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Universal Health & Safety Plan For use on all high-risk,industrial and HAZWOPER projects Department of Toxic Substances Control Belshire Environmental Subport Supplier Number:86959, 196284 Scope of Work: High-Risk Tasks performed? Contractor Site Safety Officer&Contacts: Describe Contractor's Scope of Field Work See SWP Cover Sheet for List of High-Risk Tasks Provide Name and Cell Phone Waste Pickup and Disposal Z Yes(List) 1.Working with hazardous. Danielle Palmer 949-532-0801 substances 2. Extreme heat 3. Working with heavy equipment 4. Working around mobile equipment 5. Exposure to vehicular traffic. ❑ No Required Subcontractor Documents: PM must verify that the following documents are in-place for each subcontractor; check to verify. ❑x Copy of their Project/Site-specific ■ Copy of task specific THAs/JHAs and Z Copy of the signed contract health and safety plan inspection/tailgate forms • Copy of their business license and ❑ Copy of their Corporate Safety Z Other Acknowledgement of the training certificates(task specific) Management Manual cultural sensitivity/resources training Subport Review: ❑X Approved—Skip to next Subcontractor ❑ Conditionally Approved- Identify conditions and controls below. Check`common subport conditions'that apply,add additional conditions,and describe how the conditions will be met Subport Conditions(check or add any that apply) How will the condition be met? ❑ AECOM Safety Plan must cover Subcontractor's work, and Subcontractor must provide a THA for their tasks ❑ PM must verify that Subcontractor adheres to AECOM safety plan ❑ Subcontractor variance is required-the form can be found at this link: https://mvecosystem.aecom.com/ppf/forms/Forms/S3NA 213 FM2 Subcontractor %20Variance%2OForm.docx ❑ Supervision required ❑ Special Conditions apply(related to Demolition, Diving, Underbridge Inspection Unit N/A work, and Rope Access Work ❑ Other conditions apply(Identify) ©AECOM Restricted Universal Heath and Safety Plan Template(S4(DSC)AM-209-FM-C) 14 Revision 12 September 9,2021 PRINTED COPIES ARE UNCONTROLLED.CONTROLLED COPY IS AVAILABLE ON COMPANY INTRANET.