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safety action plan confrrmatina-wage • Page 4 of 4 <br /> The below statements must be checked and implemented within your safety plan; by checking these statements you <br /> affirm that they will be accomplished.This Safety Action Plan will not be accepted unless these are checked. <br /> YES Assessments will include assessment of work behavior,as well as the identification of physical hazards. <br /> YES Reports of audit findings will be available at the job-site for review by BNSF auditors. <br /> Formal Safety Audits will be conducted by(job title);e.g.,on-site supervisor,insurance carrier representative,safety <br /> committee <br /> Name Title <br /> IX. ROADWAY WORKER PROTECTION/ON-TRACK SAFETY INFORMATION <br /> In addition to Job Safety Briefings,briefly describe how safety-related information is coordinated within your <br /> organization;e.g.,safety committee meetings,voicemail systems,mass mailings,job-site postings,etc. <br /> Kennedy/Jenks Consultants has an Injury and Illness Prevention Plan and Industrial Services Corporate Health and Safety <br /> Program.Employees are trained at least annually on railroad safety procedures and issues.Business Unit Managers and <br /> employees meet(telephone conference)periodically to discuss safety related items.Job site postings and email are also <br /> used to coordinate safety related issues. <br /> For contractors working within 25 feet of track centerline.Must mark what applies to your work group. <br /> Have own roadway worker protection plan/on-track safety program <br /> yes Will use the BNSF Engineering on-track safety program.Maintenance of Way Operating Rules <br /> (MWOR)11 and 12. This information is to be provided by your BNSF Representative. <br /> Not Applicable(No workers within 25 feet of track centerline) - <br /> A COPY OF YOUR COMPLETED SAFETY ACTION PLAN UPON SUBMISSION,WILL BE FORWARDED TO <br /> THE WEBMASTER OF THIS SITE. ADDITIONALLY,PRINT A COPY OF THIS SAFETY ACTION PLAN AND <br /> KEEP A MASTER COPY,AND PROVIDE A HARD COPY TO YOUR BNSF REPRESENTATIVE,AND TO EACH <br /> OF YOUR ON-SITE WORK GROUPS. <br /> FOR CONTRACTOR WORK GROUPS WORKING WITHIN 25'OF TRACK CENTER-LINE,A COPY OF YOUR <br /> ROADWAY WORKER PROTECTION/ON-TRACK SAFETY PROGRAM MUST BE MAINTAINED WITH EACH <br /> WORKGROUP.CONTRACTORS WHO ELECT TO ADOPT THE BNSF ON-TRACK SAFETY PROGRAM MUST <br /> MAINTAIN A COPY OF BNSF MWOR 11 AND 12 WITH EACH WORK GROUP. <br /> http://www.railroadcourses.com/bnsPsafety/safetyplanconfirmation.asp 3/5/2015 <br />