<meta name="p:dW. L. KELLY & ASSOCIATES INC.
Construction Management & Development Services
Owner/Project Name:_____________________
1) To promote a safe, healthful and secure work environment.
2) To control the causes of accident, which injure persons and/or damage property.
3) To comply with the statutory requirements of the Occupational Safety and
Health Act and New YorkState, and to meet the customer’s and our
contract requirements.
1) Be familiar with safe and secure procedures for performing tasks
assigned.
2) If not familiar or uncertain about a safe and secure procedures, request
information or assistance from their supervisor.
3) Conduct their activity in a way that conforms to their training and
knowledge.
1) Meets with field supervisors to review program
2) Coordinates and complies with Project Safety Programs as applicable.
3) Checks for quality and safety on all regularly scheduled site visits.
I have read the (Owner’s Name) __________________ “Safety Action Plan” and agree to participate and promote safety on the job. I understand that working in an unsafe manor or use of Alcohol or Drugs on the job-site can be cause for reprimand or “termination” of contract agreement.
Accepted:
Contractor: ______________________________Date:_______________________
Name of company: ___________________________________________________
Contractor Employee “signature form” completed: Yes/No Date: ______________
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Owner/Project Name: _____________________
Safety Action Plan
Contractor – Employee Signature
Agreement: as a contractor employee of (________________________), performing work for (Owner name) ____________________
I have read the above “safety Action Plan” and agree to participate as required.
Names of those who agree to participate in the Safety Action agreement.
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