimum breaking strength of 5,400 pounds
Completion of Work
When the work is completed in a confined space the following, as a minimum shall be completed:
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• Tools, equipment and materials shall be removed
• The space shall be inspected to ensure no personnel are inadvertently left in the confined space
according to the Energy Control section 16 of this manual
• The area surrounding the confined space shall be clean of materials, equipment, scraps, and debris
• The supervisor responsible for the confined space work shall inspect the work location to ensure
cleanup of materials, tools, and other items is complete
• (Lockout) locks are removed only when work is completed
• Termination of the Confined Space Permit is done when everything above is completed by Supervisor
References
OSHA 29 CFR 1910.146
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LONE STAR HAZMAT
The Leader in Emergency Response
Confined Space Pre -Job Assessment Form
Supervisor Client
Project
Scope and Description of Work:
Project No.
Date:
Safety Contact
Potential Hazards
Physical Control Methods —Air
What are the consequences if
Permissible Type PPE
Identified
Gap, Blinding, Double Blocks,
people or the environment is
Exposure Required -
- be specific
Bleed & Flush, Lockout,
exposed to hazard? — Attach
Limits Clothing, SCBA,
Use Additional Paper if
Ventilation, Purging, Disconnect,
SDS and other documents
PEL Respiratory, etc.
necessary
etc.
What method will be used to physically clean the confined space of hazardous liquids, gases, and other toxic substances?
What safety equipment is required?
What hazards will be generated by the work to be done? For example: painting, welding, grinding, material removal spills?
How will emergency rescue be performed and who will be responsible for rescue operations?
What type of rescue system will be used?
Who will perform the work? Are they Trained? Are they qualified to do the work?
Name CS Trained? Other Training needed Assignment
Name of Client's "Authorizing Agent" who has knowledge of
contents and hazards and will declare space safe for entry:
General Comments:
Confined Space Classification (circle): Non -hazardous / Hazardous Due to Work Task / Hazardous Due To
Internal Condition
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LONE STAR HAZMAT
The Leader in Emergency Response
Confined Space Entry Permit
FOR RESCUE AND EMERGENCY
NAME
NUMBER
MEANS OF CONTACTING SERVICE
This permit must be properly completed prior to entering any confined space anc is VALID ONLY FOR THE DATE AND TIME PERIOD STATED ON THIS FORM. Site
entry and rescue procedures must be readily available during the time period that this permit is in effect.
JOB LOCATION INFORMATION
PLANT NAME AND ADDRESS:
SITE LOCATION/DESCRIPTION:
CONTACT:
PHONE:
JOB DESCRIPTION:
DATE VALID:
START TIME:
END TIME:
EXPIRES ON:
❑ Toxic Material
POTENTIAL HAZARDS
❑ Hot Work
❑ Radiation
❑ Fire Suppression Systems
❑ Flammable Substances
❑ 02 Deficiency
❑ Asbestos
❑ Wet/Slippery Conditions
❑ Reduced Visibility
❑ Engulfment
❑ Heat/Cold
❑ Inwardly Converging Walls
❑ Floor Slopes Downward
❑ Mechanical Hazard
PRE -ENTRY REQUIREMENTS
❑ Entrance/Egress free of debris and objects
❑ Lines Purged/Broken/Blanked
❑ Warning Barriers/signs in place
❑ Electrical equipment rated for explosive atmosphere
❑ Monitoring/Testing of Atmosphere done (see below)
❑ No compressed gas cylinders in the confined space
❑ Draining, Flushing of Confined Space Completed
❑ Host employer and/or contractors notified
❑ Forced air, or exhaust ventilation set up
❑ Communications equipment tested
❑ Electrical equipment grounded/rated
❑ Entry and Emergency procedures have been reviewed
❑ Ground fault circuit interrupters (GFCI) provided
❑ All personnel have been informed of potential hazards
❑ Non -sparking tools are to be used
❑ Attendant properly instructed
❑ Low voltage (less than 25 V) is being utilized
❑ Rescue equipment inspected/available
❑ Copy of SDS is posted/available at work site
❑ LOTO performed (lock-out/tag-out)
Other Safety Precautions Taken:
Communications to be Used During Entry/Egress:
P ❑ Hard Hat
❑ Tyvek Suits
E ❑ Safety Glasses
❑ Tyvek Shrouds
R
S ❑ Work Gloves
❑ Ear Plugs
O
N ❑ Steel Toed Boots
❑ Respirators
A
❑ SCBA
L
Time Oxygen %
PROTECTIVE EQUIPMENT
❑ Harness/Lifeline M Li Ladders
E ❑ Retrieval Device H ❑ Barriers
s ❑ Fire Extinguisher A ❑ Ventilating Equipment
Half -Face C ❑ Communication Devices N ❑ Double Insulated Tools
Full -Face E ❑ Wristlets c ❑ Spark -Proof Tools
A
❑ Tripod L ❑ GFCI
ATMOSPHERIC TESTING RESULTS
Combustibles, %LEL Carbon Monoxide Other
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Has communication been established between authorized entrants and the attendant? ❑ Yes ❑ No
If no or not required, please explain:
Has communication been established between attendant and the Fire Department? ❑ Yes ❑ No
If no or not required, please explain:
Has Safety and Health Plan been read and understood by all? ❑ Yes ❑ No
If no or not required, please explain:
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LONE STAR HAZMAT
The Leader in Emergency Response
Confined Space Attendant Log
The purpose of this form is to keep track of the employees who enter and leave the confined space. The Confined
Space Attendant is responsible for maintaining this log. When work has been completed attached this log to the
Confined Space Work Permit
Date of Work Time Started
Location of Confined Space
Name of Attendant
Name of Relief Attendant
Name of Relief Attendant
Entrant Name Time Time
Entered Exited
Comments and notes
Permit No.
Entrant Name Time Time
Entered Exited
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Tool Safety and Inspection
Purpose
There are various types of tools and equipment used in the workplace for many different purposes. Examples
include, but are not limited to, portable hand tools, power tools, pneumatic tools, and powder -actuated tools.
The purpose of this policy is to provide employees with appropriate knowledge relating to the care and use of
tools and equipment and to protect employees from hazards associated with improper use of tools and
equipment and defective and poorly maintained tools and equipment.
Policy
Only trained and/or experienced employees may use/operate tools or equipment. Tools and equipment shall
not be modified, and they are to be used only for their designed purpose. It shall be the responsibility of the
employee to inspect tools and equipment prior to use and to use all tools and equipment in a safe manner.
Employees observed abusing, altering, modifying or misusing tools or equipment shall be subject to disciplinary
action. Employees shall wear all appropriate personal protective equipment while using tools and equipment.
Additionally, if a tool or piece of equipment is found to be defective, the tool/equipment shall be red tagged,
taken out of service until it can be replaced or repaired by a qualified person.
It shall be the responsibility of the Project Manager or Site Superintendent to designate a competent person
who will be assigned to be responsible for testing/inspecting and repairing all tools and equipment. All periodic
inspections, maintenance and repairs of tools or equipment shall be documented.
To promote safety and efficiency, the following procedures shall be followed:
Procedure
General Tool Safetv
Many serious injuries have resulted from the improper use of tools and equipment. Many of these injuries
could have been prevented if the following rules were followed:
Inspection and Maintenance
• All tools shall be identified and inventoried either individually or by group.
• All tools in the inventory shall have a documented inspection at least once every six months. In addition
to these periodic documented inspections all tools shall be inspected prior to issue and upon return by
the tool room attendants and prior to each use by the user.
• All tools will be kept in good working condition with no modifications.
• All periodic inspections and all maintenance & repairs shall be documented. Completed forms shall be
kept in a binder in the tool room or tool trailer for one year. The binder shall contain a copy of the
inspection checklist for the type of tools and/or equipment being inspected.
Selection
Use the right tool for the task instead of trying to make the wrong one fit.
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Use
• Keep control of yourself, the tool, and the job. When applying force with a tool, remember that it may
slip, break, or just suddenly do its job. Watch your hands and your balance (body mechanics) to avoid
injury.
• Vibration Absorbing Gloves are to be made available to workers using pneumatic impact guns or other
vibrating equipment. These gloves require PPE for workers operating heavy vibrating tools (i.e. jack
hammers, 90 guns, impact guns etc.). The use of these gloves is designed to dampen vibration, dissipate
impact and absorb shock, they can assist in the prevention of cumulative trauma injury often associated
with operating this type of equipment. They only work if you use them.
• Select the right protective equipment for the task and use it properly.
• Do not use tools and equipment that you have not been trained to use.
Care
• Take proper care of your tools and equipment. Keep them stored where they will not get damaged and
will not present a hazard.
• Check your tools and equipment prior to use for defects, wear, or damage. Immediately remove from
service and tag any defective tools. Damaged tools shall be turned into the tool room for repair or
replacement.
Supervision
Supervisors shall be responsible for ensuring that employees are trained before using a specific tool. Watch
your employees at work. Ask them about their immediate assignment and take an interest in finding the
safest way to do the job. Then follow up to ensure that the tools and equipment in your area are being used
safely.
Hand Tool Safety
• Hand tools shall only be used for the purpose for which they are intended.
• All appropriate PPE will be worn while using hand tools.
• Wrenches, including adjustable, pipe and socket shall not be used when jaws are sprung to the point of
slippage.
• Pipe wrench parts (i.e., jaws) are not to be removed and used for anything other than manufactured use.
• The use of snipes and cheater bars or double wrenching to gain leverage is prohibited.
• Always use tool holder while using hammer and knocker wrenches.
• Hand tools shall be tagged and removed from service if any of the following defects are present:
o Impact tools, such as hammers, flange wedges chisels, drift pins, pin bars and knocker wrenches with
visible signs of mushrooming, cracking or bending.
o Wooden handle tools, such as hammers, picks, shovels, and brooms with visible sign of cracking,
loosening or splintering of the handle.
o Wrenches, such as adjustable, combo and pipe with visible signs of bending, cracking, defective
handles or other defects that impair their strength.
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Electrical Power Tool Safety
• All appropriate PPE will be worn while using power tools.
• Be sure that the proper permit has been obtained prior to use of electrical power tools.
• GFCI's are to be used with all portable electric equipment. GFCI's are to be inspected and tested prior to
each use.
• Do not connect electrical power unless the operating switch is turned off.
• Employees shall avoid loose fitting clothing when operating power tools.
• The power source on tools shall be physically disconnected prior to attempting any repairs or attachment
replacement.
• Protective guards on power tools shall not be removed, altered or modified. All guarding will meet the
requirements set forth by ANSI B15.1 1926.300 (c)
• Trigger/switch locks on power tools are prohibited.
• All electrical tools and power cords must be inspected per the Electrical Equipment Safety and Inspection
Policy.
• Electrical tools and power cords must display the current inspection color code for the current inspection
period to it being placed in service.
• Electrical tools shall not be hoisted or carried by their power cords.
• Cords are tripping hazards. Route them so as to minimize interference in walkways. Overhead is
preferred.
• Electrical power tools shall be tagged and removed from service if any of the following defects are
present:
o The electrical power tool cord does not have the current inspection color code.
o Power cord is frayed, cut or damaged. The use of electrical tape to cover damage to cords is
prohibited.
o Defective or faulty on/off switches.
o Loose or defective components
Air Power Tool Safety
• All hoses exceeding 1/2" inside diameter shall have a safety device at the source of supply or branch line
to reduce pressure in case of hose failure.
• Chicago fittings shall be pinned.
• Attachments on air tools shall be secured by retainer pins and rings.
• Do not connect the air unless the operating switch is turned off.
• Do not disconnect until the air supply is shut off and air pressure is bled off.
• Air power tools shall not be hoisted or carried by their hoses.
• Hoses are tripping hazards. Route them so as to minimize interference in walkways. Overhead is
preferred.
• Air power tools shall be tagged and removed from service if any of the following defects are present:
o Air power tools, such as air power grinders, impact wrenches, German hacksaws with visible signs of
deformities in the body of the tool, improperly functioning actuator, bent or deformed blades, or
any signs of obvious damage to the air supply line fittings.
o Hoses must be visually inspected for cracking, signs of aging, worn or damaged connecting fittings,
or any other obvious deformities, such as blistering or bulge.
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Fire Prevention Policy
Purpose
Fire Prevention/Protection Policy is intended to provide compliance with all related OSHA regulation and
standard safe work practice. The purpose of the policy is to prevent fires and to provide guidelines for action in
the event that a fire does occur.
Fire prevention program combines the following policies:
• Haz Com Training Policy
• PPE Policy
• Electrical Safety Policy
• Emergency Action Plan
These policies encompass methods used for incidence avoidance, incident response and specialized training
required in the event of a fire.
Issues addressed in the above policies include, but are not limited to:
• Evacuation Procedure
• Extinguisher Training
• Basic Process Safety Training (if applicable)
• Hot Work Safety Training (if applicable)
• Confined Space Entry Safety Training (if applicable)
• Emergency Life Support Training
• Respiratory Protective Devices Training (if applicable)
• Assured Grounding Programs
Policy
Employees shall be informed of the proper actions to take in the event of a fire and methods of utilizing fire
extinguishers. This includes but is not limited to notification and evacuation procedures. It is STRESSED that at no time
does the task of fighting fire supersede an employee's primary duties of:
• Ensuring their own personal safety and the safety of others.
• Reporting the incident to the proper authority and ensuring personnel accountability for yourself and all
subordinates at the jobsite, in accordance with company and client policy.
Procedure
• All employees are responsible for good housekeeping practices to enhance fire prevention methods.
Supervisors will be held accountable for the housekeeping of their job sites.
• If applicable, welding machine mufflers will be equipped with an approved spark arresting muffler.
• Only approved containers will be used during fueling operations. These shall be of the self -closing type.
• Flammable material shall be kept under control. It shall be stored in compliance with applicable OSHA and
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client regulations. The quantity of flammable/combustible material shall be kept to a minimum on the job site.
• Welding, cutting and grinding sparks shall be involved.
• Hot work areas shall be kept wetted down, and a fire extinguisher and hose maintained on each jobsite.
• Oily rags shall be immediately disposed of in designated hazardous waste containers.
• No hot work is to be performed without a Hot Work Permit.
• All vehicle entry into process areas requires a permit or permission from the operator.
• Use bonding straps to discharge and prevent static charges during transfer of flammable liquids from one
container to another.
• Report all spills or suspicious odors immediately.
• Fire extinguishers are to be kept in areas easily accessible to employees. Only approved fire extinguishers are
to be used. They must have an inspection tag attached. Extinguishers are to be maintained in a fully charged,
ready to operate state. Extinguishers are to be inspected before each use and documented annually. Training
is provided to all employees who use or may use fire extinguishers on an annual basis.
• NEVER put yourself or others at risk while attempting to extinguish an incipient fire.
• DO NOT USE any fire hoses larger than 1-3/4", unless fully trained as an industrial firefighter.
• NEVER attempt to extinguish a pressurized fuel fed fire.
• DO NOT direct a fire nozzle with a straight stream at any type of LPG fire. This action could extinguish the fire,
producing an LPG vapor cloud capable of detonation.
• DO NOT USE fire monitors as the force can damage small equipment and certain high chrome alloy equipment
cannot have water applied as cracking could occur.
• DO NOT APPLY water to any acid or caustic release as it can cause a violent reaction. Additionally, low
concentration acids or caustics become extremely corrosive, causing an increasing leak condition.
In the Event of a Fire:
• Remain calm
• Only extinguish a fire when it is clearly within your abilities and the equipment available
• Know the location of the nearest alarm and how to activate the emergency system
• Know the evacuation routes and collection points
• If the fire cannot be extinguished, leave the area immediately and report to your evacuation area
• Await further instructions from the Incident Commander, or designated responsible personnel
Basic Fire Science:
• The combination of fuel, heat, oxygen equals the well-known fire triangle. To understand fire better, a
fourth factor is added, a molecular chain reaction. This is because fire results from a series of reactions
in which complicated molecules "crack" into easily oxidized fragments. Disruption of this chain, along
with the removal of fuel, heat or oxygen, is recognized as a method of fire extinguishment through the
use of dry chemical extinguishers.
Fuel
Fuel Hear Molecular
Oxygen Chain
Reaction
Oxygen 182
Heat
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• Heat Energy - Can be produced by building up molecules (composition) or breaking apart
(decomposition) by heat or a solution when materials are dissolved in a liquid, or by combustion.
• Heat Transfer - A law of physics states that heat tends to flow up from a hot substance or place to a cold
substance or place. This is through conduction (transfer of heat through a medium such as metals) or
through convection (transfer of heat with a medium -usually circulatory).
• Fuels - Those substances that will burn when heat is applied. The most common fuels are not pure
elements such as carbon, but compounds and mixtures such as paper and wood.
• Oxygen - Makes up a major portion of the oceans and earth's crust and one -fifth of our atmosphere.
Atmospheric oxygen is the major source of oxygen that supports combustion. Oxygen itself does not
burn, however, without it, combustion is impossible. Normal burning is the combination of fuels with
oxygen under the influence of heat.
• Combustion - A rapid oxidation or chemical combination accompanied by heat.
• Oxidation - The ability of materials to produce oxygen during a chemical reaction.
• Spontaneous Combustion - When oxidation is allowed to occur, enough oxygen is available, heat is
produced, molecules become more energetic and combine with oxygen at an increasing rate,
temperatures rise, and visible heat (flames) are produced.
Classes of Fires:
• Class A - Ordinary combustibles (wood/paper/textiles)
• Class B - Flammable liquids (gasoline/oils/grease)
• Class C - Live electric (wiring/generators/motors)
• Class D - Combustible metals (finely divided form/chips, turnings)
Types of Fire Extinguishers:
• Water - extinguisher for ordinary combustible fires
• Dry Chemical or CO2 - extinguisher for electrical equipment fires and for flammable liquid fires
• Multipurpose Dry Chemical - extinguisher for ordinary combustible fires, liquid fires, and electrical
equipment fires
• Foam - extinguishing agent for hydrocarbon fire
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Emergency Action Plan
PURPOSE
The purpose of an Emergency Action Plan is to protect the employees from serious injury, property loss, or
loss of life, in the event of an actual or potential emergency. An emergency may include, but not limited to,
any of the following: fire, tornado, earthquake, bomb threat, or hazardous chemical spill.
GENERAL
Emergency preparedness and response planning is an important factor in ensuring employee safety,
protecting the environment, public safety, and company assets. Therefore, operations do not require any
personnel to continue operating critical equipment during an emergency evacuation. Following an emergency
evacuation, no employee is permitted to re-enter the building until authorized.
A written copy of the Emergency Action Plan shall be kept in the workplace and available to employees for
review.
EMPLOYEE TRAINING
The Safety Manager has overall responsibility of designating and training employees to assist in a safe and
orderly evacuation as well as implementing this plan and updating as needed. Additionally, the Safety
Manager will assist any employee who may need more information about the plan or an explanation of their
duties under the plan. All employees shall be trained in the following areas:
The Alarm System
Preferred means of reporting fires and other emergencies,
Emergency escape procedures and route assignments,
Procedures to account for all employees after emergency evacuation has been completed,
Rescue and medical duties for those employees who perform them, and
Muster Area
Refresher training is required; (1) When the plan is developed or the employee is assigned initially to a job, (2)
When the employee's responsibilities under the plan change, or (3) When the plan is changed.
ALERTING BUILDING OCCUPANTS
In case of a fire, call the local Fire Department on 911. In addition, the smoke alarms will alert building
occupants of the need for evacuation. Any pertinent fire or rescue information should be conveyed to the Fire
Department.
Persons discovering a fire, smoky condition or any other emergency should activate the fire alarm system and
um
Vendor Services Agreement Lone Star Hazmat Response, LLC 244 of 257
make a verbal and/or PA announcement immediately.
EVACUATION PROCEDURES
When the fire alarm sounds or a verbal announcement is made, all personnel should ensure that nearby
personnel are aware of the emergency, quickly shutdown operating equipment, close doors and exit the
building.
All occupants should proceed to their Designated Muster Area via their primary or alternate exits and await
further instructions from their Safety Monitor.
REMEMBER R.A.C.E.
Rescue: When you discover a fire, rescue people are in immediate danger if you can do so without
endangering yourself.
Alarm: Sound the alarm by pulling a fire box and call 911 from a safe distance.
Confine: Close all doors, windows and other openings.
Evacuate: Evacuate the building.
DESIGNATED MEETING AREA
When an alarm sounds or a verbal announcement is made, all occupants will proceed to the nearest exit and
gather at the designated "Muster Area" which is pictured on the facilities emergency evacuation maps
throughout the facility. The "Muster Area" is designated to be the safe meeting point for all personnel. Once
the evacuation has been completed, the Safety Monitor shall conduct a head count. The "Receptionist" will
have the responsibility of bringing the "Sign -In Roster" to the Muster Area to account for all employees and
visitors after the evacuation.
RESCUE & MEDICAL DUTIES
• Do not move injured personnel.
• Always keep injured personnel lying down, covered and warm.
• Emergency Medical Technicians (EMT) will conduct all rescue and medical duties.
Vendor Services Agreement Lone Star Hazmat Response, LLC 245 of 257
Background
Heat stress is known to cause mild to severe illness and even death. As such, exposure to heat from the sun is a
serious health and safety issue for LSHR and its Employees. It is the Policy of LSHR that all employees who are
exposed to heat from the sun in the course of their duties be protected from heat stress. This objective shall be
achieved by following the practices and procedures in this Policy and as directed by the Managers and
Supervisors of LSHR.
Policy
LSHR shall protect employees and meet legal obligations by establishing procedures and practices to reduce
employees' exposure to heat from the sun. All employees shall follow their roles and responsibilities as
described in this Policy to carry out practices and procedures to prevent overexposure to heat from the sun.
Scope
This Policy applies to all LSHR management, employees, constructors and subcontractors.
Roles and Responsibilities
Management shall: Maintain practices and procedures to prevent overexposure to heat stress. Employee input
is key this this process and is encouraged. These practices and procedures shall be reviewed once per year or as
necessary, including assessing heat stress risks and implementation of control measures to reduce these risks.
Each year the company will provide training in heat stress safety.
The Health and Safety Committee and OHS Lead shall investigate any incidents and recommend methods to
eliminate excessive heat exposure in a timely fashion.
Supervisors shall: Monitor worksites for heat/humidex levels daily during heat alert/high humidex periods and
implement response actions in accordance with Daily Heat Stress Response Procedure. This includes posting
Heat Stress Alerts and Heat Stress Warnings when appropriate. Utilize Heat Stress Risk Assessments for jobsites,
such as the Heat Stress Risk Assessment for Outdoor Workers — Daily Monitoring Plan and completing
appropriate records (such as Heat Stress Risk Assessment for Outdoor Workers — Daily Assessment Records).
Ensure new employees are aware of the Heat Stress Safety Policy and practice heat safety. Remind staff as
opportunity presents to stay hydrated and seek shade during job tasks and breaks. Make cool water supply
easily accessible.
Ensure that all employees are wearing/using appropriate personal protection Allow employees to acclimatize
to hot working environments; staff should start out gradually and build up to optimum work level over a period
of days. Implement acclimatization regimen in accordance with the approved safe work procedures. Schedule
more physically demanding tasks, before 11am or after 3pm, in the cooler times of the day on high humidex
days when possible. Rotate people through hot, heavy demand jobs, if possible. Post and share daily Humidex
with outdoor workers. Ask how workers are feeling. Supervisors should monitor workplace temperature and
humidity and check workers' condition. Allow workers to stop their work if they become extremely
uncomfortable. Implement work/rest cycle regimen in accordance with the approved safe work procedures.
Allow employees to self -pace their workloads during high heat stress periods and in accordance with the
approved safe work procedures. Reduce work for anyone at risk. Supervisors should use common sense in
determining fitness for work in hot environments.
Some factors to consider are age, poor conditioning, pregnancy, previous heat injuries, certain medical
conditions, lack of acclimatization. Be vigilant for signs and symptoms of heat stress. Ensure that first aid is
Vendor Services Agreement Lone Star Hazmat Response, LLC 246 of 257
provided when necessary and will arrange emergency medical aid when appropriate. Include heat safety into
toolbox/safety talks on a monthly basis between April and October. Report and investigate all incidents of
overexposure to heat and take corrective action.
Employees shall: Be familiar with the heat stress policy and procedures in the workplace. Policies and
procedures usually include guidelines on acclimatization and work/rest cycles. Acclimatize. It takes time to
adjust to working in heat. Work with your supervisor to gradually increase your workload and heat exposure in
accordance with the acclimatization regimen in the approved safe work procedures. Take more rest breaks
when doing heavier work, and in high heat and humidity. Take breaks in the shade or in air-conditioned buildings
or vehicles. Follow the work/rest cycle regimen as directed by your supervisor.
If possible, schedule work to minimize heat exposure. Do the hardest physical work during the coolest part of
the day. Encourage your co-workers to practice heat safe behaviors. Drink water frequently. Drink enough water
so that you never become thirsty. During moderate activity in moderately hot conditions, workers should drink
about 1 cup of water every 15-20 minutes. Eat healthily. You can and should replace essential elements lost
during sweating. Eat a balanced diet rather than taking salt tablets or drinking expensive sports drinks. Wear/use
personal protection as required by their employer. This includes a wide -brimmed hat or hard hat with brim
attachment and neck flap, and light-colored, loose -fitting clothing made of breathable fabric. Avoid non -
breathable synthetic clothing. Be aware that some protective clothing or personal protective equipment may
increase the risk of heat stress.
If necessary, consider also wearing specialized heat -protective clothing to help keep your body temperature
down. Heat -protective clothing that may be useful for outdoor workers Heat Stress Safety Policy Example - Small
Workplace 4 includes temperature -controlled clothing such as air-cooled suits, water-cooled suits, and ice -
cooled waistcoats. Wash clothes regularly and maintain good hygiene. Know signs and symptoms of heat
illnesses. Watch out for heat -stress symptoms in yourself and your coworkers. Report heat symptoms early. Use
the buddy system to monitor one another as you may not see or feel the effects. Know what to do in an
emergency. The plan should include procedures for providing affected workers with first aid and arranging for
medical aid. Remember that your physical condition can reduce your ability to deal with the heat. Age, weight,
fitness, health conditions (heart disease or high blood pressure), recent illness, or medications can all affect your
ability to withstand high temperatures. If you are on medication, read the label or talk to your doctor to
understand how it might cause your body to react to the sun and heat. Avoid eating large meals before working
in hot environments. Should an incident occur: Employees shall immediately report instances of heat stress to
their Supervisor. The Supervisor shall immediately take steps for first aid as necessary. The Supervisor shall take
steps to reduce or eliminate the heat stress conditions/exposures without delay. The Supervisor shall report the
incident to Senior Management. The Supervisor shall complete an accident reporting form.
Active Shooter
An active shooter is a person or persons who appear to be actively engaged in killing or attempting to kill people,
or injuring people, most often in populated areas. In most cases, active shooters use firearm(s). In some cases,
active shooters use improvised explosive devices to cause additional victimization. Active shooter situations
evolve rapidly, demanding immediate response by local authorities. All active shooter events are to be reported
to 9-1-1 immediately.
In addition, the following actions are recommended:
Run from the threat: If you have a clear path of escape
Vendor Services Agreement Lone Star Hazmat Response, LLC 247 of 257
• Don't gather belongings first
• Know all emergency exits wherever you are
• If you're in an open area and there's distance between you and the shooter, run in a zig-zag pattern
• Prevent others from entering the area where shooter may be
• Keep your hands visible
• Call 911 when you are safe
Hide: Barricade or secure your area to delay the attacker if you do not have a clear path of escape
• When in doubt, seek a secure location
• Lock room/office, stay quiet, turn lights off, hide under desk, in closet, cell phone on silent (not just
vibrate)
• If room does not lock: barricade door with whatever is available -chairs, tables, desk, etc. In classrooms,
use door barricade device if available.
• Stay in place until instructed to leave the building by public safety or law enforcement (Don't open the
door unless you can confirm it's the authorities)
Fight: As a last resort, attempt to incapacitate the shooter, improvise weapons or throw items
• Attack as a team if possible, from multiple angles
• Use items such as chairs, fire extinguishers, coffee mugs, etc.
If you are not immediately impacted by the incident, please take the following action:
• Stay away from the building/area;
• Notify everyone around you to stay away from the area;
• Obey all verbal direction given by law enforcement/public safety officers;
• Take protective action and stay away from door and windows.
Non-Negotiables
Here at LSHR we believe in a safety, first mindset as it is one of our core values. Safety rules are in place to make sure
that injuries and incidents are prevented to promote a safe work environment for our employees. There are some safety
violations that are nonnegotiable that will lead to disciplinary action and or termination of employment.
• Personal Protective Equipment (PPE) will be worn at all times on all job sites. This includes a hardhat, safety vest,
safety glasses, steel toes and what level protection is needed.
• At no time is an employee to make entry into a confined space without authorization to do so.
• If Lockout/Tagout (LOTO) is not performed where warranted.
• If an employee is not Fit For Duty.
• Damage/Destruction of company property and or customer property.
• Failure to report incidents/injuries by the end of the scheduled workday.
• Failure to use grounding and bonding when necessary.
Vendor Services Agreement Lone Star Hazmat Response, LLC 248 of 257
1-5 List of Employees' Certification Final
Name of Employee
Total Year's of
Experience in cleaning
Hazardous and Non-
Hazardous Waste
ANSI
Certification
(Yes or No) If
yes, please
specify name
and level of
certification
ASME
Certification
(Yes or No) If
yes, please
specify name
and level of
certification
ANST
Certification
(Yes or No) If
yes, please
specify name
and level of
certification
NFPA
Certification
(Yes or No) If
yes, please
specify name
and level of
certification
OSHA
Certification
(Yes or No) If
yes, please
specify name
and level of
certification
HAZWOPER
(Yes or No) If
yes, please
specify name
and level of
certification
RCRA
(Yes or No) If
yes, please
specify name
and level of
certification
Other
Applicable
Certifications
(Please specify
name and level
of certification)
1 Matthew Gilbreath
9
Yes Hazwoper40
Confined Space
2 Chuck Morgan
5
Yes. Hazwoper 40
3 Zach McEntire
5
Yes Hazwoper 40
Confined Space
4 Jared Witless
3
Yes. Hazwoper 40
5 Robert Charboneau
4
Yes Hamoper 40
6 Antonio Navarro
2
Yes. Hazwoper 40
7 Collin Heistand
4
Yes Hamoper 40
8 Devon Lee
2
Yes. Hazwoper 40
9 Ebell Read
1
Yes Hamoper 40
10 Jashod Lyles
I
Yes. Hazwoper 40
11 Justin Tyra
I
Yes Hazwoper 40
12 Rebecca Bauer -Bennett
I
Yes. Hazwoper 40
Confined Space
13 Thomas Arroyos
2
Yes Hamoper 40
14 Traylon Traylor
2
Yes. Hazwoper 40
15 Tyler Nelson
1
Yes Hamoper 40
116
117
118
119
120
Vendor Services Agreement Lone Star Hazmat Response, LLC 249 of 257
LONE S TAR HAZMAT
The Leader in Emergency Response
April 24, 2025
City of Forth Worth
Juby Jacob — Buyer
100 Fort Worth Trl.
Fort Worth, TX 76102
Re: Company Overview
Lone Star Hazmat Response is a leading provider of emergency spill response and
environmental remediation services, headquartered in Tyler, Texas. With nearly two decades of
experience, the company has established a strong presence across the Southern United States,
including Texas, Oklahoma, Arkansas, Louisiana, Kansas and New Mexico .
History & Growth
Founded in 2016, Lone Star Hazmat has grown from a single -location operation with 4
employees into a network of over 15 regional and remote response centers with more than
150 employees.
Mission & Philosophy
Our mission is to serve five core sectors —Transportation, Government, Insurance, Industrial,
and Oil & Gas —through its primary services: Emergency Response, Remediation Services,
Project Management, Environmental Consulting, and Product Sales. Guided by Christian
principles, our philosophy emphasizes safety, customer care, positive attitude, love, and fiscal
responsibility.
Services & Expertise
• 24/7 Emergency Spill Response: Rapid response to hazardous and non -hazardous material
spills, with average arrival times significantly faster than industry standards.
• Environmental Remediation: Comprehensive cleanup services for various environments,
including hard surfaces, drainage systems, and waterways, utilizing advanced techniques
and equipment.
• Regulatory Management: Assistance with spill reporting, compliance, and auditing to
ensure adherence to state and federal regulations.
• Specialized Services: Including biohazard cleaning, chemical spill management, hazardous
material handling, and vac truck services.
Organizational Structure
Lone Star Hazmat's leadership team comprises:
• President, Richard Lenius, Oversees the executive team
• Vice President QA/QC, Dana Taylor, Oversees the estimating, procurement, dispatch, and
project management team
• Vice President Marketing, Philip Aldredge, Oversees the sales and marketing team
24/7 EMERGENCY RESPONSE LINE: 888.9HAZMAT
115 W 5TH Street I Tyler, Texas 75701
OFFICE: 903.531.0000
or Services Agreement Lone Star Hazmat Response, LLC
LgWg 1#Wzmat.com
Corporate Controller, Sally Cheavens, Oversees the financial team
Corporate Field Operations Manager, Matt Gilbreath, Oversees the Regional Response
Managers.
Director of Waste Management, Michael Smith, Oversees the waste management
department.
Lone Star Hazmat Response employs a team of certified professionals trained to handle various
emergency situations, operating from multiple response centers strategically located to ensure
prompt service delivery.
or Services Agreement Lone Star Hazmat Response, LLC
24/7 EMERGENCY RESPONSE LINE: 888.9HAZMAT
115 W TH Street I Tyler, Texas 75701
OFFICE: 903.531.0000
LggVratj Wzmat.com
t7k LONE STAR HAZMAT
The Leader in Emergency Response
April 21, 2025
City of Forth Worth
Juby Jacob — Buyer
100 Fort Worth TH.
Fort Worth, TX 76102
Re: Occupational Safety and Health Statement
J u by,
Lone Star Hazmat Response, LLC (LSHR) is firmly committed to maintaining the highest standards
of safety and health in all aspects of our operations. As a provider of hazardous materials
response and environmental services, we recognize our responsibility to ensure the safety of our
employees, clients, the public, and the environment.
When performing work for the City of Fort Worth, LSHR will fully comply with all applicable local,
state, and federal safety and health regulations, including but not limited to the following:
• The Occupational Safety and Health Administration (OSHA) standards
• The Environmental Protection Agency (EPA) regulations
• The National Fire Protection Association (NFPA) codes and standards
• All other relevant consensus and recognized non -consensus standards
LSHR maintains an active safety program that includes regular training, safety audits, hazard
communication, emergency response planning, and continuous improvement efforts. Our team
is thoroughly trained and equipped to perform hazardous materials operations safely and in full
regulatory compliance.
We are dedicated to fostering a safety -first culture throughout our organization and to ensuring
that all work is performed with the utmost care and professionalism.
Sincerely,
Environmental Health & Safety Manager
24/7 EMERGENCY RESPONSE LINE: 888.9HAZMAT
115 W 5TH Street I Tyler, Texas 75701
OFFICE: 5903.5 31.0000
or Services Agreement Lone Star Hazmat Response, LLC Lon22$tcglr 5Znlat.cOm
LONE S TAR HAZMAT
The Leader in Emergency Response
April 21, 2025
City of Forth Worth
Juby Jacob — Buyer
100 Fort Worth TH.
Fort Worth, TX 76102
Re: Sorbents and Associated Costs
All sorbents and associated costs are included in BidTable BT-89EK
or Services Agreement Lone Star Hazmat Response, LLC
24/7 EMERGENCY RESPONSE LINE: 888.9HAZMAT
115 W 5TH Street I Tyler, Texas 75701
OFFICE: 903.531.0000
LgqTgjdWzmat.com
LONE S TAR HAZMAT
The Leader in Emergency Response
April 21, 2025
City of Forth Worth
Juby Jacob — Buyer
100 Fort Worth TH.
Fort Worth, TX 76102
Re: Exceptions
Juby,
Lone Star Hazmat Response takes no exceptions to the Proposal or Draft Vendor Service
Agreement.
Sincerely,
Dana Taylor
Vice President QA/QC
24/7 EMERGENCY RESPONSE LINE: 888.9HAZMAT
115 W 5TH Street I Tyler, Texas 75701
OFFICE: 903.531.0000
or Services Agreement Lone Star Hazmat Response, LLC LgrWbtT#Wzmat.com
1-7
Equipment Capabilities Final
Year of
Location for each piece of
Category
Equipment Type
Name/Description(eg: CAT320) Features
Quantities
Manufacturer
equipment
Skid Steer
CaseTR310 2017
1 DFW Branch
Vac -Trailer
Ditch Witch 2013
1 DFW Branch
land Response - Small to Medium -Size
8CY Dump Trailer
BigTex 2019
1 DFW Branch
Projects or Emergency Response (ER)
Power Broom
Stihl
1 DFW Branch
1.5-Ton Truck
Ram 4500 2022
7 DFW Branch
Utility Trailer
Big Tex16' 2020
1 DFW Branch
Excavator
As available As available
DFW
25CY End Dump
As available As available
DFW
land Response -Medium to Large -Size
15CY Dump Truck
As available As available
DFW
Projects or Emergency Response (ER)
Back Hoe
As available As available
DFW
30CY Roll Off
As available As available
DFW
Jon Boat 12'-16' Grizzly
15'+Centered Console Boat Grizzly
Water Response - Small to Large -Size Projects
Boom Deployment Equipment Grizzly
or Emergency Response (ER)
Containment Booms FyterTech
4-Gas Meter
5-Gas Meter
Air Response and Monitoring-Smallto Large- PID
Size Projects or ER
RKI Instruments
RKI Instruments
Honeywell - BW
2 Ardmore Branch
1 Ardmore Branch
1 Ardmore Branch
20 DFW Branch
1 DFW Branch
1 DFW Branch
1 DFW Branch
Vendor Services Agreement Lone Star Hazmat Response, LLC 255 of 257
1-6 Licenses and Certificates Final
Name of Employee
1
Matthew Gilbreath
2
Chuck Morgan
3
Zach McEntire
4
Jared Willess
5
Robert Charboneau
6
Antonio Navarro
7
Collin Heistand
8
Devon Lee
9
Ebell Read
10
Jashod Lyles
11
Justin Tyra
12
Rebecca Bauer -Bennett
13
Thomas Arroyos
14
Traylon Traylor
15
Tyler Nelson
16
17
18
19
20
Confined
Fall Protection
Hazardous
Space Entry
and Rescue
Total Year's of
Materials
Competent
Competent
Experience
Technician
Person
Person
9
X
X
X
5
X
5
X
X
X
3
X
4
X
2
X
4
X
2
X
1
X
I
X
1
X
I
X
X
X
2
X
2
X
I
X
Other
Applicable
Certifications
DOT (Please specify
HAZAMAT name and level
Shipper of certification)
Vendor Services Agreement Lone Star Hazmat Response, LLC 256 of 257
EXHIBIT D
VERIFICATION OF SIGNATURE AUTHORITY
LONE STAR HAZMAT RESPONSE, LLC
115 W. 5TH STREET
TYLER, TEXAS 75701
Vendor hereby agrees to provide City with independent audit basic financial statements, but also
the fair presentation of the financial statements of individual funds.
Execution of this Signature Verification Form ("Form") hereby certifies that the following
individuals and/or positions have the authority to legally bind Vendor and to execute any agreement,
amendment or change order on behalf of Vendor. Such binding authority has been granted by proper order,
resolution, ordinance or other authorization of Vendor. City is fully entitled to rely on the warranty and
representation set forth in this Form in entering into any agreement or amendment with Vendor. Vendor
will submit an updated Form within ten (10) business days if there are any changes to the signatory
authority. City is entitled to rely on any current executed Form until it receives a revised Form that has been
properly executed by Vendor.
1. Name:
Position:
Signature
2. Name:
Position:
Signature
3. Name:
Position:
Signature
Name:
Signature of President / CEO
Other Title:
Date:
Vendor Services Agreement Lone Star Hazmat Response, LLC 257 of 257