contractor safety policies and procedures

SCHNEIDER ELECTRICNorth American DivisionSafety, Health and Environmental Procedures

Procedure Number:

PAGE 1 OF 25DATE EFFECTIVE:

NAME: Contractor Safety & Environmental Procedure SUPERSEDES: New PURPOSE: To ensure Contractors perform work on our sites

without posing a threat to their Safety or the Safety of our employees. They will also take all necessary measures to ensure the protection of human health and the environment. Safety and Environmental performance is a consideration in the Contractor administration and selection process.

Approval Initials Date Approval

Initials Date

ISSUED BY: Corporate DEPT: SH&E DISTRIBUTION: Non-Limited

ATTACHMENTSAttachment A Additional Site RequirementsAttachment B Contractor Approval ChecklistAttachment C Contractor Safety Information Data SheetAttachment D Contractor Orientation ChecklistAttachment E Contractor Site Safety RepresentativeAttachment F Sample – Letter of ApprovalAttachment G Contractor Job Site Safety ChecklistAttachment H Contractor Safety ReportAttachment I Contractor Safety Program Training LogAttachment J Contractor Hold Harmless Agreement

1. SCOPE

This policy applies to Schneider Electric North American Division and its subsidiaries and affiliates in North America (referred to collectively in this policy as “Schneider Electric”). Schneider Electric has prepared this Contractor Safety & Environmental Program to provide specific guidelines for determining the suitability of service providers relative to safety, health and environmental (SH&E) performance. This program applies to the following specific service providers:

Equipment installation or repair companies Electrical Services Companies Rigging/Crane Companies Building construction or repair companies

HVAC service and repair

Mechanical and Plumbing installation and repair

Food service organizations

Custodial service companies

Any other contractor or subcontractor used on site

Service providers contracted directly to Schneider Electric are evaluated and selected using the guidelines established in this Program. Each contractor utilized by Schneider Electric is evaluated to determine adherence to the intent and compliance with the requirements of this program. Contractor personnel at the site must comply with all applicable SH&E regulations and Schneider Electric’s SH&E policies and procedures.

2. PROCEDURE

This section describes the process for bidding and performing work for Schneider Electric. Service providers (as listed in the Scope) that will perform work on our site are subject to the requirements detailed in this section. The process of managing the Contractor Safety & Environmental Procedure is divided into three steps: A. Approval, B. Orientation, and C. Training, followed by audits. Each of these steps is described below.

A. Safety & Environmental Approval of ContractorsEach Contractor is reviewed and approved before being allowed to bid work that will be contracted directly to Schneider Electric. Approval consists of the following steps:

1) Each prospective Contractor is provided a copy of the Contractor Safety & Environmental Program and instructed to complete and submit the following:

Contractor Approval Checklist (Attachment B)

Contractor Safety Information Data Sheet (Attachment C)

Contractor Site Safety Representative (Attachment D)

2) The Contractor completes the required forms and submits these along with a copy of any specific written safety programs that will be used as part of the work (i.e., hazard communication, lockout/tagout, confined spaces, etc.)

3) The Schneider Electric representative (Safety & Environmental Mgr., Plant Engineer, Project Supervisor, etc.) reviews each Contractor’s submittal to determine if the company meets the minimum criteria for approval. Approval is based on the following:

Workers’ Compensation Experience Modification Rating (EMR) of 1.0 or less.

OSHA Recordable of less than 10.0 and Lost Time Accident frequency rates less than 3.0.

Hold Harmless Agreement from Contractor. (Attachment J)

Certificates of Insurance for WC, Auto, and General Liability (Attachment J)

Contractor Safety Programs contain the following:Safety & Environmental Policy Environmental Awareness (General)Hazard Communication/WHMIS Safety Rule EnforcementEmployee Rights & Responsibilities HousekeepingEmployee Access to Employee- Infectious ControlExposure and Medical Records Accident Reporting & InvestigationMachine Guarding Alcohol and Drug policyMaterial Handling (Manual Lifting) Unsafe Act/Condition Reporting

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Driving Safety Parking Lot SafetyElectrical Safety Personal Protective EquipmentEmergency Procedures Fall PreventionErgonomics Lockout/Tagout

Where applicable, the programs should also include:Confined Spaces Hearing ConservationRespiratory Protection Industrial Truck OperationsElectrical Safety Work-Related Practices

For Contractors renewing approval, review of completed Contractor Job Site Safety Checklist forms indicates positive findings during previous work.

Compliance with any additional site-specific SH&E requirements (Attachment A).

Understanding that all jobs bid will include an on-site supervisor.

Contractor will supply all necessary tools and equipment for the job. Schneider Electric tools and equipment will not be used by the contractor except in an emergency situation where human life is in danger.

4) Following the review, the Schneider Electric representative notifies the Contractor regarding the result of the approval process using the Letter of Approval form (Attachment F).

5) Each Contractor must renew approval at the beginning of each calendar year. With each bid, the Contractor submits a copy of the Letter of Approval (to verify prior approval) and an updated Contractor Site Safety Representative (Attachment E) form. When approval expires, the process outlined above is repeated.

B. Contractor Orientation

1) Prior to beginning work, the Contractor Site Safety Representative receives an orientation briefing from the Schneider Electric representative regarding requirements for working at the site. This briefing would include the following: Emergency Contact Information

All work on site requires the contractor to provide an on-site supervisor.

All work performed on-site will be with contractor’s tools and equipment. Schneider Electric tools and equipment will not be used.

Site Smoking Policy

Site Housekeeping Requirements

Parking and Site Access Restrictions

Schneider Electric’s Safety &Environmental Rules and Practices (Location SH&E Handbook)

Overview of the plant Environment policy including management of all generated wastes.

Overview of Zero Tolerance Policy regarding harassment and use of alcohol and/or drugs

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Emergency response information (alarm signals, location of shelter areas, etc.)

Notification requirements regarding accidents, incidents and near misses

Requirements regarding use of chemicals at the site and means of obtaining a Material Safety Data Sheet.

Required Personal Protective Equipment (PPE) while on the site

Required permits for performing the work and means of obtaining permits, i.e. hot work permit.

Use of ladders, scaffolding or rigging.

Fall protection policy at heights of 6 feet or higher.

Requirements regarding lockout/tagout

Electrical safety requirements, including no live work and appropriate PPE.

Location and hazards of confined spaces in the vicinity of the work area(s)

Use of electrical equipment and Ground Fault Circuit Interrupters (GFCI)

If there are any hazardous materials, i.e. PCBs or ACM’s, or noise control areas in the building.

Site-specific requirements regarding these items are outlined on the attached Contractor Orientation Checklist (Attachment D). The Contractor’s Site Safety Representative is responsible for training all onsite Contractor personnel in these and other site-specific requirements.

2) Contract Administration

Once work has begun, the onsite activity of each Contractor performing work for Schneider Electric is periodically reviewed to document compliance with provisions of the safety program. The Schneider Electric representative performs this review using the Contractor Job Site Safety Checklist (Attachment G). These reviews are performed according to the schedule presented below.

Project Duration Review ScheduleUp to one day Immediately prior to the conclusion of the workUp to one week At least once during the work

At the conclusion of the workMore than one week At least twice during the first week of work

At least once per additional week of work

At the conclusion of the workOngoing At least once per month

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For work that lasts one week or more, the Contractor must submit a report of onsite activities to the Schneider Electric representative using the Contractor Safety Report form (Attachment H).

The results of each review are communicated to the Contractor Site Safety Representative for corrective action. Results of these reviews are considered when determining whether to renew or maintain approval for the Contractor.

3) Withdrawing Approval for a Contractor

Schneider Electric reserves the right to terminate any approved Contractor for failure to comply with site rules and regulations and/or to correct unsafe conditions or practices.

Schneider Electric reserves the right to remove any approved Contractor from the “Approved Contractor List” for failure to comply with established safety rules and regulations or for allowing an unsafe condition to exist in the workplace. Upon correction of the deficiency, the Contractor’s name may be reinstated on the “Approved Contractor List.” Additionally, Schneider Electric reserves the right to terminate any agreement according to the terms and conditions of such agreement.

C. Training

The Schneider Electric Representative, during a Toolbox meeting, will communicate to Schneider Electric employees the requirements of the Contractor Safety &Environmental Program as well as any potential hazards introduced to their work area by the Contractor.

Employees who are involved in the evaluation process must be knowledgeable regarding the specific work that is to be performed. For example, employees who are qualified under the electrical safe work practices would review Contractor electrical safety programs.

Employees who perform reviews of the Contractor’s onsite activities shall be trained to recognize hazardous conditions and to complete the Contractor Job Site Safety Checklist (Attachment G).

All training shall be documented using the Contractor Safety Program Training Log (Attachment I).

3. DEFINITIONS

A. Contractor: A business that is in contract with Schneider Electric to perform a service or provide a product.

B. Experience Modification Rate (EMR): An evaluation of a company’s last three full years of workers’ compensation losses based upon payroll amount and their Standard Industrial Classification (SIC) Code. This evaluation compares the anticipated losses for a particular firm versus the actual losses experienced by the firm. An EMR of 1.0 means that actual losses were equal to anticipated losses.

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C. Hazardous Conditions: Any existing or potential condition in the workplace, which, by it-self or by interacting with other variables, can result in deaths, injuries, property damage, or other losses.

D. Lost-Time Accident Frequency Rate: The number of lost workday cases per 100 employees. These cases include recordable injuries that involve days away from work. To determine the frequency rate, multiply the total number of cases by 200,000 and divide the answer by the total employee hours worked.

E.E. OSHA Recordable Injury Frequency Rate: The number of OSHA recordable injuries per 100 employees. These injuries include all work-related deaths and illnesses and those work-related injuries that result in loss of consciousness, restriction of work or motion, transfer to another job, or medical treatment beyond first aid. To determine the frequency rate, multiply the total number of recordable cases by 200,000 and divide the answer by the total employee hours worked.

F. SIC (Standard Industrial Classification) Code: Classification system used by the Bureau of Labor Statistics, which groups business operations under a two, three or four-digit code. The Bureau associates vital statistics with each defined code. Injury rates compiled by the Bureau and associated with particular industries are used as baselines for determining performance against similar workplaces.

4. RESPONSIBILITIES

A. Location Plant Engineer

Maintains a current list of approved Contractors for use at his/her account locations

Authorizes, in consultation with SH&E, approval of any Contractor failing to meet the minimum valuation criteria as outlined in this Program.

Administers the written Contractor Safety Program. Requires evaluation of all Contractors submitting bids for work.

B. Schneider Electric Representative (Usually the SH&E Manager)

Ensures that Schneider Electric employees are trained and aware of potential hazards introduced to their work area by the Contractor (Documented in Toolbox meeting).

Ensures that all Schneider Electric employees understand and comply with the requirements of this Program.

Identifies Contractors whose work on-site could impact the environment and/or health and safety of employees at the site.

Provides or arranges a site orientation briefing for the Contractor Site Safety Representative regarding environmental health & safety requirements specific to the location and the Contract (Attachment D).

Informs Contractor Site Safety Representative of presence of toxic or hazardous chemicals and provides Material Safety Data Sheets (MSDS) as requested.

Coordinates appropriate safety procedures, e.g. lockout/tagout, hot work permits, access to restricted areas, etc. with Contractor Site Safety Representative.

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Performs general review of Contractor activities to document adherence with applicable SH&E requirements (Attachment F). All noted deviations from site requirements by Contractor personnel are reported directly to Contractor Site Safety Representative for correction.

Maintains copies of all documentation submitted by each Contractor related to approval, orientation and review of onsite work

C. Buyers

Use only approved Contractors from updated list.

Assist with identification of prospective Contractors for performing work at the site.

D. Employees

Notify immediate supervisor of any Contractor employee action that has or may result in a hazardous condition or behavior.

E. Contractors

Designate a “Contractor Site Safety Representative” who has responsibility and authority for ensuring compliance with the requirements of this Program.

Comply with current federal Safety and Environmental regulations and all applicable state and local laws, codes, rules, regulations or ordinances governing the work.

Ensure that all Contractor employees comply with applicable site SH&E requirements.

Ensure Contractor provides all necessary and appropriate tools and equipment, including personal protective equipment, required for safe completion of required tasks.

Utilize a workforce that is appropriately trained in all SH&E aspects of the job.

Provide documentation of employee training, as requested.

Maintain all equipment, tools and work areas in a clean and safe manner.

Obtain necessary permits for performing the work.

Provide for onsite first aid and emergency medical services.

Notify Schneider Electric’s Representative of any injury, incident or near miss involving Contractor employees while at the project location.

Perform inspection of work activities and areas for compliance with SH&E standards and procedures.

Inform Schneider Electric of any subcontractors to be used as part of the work and ensure these subcontractors comply with all SH&E requirements.

Provide a copy of the Contractor Safety Report (Attachment H) weekly and/or monthly according to the requirements of Schneider Electric.

Ensure that no Contractor activities endanger other personnel working at the site.

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Participate in all evacuation drills.

Accept that failure to comply with SH&E requirements, including failure to correct unsafe practices and conditions, are sufficient grounds for Schneider Electric to require work stoppage or termination of the contract agreement.

5. AUTHORITY

A. The Plant Engineer or Project Manager has the authority to implement this procedure and to review and audit the implementation of this procedure.

B. The SH&E Manager has the authority to update and audit this procedure.

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Attachment ADate:

ADDITIONAL SITE REQUIREMENTSThis attachment outlines SH&E evaluation and approval requirements which are in addition to those presented in the Schneider Electric Contractor Safety Program. These requirements include:(List or Attach Additional SH&E Approval Criteria)

Example: Additional requirement for electrical subcontractors:

Fire retardant PPE, CAT III measurement equipment, voltage rated gloves, 4/0 grounding cable with permanent connections, GFI in use

Evaluation, orientation and review additional service providers subject to these requirements:

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Attachment BDate:

CONTRACTOR APPROVAL CHECKLIST Yes No N/A

1. Has Schneider Electric’s Contractor Safety Information Data Sheet been completed?

2. Are all applicable Licenses / Permits completed and on file? (Attach copies)

3. Have all affected employees received appropriate training, including Hazard Communication Training as required by OSHA 29 CFR 1910.1200 or WHMIS?

4. Have any Safety or Environmental regulatory citations been issued to this company in the last 3 years? (If yes, attach a summary describing the inspection and resultant citation.)

5. Does this company have a mandatory substance abuse program? Pre-employment Screening?

Random Testing?

Testing for Cause?

6. Is there a light duty / restricted work policy?

7. Do all new employees complete Safety & Environmental Orientation prior to performing any work activities?

8. Are routine safety inspections conducted?

9. Are safety and environmental program audits routinely conducted?

10. Are on-site “toolbox” safety meetings routinely conducted?

11. Are accident investigations conducted and documented?

12. Does this company employ a Safety Coordinator, Safety Supervisor, or Director of Environmental, Health & Safety? (Please circle all that apply.)

13. Is a Safety / Health incentive program provided?

14. Is there a written Environmental, Health & Safety Program?

15. Does the program address the following key elements: Management commitment and expectations?

Employee participation?

Accountability / responsibility for managers, supervisors and employees?

Resources for meeting safety and health requirements?

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Attachment B (cont.)Date:

CONTRACTOR APPROVAL CHECKLIST Yes No N/A Periodic safety and health performance appraisals for all

employees? Hazard recognition and control?

A Confined Space Entry Program?

A “Hot Work” Permitting Program?

A Hazardous Energy Lockout / Tagout Program?

A Medical Surveillance Program?

A Personal Protective Equipment Program?

A Respiratory Protection Program?

A Fall Protection Program with employees tied off at 6ft. or higher?

Worker Exposure Monitoring Program?

A Powered Industrial Vehicle Program (Cranes, forklifts, JLGs, etc.)?

A Housekeeping Program?

An Emergency Preparedness & Evacuation Program?

A Waste Disposal Program?

A Fire Protection and Prevention Program?

A Recordkeeping Program (Training, inspections, audits, etc.)?

An Electrical Safety Program with “No Live Work Policy”?

A Tool and Equipment Inspection Program?

Do employees read, write and understand English such that they can perform their job tasks safely without an interpreter?

____________________________________ ____________________________________Signature of Contractor Signature of Contractor Safety Site Representative

____________________________________ ____________________________________ Phone Number Contact Phone Number

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Attachment CDate:

CONTRACTOR SAFETY INFORMATION DATA SHEET

Name of Vendor: ______________________________ SIC Code: __________

Man-hours Worked (for past three years): __________ ____________ _____________

Total OSHA Recordable Rate (for past three years): _______________ __________Rate Year

Rate = (Total Recordable Injuries) x 200,000/ _______________ __________Total Employee Hours Rate Year

_______________ __________Rate Year

Industrial average: __________ Year: __________

Lost Time Accident Rate (for past three years): _______________ __________Rate Year

Rate = (Total Lost Time Accidents) x 200,000/ _______________ __________Total Employee Hours worked Rate Year

_______________ __________Rate Year

Industrial average: __________ Year: __________

Number of Fatalities(for past three years): _______________ __________Number Year

_______________ __________Number Year

______________ __________Number Year

Industrial average: _________ Year: _________

__________________________________________ _____________Signature of Contractor Safety Representative Date

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Attachment DDate:

CONTRACTOR ORIENTATION CHECKLIST1.0 Emergency Contact Information Completed

Schneider Electric/Customer Resources: Office # Pager #Schneider Electric Project Manager

Contractor’s Safety CoordinatorSchneider Electric’s Facility Engineer

External Resources Office # Pager #Police/ Fire Department 911 or 9-911Local Medical FacilitiesSecurityHAZMAT Response Team

2.0 Site Smoking Policy Completed

___ Smoking is not permitted anywhere at this site. ___ Smoking is permitted ONLY in the following areas:

3.0 Parking and Site Access Restrictions Completed

Contractor employees are restricted from parking personal vehicles on site unless authorized by a Site Representative. Parking is available at

__________________________________________________. (This is /is not a secure lot that is patrolled regularly by site security.)

Shuttle/bus service is available from the hours of ___:___ AM/PM to ___:___ AM/PM.

Parking on-site is limited. If driving a company vehicle, arrangements for parking on site must be made with a Site Representative.

Speed Limit --- __________mph

Sit only in seats that are provided and have seatbelts

Yield to pedestrians approaching the service roads

Come to a complete stop at Stop signs.

Park only in approved, designated parking spots as authorized by the Site Representative

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Attachment D (cont.)Date:

CONTRACTOR ORIENTATION CHECKLIST

4.0 Site Housekeeping Requirements Completed

It is the responsibility of the Contractor employees to maintain a clean and orderly work area to minimize fire and fall hazards. It has been proven through OSHA statistics that poor housekeeping

leads to slips, trips, and falls on construction sites. Therefore, when contracted work has been completed or at the end of the work day/shift, Contractor ensures that the area is clean.Employees shall immediately notify their Supervisor of any perceived fire or fall hazards.

Clear access shall always be maintained in Contractor working areas to electrical panels, fire extinguishers, safety showers and eyewash stations, and fire hydrants. Non-compliance with this

policy may impede the response time of emergency responders and cause unnecessary delays in the event of an emergency.

5.0 Schneider Electric’s Safety & Environmental Rules and Practices (Location SH&E Booklet)

A copy of this document may be obtained from the Schneider Electric representative.

Completed

6.0 Overview of Zero Tolerance Policy regarding Sexual Harassment and Discriminatory Behavior Completed

Schneider Electric has a ZERO TOLERANCE policy for both sexual harassment and discriminatory behavior. Unprofessional behavior that creates a hostile work environment for individuals with regard

to Age, Race, Religion, Physical Disabilities, or Sexual Orientation will not be tolerated. Both types of behavior are very subjective and difficult to defend against. If a complaint is registered,

by law Schneider Electric will pursue that complaint to the extent that the law requires. Violators will be removed from the site.

7.0 Overview of Zero Tolerance Policy regarding Alcohol and Drug Use Completed

Employees and visitors shall not report to work at the site under the influence of any substance that may affect their ability to safely perform their work, operate equipment, make conscientious decisions,

or that may in any way jeopardize the health and safety of other employees.If there is reason to believe that someone is under the influence of such a substance, that person may be asked to submit to drug testing or leave the site. If a controlled or illegal substance is suspected,

the proper authorities will be contacted.Illegal substances shall not be brought to the site. Anyone taking prescribed medication and/or who is

under the care of a doctor shall notify their immediate supervisor who will then tailor their work assignment accordingly.

8.0 Emergency response information (alarm signals, shelter areas, etc.)

A copy of this document may be obtained from the Site Representative. Completed

9.0 Notification requirements regarding accidents, incidents and near misses


10.0 Requirements regarding the use of chemicals at the site and means of obtaining a Material Safety Data Sheet.


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11.0 Required Personal Protective Equipment (PPE) while on the site Completed

Contractors are responsible for providing their employees with proper Personal Protective Equipment (PPE) to protect them while they are working and must train them in the proper inspection,

maintenance, and safe use of that equipment. Contractors are responsible for conducting job assessment to determine the proper PPE necessary for each job.

At a minimum, construction employees are expected to wear hard hats and appropriate work boots, plus ANSI Z-87-approved safety glasses with safety frames and side shields at all times. Additionally,

harnesses, respirators, gloves, face shields, and hearing protection are typically required in most construction zones. In plant areas, steel-toed shoes are required, and strongly recommended in

construction areas.Fall Protection

100% tie-off

6’ tie-off required in all circumstances (Steel Erection, Scaffold Erection, etc.)

5,000 lb. Anchorage required

Employees must be trained in proper inspection, maintenance and safe use of equipment.

Respirators Require written program

Medical approval for all employees utilizing respirators

Training

Hearing Conservation If the work area is above 90dB on the TWA, a written program and hearing protection is required.

12.0 Required permits for performing the work and means of obtaining permits Completed

_____ Hot Work PermitAnything that generates heat, flame or spark, OR any electrical hot work (Live electrical panels or circuits) requires a hot work permit. An appropriate Fire Extinguisher, dedicated trained fire watch

person (who understands elements, stages, and causes of fire, etc.), and an evaluation of explosive/flammable atmospheres is necessary.

_____ Confined Space Entry PermitThis requires a site-specific program. All companies conducting confined space entries must submit a written program and documented evidence that their employees have been adequately trained in their duties and hazards associated with their work. Contractors must provide their own calibrated monitors

and rescue equipment._____ Lockout/Tagout Permit

This requires a site-specific program. Contractors must coordinate their Lockout/Tagout procedures with those existing on-site. Once affected circuits, piping, dissipated hazardous energy, switches, valves and/or other processes have been identified by the Customer and/or Schneider Electric,

contractor personnel shall place their own lock on the Customer’s lock to ensure against accidental start-up.

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13.0 Use of ladders, scaffolding or rigging Completed

_____ LaddersSee Fall Protection Procedure for ladder and scaffolding safety.

_____ ScaffoldingAll cross braces and handrails must be installed. A competent person is required for scaffold erection

and inspection. Scaffolding is to be inspected daily by a competent person and the inspection tags signed. Tagging systems are site-specific.

_____ RiggingAll rigging must have a legible load tag and must be inspected before each pick. Riggers shall be designated as competent persons. Chains are not allowed except for use with a chain fall. Only

synthetic or wire rope slings are allowed.

Information regarding Other Permits as required by site and the means for obtaining these permits is available from the Site Representative.

14.0 Requirements regarding lockout/tagout.


15.0 Location and hazards of confined spaces in the vicinity of the work area(s)

A copy of this document may be obtained from the Site Representative.

Completed

16.0 Use of electrical equipment and Ground Fault Circuit Interrupters (GFCI)

All electrical equipment must be connected to a GFCI. Tools shall be regularly inspected for defects (cuts, exposed insulation, missing ground pin, etc.). Tools with damaged cords or plugs shall be removed from service immediately.

Completed

Other Site Specific Requirements Completed

Completed

Completed

Completed

Completed

______________________________ _____________________________Signature of Contractor Signature of

Contractor Site Safety Representative

____________________________________ ____________________________________Phone Number Contact Phone Number

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Attachment EDate:

CONTRACTOR SITE SAFETY REPRESENTATIVECONTRACTOR SITE SAFETY REPRESENTATIVE

Name of Contractor:

Project Identification:

The following named person is the Contractor Site Safety Representative for the above referenced contract.

He/she is capable of identifying existing and predictable hazards in the surroundings or working conditions that

are unsanitary, hazardous, or dangerous to employees. In addition, this employee is the contact person

between Schneider Electric and ________________________________________ (insert name of Contractor), in

the event that Schneider Electric personnel observe any unsafe condition, practice, etc.

Name of Contractor Site

Safety Representative: ________________________________________

Appointed by: _______________________________________________

Title: ______________________________________________________

Signature: __________________________________________________

Date: ______________________________

Submit this form with each bid.

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Attachment FDate:

SAMPLE – LETTER OF APPROVAL

(Date)

Contractors NameAddress 1Address 2City, State - Zip Code

Dear :

Thank you for submitting application for approval to work for Schneider Electric.

Our review indicates that your past safety performance, based on OSHA frequency rates and experience modification rate (EMR), meets (does not meet) our criteria for approval. Reviews of Environmental, Health & Safety (HAZCOM, Bloodborne, etc.) programs submitted by your firm indicate that they are acceptable (not acceptable).

This letter is valid through the end of the calendar year. Should your firm demonstrate non-compliance to established site safety rules and regulations, revocation of approval status may result.

During this period, you are approved to submit bids for and perform contract work at the Schneider Electric Site located at: (Location). You need only to attach a copy of this letter to your bid.

Thank you for committing to “Working together – SAFELY.”

Sincerely,

Schneider ElectricNameTitle

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Attachment GDate:

CONTRACTOR JOB SITE SAFETY CHECKLIST

Contractor: ________________________________________ Date: ___________________

Job Location: ________________________________________

Project Title: _________________________________________

Evaluated by: _________________________________________

Some of the questions in the checklist may not apply to all job sites; conversely, additional questions may be necessary.

Category Acceptable N/A RemarksPERSONAL PROTECTIONHead ProtectionHearing Protection“Safety” GlassesFace shieldRespiratory protectionSafety full-body harness (man-lifts, above grade, personnel baskets)Protective clothingEquipment guards on equipmentFoot protectionGlovesELECTRICAL TOOLS/EQUIPMENTCovers on boxes, switches, receptacles (tight-fitting) or double insulatedPower tools and appliances groundedWelding machine groundedGround fault interruptersGround extension cord with good connectorsPNEUMATIC TOOLS/EQUIPMENTPower tools secured to hoseDevice at air source to reduce pressure if hose failsPERMITSConfined SpaceStandby personnelHot WorkFire extinguisherAppropriate permit for work displayedPermit has appropriate signaturesEXCAVATIONS AND TRENCHINGSloping, stair-stepping or shoring of wallsLadder or steps in hole/trench for quick exitWarning tape or barriers installedAll nails on boards removed or bent over

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Attachment G (cont.)Date:

CONTRACTOR JOB SITE SAFETY CHECKLIST CONTRACTOR JOB SITE SAFETY CHECKLIST CategoryCategory AcceptableAcceptable N/AN/A RemarksRemarks

SCAFFOLDS/LADDERSLadders meet construction standardsAdequate footingsScaffolds are plumb and securedToe boards/guard rails in placeAccess ladder to elevated work platformLadders tied offAdequate working platforms on scaffoldsCOMPRESSED GAS CYLINDERSSecure in an upright positionMetal valve caps must be in place on all cylinders not in useStore spare oxygen and combustible gas cylinders 20 feet apart or separated by a five foot high barrierSUSPENDED LOADSSecured by tag line to prevent swinging No personnel working beneath loadWire lines and connectors inspected/certifiedFUEL CONTAINERSApproved cans properly labeledStorage of flammable liquids in designated areas onlyBulk storage of fuels vented, labeledVEHICILE AND MOBILE EQUIPMENTBacked-up alarms on mobile equipmentLoad chart displayed inside equipmentOverhead guards on forkliftsWORKING SURFACESClear of tripping hazardsNon-slip surfaces on floors or rampsFloor openings guardedStairs designed with hand rails, treads, risers, angles that meet standardsWASTE DISPOSALTrash and rubbish removed dailyHazardous wastes segregated for proper disposalOTHER

COMMENTS

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Attachment HDate:

CONTRACTOR SAFETY REPORT

Contractor’s Name ____________________________

Project Manager / Superintendent _____________________________

Safety Representative _________________________

Month Ending ________________________________

Project SafetyCoordinator ________________________________

Project _____________________________________

INSTRUCTIONS: Complete Sections 2, 3 and 4. The Contractor Project Manager or Superintendent must sign the report and return to the Schneider Electric Project Manager.

1. SIGNIFICANT ACCOMPLISHMENTS, INCIDENTS, NEAR MISSES, OR ISSUES REQUIRING SPECIAL ATTENTION (log daily activities here)

2. HAZARDOUS MATERIALS USED ON SITE/SHIPPED OUT

Date(s) SubstanceDescription

Unused TotalIn Storage

Gallons ofWaste Generated

Total Gallons ofWaste in Storage

3. SAFETY MEETINGS/TOOL BOX TALKS

Date(s) Conducted by Topic Description No. of Participants

4. INJURY ANALYSIS STATUS

TOTAL MAN-HOURS

NUMBER OF EMPLOYEES

TOTAL OSHA RECORDABLES

TOTAL LOST TIME ACCIDNTS

TOTAL LOST TIME WORKDAYS

SIGNATURESContractor Site

Superintendent _____________________________

Contractor SafetyRepresentative _______________________________

Date _______________________________________

Project SafetyCoordinator ________________________________

NOTE: Please attach additional information with this form as needed.

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Attachment IDate:

CONTRACTOR SAFETY PROGRAM TRAINING LOGCONTRACTOR SAFETY PROGRAM TRAINING LOG

Instructor: _____________________________

I have trained the employees listed below on the Contractor Safety Program.

Instructor Signature: ____________________________

Employee NameEmployee Name Employee SignatureEmployee Signature DepartmentDepartment DateDate

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Attachment J Date:

Hold Harmless Agreement

Date:

To:____________________________________________________________________

Dear

Subject:

Enclosed are our insurance requirements and a copy of our Indemnification and Hold Harmless Agreement. Prior to any _________ work being started, the Contractor(s) must comply with our insurance requirements, as evidenced by them forwarding a Certificate of Insurance meeting the amounts outlined on the enclosed, and they must execute the Hold Harmless Agreement, and forward it to my attention. They can fax them to me at (847) 925-7378.

Thanks for your help with this matter.

Sincerely,

________________

cc:

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Attachment J (Cont.)

(Page 1 of 3)INDEMNITY AND SAVE HARMLESS AGREEMENT

The undersigned party (hereinafter the CONTRACTOR), as inducement for, and as consideration for, the execution by SCHNEIDER ELECTRIC/SQUARE D COMPANY (hereinafter the COMPANY) of the purchase order or agreement identified below (hereinafter the CONTRACT) and notwithstanding any terms or conditions of the Contract to the contrary, agrees to protect, defend, indemnify and save harmless the COMPANY and its parent, subsidiary and affiliated companies, if any, from and against any and all liability, loss, damage, expense, claims and demands of every kind and character (hereinafter damage claims), arising from the negligence of the CONTRACTOR, whether due to the CONTRACTOR’S joint or sole negligence, provided, however, that the Contractor shall not be liable by reason of this agreement for any payment of damages to the extent arising out of damage claims resulting from the negligence of the COMPANY. The CONTRACTOR shall at its own expense investigate all damage claims, except those damage claims resulting from the negligence of the COMPANY, and shall defend any and all actions based thereon and shall pay all costs, damages, awards and expenses of whatever nature, including attorney’s fees arising from the joint or sole negligence of the CONTRACTOR. For the purpose of this agreement, violation of an applicable safe place statute by the CONTRACTOR will constitute negligence and any damage claims arising out of such negligence shall be subject to the provisions of this agreement. The CONTRACTOR agrees to furnish the COMPANY with a certificate, in a form satisfactory to the COMPANY, evidencing that the foregoing obligations are adequately covered by policies of insurance issued by a carrier satisfactory to the COMPANY.

Identification of Contract:

Name of Contractor

(Authorized Signature)

By:

Title:

Date:

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Attachment J (Cont.)(Page 2 of 3)

Contractor shall maintain in force at all times during the course of this work at least the following types and amounts of insurance with insurance companies rated A or better and financial size not less than X by A. M. Best Company:

Description of CoverageContractor Category AAmount of Insurance

Contractor Category BAmount of Insurance

Workers' Compensation (U.S. Only) (Alternatively Contractor can supply proof as a state qualified self-insured company)

Statutory Statutory

Employers' Liability (U.S. Only) $100,000Each Accident and Disease

$500,000Each Accident and Disease

Comprehensive General Liability Insurance (Written on a Comprehensive Occurrence Form) including the following:

Combined Single Limit Bodily Injury and Property Damage$500,000 Per Occurrence

Combined Single Limit Bodily Injury and Property Damage$2,000,000 Per Occurrence

• Premises/Operations Liability

• Products/CompletedOperations Liability

• Contractual Liability(To cover the Indemnity and Save Harmless Agreement)

• Broad Form Property Damage

• Independent Contractors(Required if Contractor employs subcontractors for work or service)

Automobile Liability Insurance for any Auto Owned, Non-owned, Leased, Rented or Hired and used in the fulfillment of this agreement

Combined Single Limit Bodily Injury and Property Damage$500,000 Per Occurrence

Combined Single Limit Bodily Injury and Property Damage$2,000,000 Per Occurrence

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Attachment J (Cont.)(Page 3 of 3)

An Umbrella or Excess Liability policy may be used to increase basic limits to the required levels.

Contractor Category A:

Contractors who provide work or service (including work or service on electrical systems less than 110 volts) which does not involve the use of ladders over 8’ in length, scaffolding, power tools (other than small power hand tools), cutting/welding equipment or heavy machinery.

Contractor Category B:

All other categories of work or service as defined in this procedure including Contractors who do not qualify under Contractor Category A above.

Certificate of Insurance:

Prior to commencing work, and thirty (30) days prior to the expiration of any insurance required herein, Contractor shall furnish Square D Company with a Certificate of Insurance, in a form acceptable to Square D Company. The Certificate of Insurance must be signed by an authorized representative of Contractor’s insurance company and show that the insurance coverages and limits of liability shown above are being provided by Contractor’s insurance company, showing the effective and expiration dates, policy numbers and insurer, acknowledging Contractual Liability Insurance for this Agreement, name Square D Company, its parent company and subsidiaries, and their directors, officers and employees as an additional named insured under their Comprehensive General Liability Insurance policy and waive right of subrogation against Square D Company under Workers’ Compensation Insurance. The Certificate of Insurance shall also contain the following statement: “No reduction, cancellation or expiration of any of these insurance policies shall become effective until at least thirty (30) days written notice thereof is received by Square D Company.”

Contractor hereby agrees to execute the Indemnity and Save Harmless Agreement attached hereto and made a part of this Agreement, prior to commencement of the work.

The insurance requirements shall survive this Agreement. Square D Company shall have no obligation to review or verify the existence of Contractor’s insurance. The consent of Square D Company to the insurance and limits shown above shall not be considered as a limitation of Contractor’s liability under this Agreement nor an Agreement by Square D Company to assume liability in excess of said amounts or for risks not insured hereunder. Failure of Contractor to maintain complete insurance does not lessen Contractor’s liability and may be deemed a material breach allowing Square D Company to terminate this Agreement.

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ContractorA.DOC

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contractor safety policies and procedures

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