U.S.

Army Corps of Engineers Date of Inspection

Print Form
Safety Inspection Checklist
Accident Prevention Plan
Location (Plant or Facility) Contract Number

Contractor Name Project Name

Inspector Name (Print) Inspector Signature

This checklist serves as a guide only, it does not replace or eliminate the need to comply with the requirements set forth in
Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated 15 September 2008. The references included in this
checklist correspond to the applicable sections of EM 385-1-1.
Item Description Yes No N/A Remarks (Any NO or N/A item)
1. Signature sheet

a. Includes the title, signature, and phone number of the Plan

Preparer (Qualified Person, Competent Person, such as corporate
safety staff person, QC)

b. Includes the title, signature, and phone number of the Plan

Approver (company/corporate officers authorized to obligate the
company.)

c. Includes the name(s), signature(s), and title(s) for Plan

Concurrence (provide concurrence of other applicable corporate and
project personnel (contractor)) (e.g. Chief of Operations, Corporate
Chief of Safety, Corporate Industrial Hygienist, project manager or
superintendent, project safety professional, project QC.)

2. Background information
a. Includes the Contractor Name.
b. Includes the Contract Number.
c. Includes the Project Name.
d. Includes the Brief Project Description.
e. Includes the location of the project.
f. Includes the Listing of Phases of Work and Hazardous Activities
Requiring an Activity Hazard Analyses (AHA).
3. Statement of Safety and Health Policy. Includes a copy of current
corporate/company Safety and Health Policy Statement, detailing
commitment to providing a safe and healthful workplace for all
employees. Includes the Contractor's written safety program goals,
objectives, and accident experience goals for the current contract.

4. Responsibilities and Lines of Authorities

a. Includes a statement of the employer's ultimate responsibility for

the implementation of the SOH program

b. Includes the identification and job responsibilities of personnel

responsible for safety - at both corporate and project level –
including their resumes.
c. Includes the lines of authority.
CESO Checklist A-02, Apr 11
 U.S. Army Corps of Engineers Date of Inspection
Safety Inspection Checklist
Accident Prevention Plan
Item Description Yes No N/A Remarks (Any NO or N/A item)
5. Subcontractors and Suppliers
a. Includes identification of subcontractors and suppliers (if known).
b. Includes safety responsibilities of subcontractors and suppliers.
6. Training
a. Includes requirements for new hire SOH orientation training at
the time of initial hire of each new employee.
b. Includes the list of mandatory training and certifications
applicable to this project (e.g., explosive actuated tools, confined
space entry, crane operator, diver, vehicle operator, HAZWOPER
training and certification, PPE) and any requirements for periodic
retraining / recertification.
c. Includes the identity requirements for emergency response
training.
d. Includes the procedures for periodic safety and health training for
supervisors and employees
7. Safety and Health Inspections
a. Includes the name(s) of individual(s) responsible for conducting
safety inspections. (e.g., PM, safety professional, QC, supervisors,
employees)
b. Includes proof of inspector's training / qualifications.
c. Indicates when inspections will be conducted.
d. Furnished sample forms upon which inspections will be recorded.
e. Indicates deficiency tracking system and follow-up procedures.
f. Includes the names of competent and / or qualified person(s) and
proof of competency / qualification to meet specific OSHA
competent / qualified person(s) requirements.
g. Includes any external inspections / certifications which may be
required. (e.g., US Coast Guard)
8. Accident Reporting
a. The plan identifies how, when, and who shall complete the
Exposure data (man-hours worked).
b. The plan identifies how, when, and who shall complete accident
investigations, reports, and logs.
c. The plan identifies how, when, and who shall make immediate
notification of major accidents.
9. Plans (Programs, Procedures) required by the Safety Manual
a. Layout plans (04.A.01)
b. Emergency response plans:
(1) Procedures & Test (01.E.01)
(2) Spill Plans (01.E.01, 06.A.02)
(3) Fire Fighting Plan (01.E.01, 19.A.04)
(4) Posting of Emergency Telephone Numbers (01.E.05)
CESO Checklist A-02, Apr 11
 U.S. Army Corps of Engineers Date of Inspection
Safety Inspection Checklist
Accident Prevention Plan
Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address
all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:
Item Description Yes No N/A Remarks (Any NO or N/A item)
9. Plans (Programs, Procedures) continued.
(5) Man overboard/abandon ship (19.A.04)
(6) Medical Support. Outline on-site medical support and off-site
medical arrangements including rescue and medical duties for
those employees who are to perform them, and the name(s) of
on-site Contractor personnel trained in first aid and CPR. A
minimum of two employees shall be certified in CPR and first-aid
per shift/site (Section 03.A.02; 03.D)
c. Plan for prevention of alcohol and drug abuse (01.C.02)
d. Site Sanitation Plan (Section 02)
e. Access and haul road plan (4.B)
f. Respiratory Protection Plan (05.G)
g. Health Hazard Control Program (06.A)
h. Hazard Communication Program (06.B.01)
i. Process Safety Management Plan (06.b.04)
j. Lead Abatement Plan (06.B.05 & specifications)
k. Asbestos Abatement Plan (06.B.05 & specifications)
l. Radiation Safety Program (06.E.03.a)
m. Abrasive blasting (06.H.01)
n. Heat/Cold Stress Monitoring Plan (06.I.02)
o. Crystalline Silica Monitoring Plan (Assessment) (06.M)
p. Night Operations Lighting Plan (07.A.08)
q. Fire Prevention Plan (09.A)
r. Wild Land Fire Management Plan (09.K)
s. Hazardous energy control plan (12.A.01)
t. Critical Lift Procedures (16.H)
u. Contingency Plan for Severe Weather (19.A.03)
v. Float Plan (19.F.04)
w. Site-Specific Fall Protection & Prevention Plan (21.C)
x. Demolition plan (to include engineering survey) (23.A.01)
y. Excavation/trenching plan (25.A.01)
z. Emergency rescue (tunneling) (26.A.)
aa. Underground construction fire prevention and protection plan
(26.D.01)
bb. Compressed air plan (26.I.01)
cc. Formwork and shoring erection and removal plans (27.C)

CESO Checklist A-02, Apr 11

 U.S. Army Corps of Engineers Date of Inspection
Safety Inspection Checklist
Accident Prevention Plan
Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address
all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:
Item Description Yes No N/A Remarks (Any NO or N/A item)
9. Plans (Programs, Procedures) continued.
dd. Pre Cast Concrete Plan (27.D)
ee.Lift slab plans (27.E)
ff. Steel erection plan (27.F.01)
gg. Site Safety and Health Plan for HTRW work (28.B)
hh. Blasting Safety Plan (29.A.01)
ii. Diving plan (30.A.13)
jj. Confined space Program (34.A)
10. Risk Management Processes. Detailed project-specific hazards
and controls shall be provided by an Activity Hazard Analysis (0I.A.13)
for each major phase/activity of work.
Other Remarks

CESO Checklist A-02, Apr 11