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Universal Health & Safety Plan <br /> For use on all high-risk,industrial and HAZWOPER projects <br /> Department of Toxic Substances Control <br /> 7. Subcontractor Selection <br /> 7.1 Subcontractor Pre-Qualification <br /> Ensure all subcontractors including lower tier subcontractors are prequalified to perform work for AECOM. Coupa is the <br /> preferred method for pre-qualifying subcontractors. If a subcontractor is conditionally approved, ensure the subcontractor meets <br /> all conditions of approval. If a subcontractor requires a variance, complete the Subcontractor Variance form, <br /> • GPRS <br /> Scope of Work: <br /> ASSIGNED TASK(S) HIGH RISK TASK I CONTRACTOR SITE SUPERVISOR <br /> ■ Utility Clearance ■ No Krista Campbell (818-813-3614) <br /> Required Subcontractor Documents: <br /> PM must verify that the following documents are in-place for each subcontractor; check to verify. <br /> Select One: ■ Copy of task specific THAs/JHAs and inspection/tailgate forms <br /> ❑ Subcontractor's Project/Site-specific Health and <br /> Safety Plan ElCompetent Person Documentation <br /> OR ❑ Copy of their business license and training certificates(task specific) <br /> 0 Subcontractor will work under AECOM's Health ❑ Copy of their Corporate Safety Management Manual <br /> and Safety Plan and field personnel will sign the <br /> AECOM HASP Acknowledge Form El <br /> of the signed contract <br /> Prequalification Status <br /> Supplier Status Actions) <br /> 0 Approved None, skip to next subcontractor <br /> ❑ Conditionally Approved List condition(s)of approval below and describe how condition(s)will be met. <br /> ❑ Pending Approval Subcontractor is NOT approved for use <br /> Safety Conditions of Approval that Apply to Subcontractor (check all that apply) <br /> ❑ AECOM PM will prepare and obtain AECOM SH&E approval of a variance to use this subcontractor. AECOM PM will <br /> ensure the control measures listed in the variance are implemented. <br /> 0 Subcontractor will work under the AECOM HASP. AECOM PM will verify that the AECOM HASP covers the <br /> subcontractor's scope of work. Subcontractor's field personnel will review the AECOM HASP and sign the HASP <br /> Acknowledgement Form (Section19). <br /> ❑ Subcontractor has prepared a Site-Specific HASP for their activities that has been reviewed and accepted by AECOM <br /> SH&E. <br /> 0 AECOM Site Supervisor and/or Site Safety Officer will supervise the subcontractor's field activities at the Site. <br /> ❑ Other: n/a <br /> • PeneCore Drilling <br /> Scope of Work: <br /> ASSIGNED TASK(S) HIGH RISK TASK CONTRACTOR SITE SUPERVISOR <br /> ©AECOM Restricted <br /> Universal Heath and Safety Plan Template(S4[DSC]AM-209-FM2-C) 44 <br /> Revision 15 October 18,2023 <br /> PRINTED COPIES ARE UNCONTROLLED.CONTROLLED COPY IS AVAILABLE ON COMPANY INTRANET. <br />