Owner/Project Name:_____________________

Safety Action Plan

Purposes:

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.

All Personnel:

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.

Project Manager:

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.

In Agreement:

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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