Vectren Corporation
Vectren Contractor Safety Evaluation
RETURN SIGNED FORM TO :
Michael Preske
U.S. MAIL:
Vectren Corporation
Procurement Department
Attn: Michael Preske
1 N. Main Street, P.O. Box 209
Evansville, IN. 47702-0209 (or)
Facsimile:
812-491-4701 – email: mpreske@vectren.com
Questions:
812-491-4226
Company Name
Address
State & Zip Code
Telephone Number
Fax Number
Vectren (Primary)
Contact Person
Standard Industry Code
(SIC)***
Today's Date
Health & Safety Contact Name
Safety Contact Telephone
Number
Safety Contact E-mail address
***SIC may be found on the Internet at http://www.osha.gov/oshstats/sicser.html.
Vectren is committed to working with safe contractors. Therefore, Vectren has
established a "PASS / FAIL" criteria to help find contractors with effective safety
programs.
Before your organization will be allowed to work at a Vectren site, your safety
performance will be compared to the criteria specified below.
PASS / FAIL CRITERIA
If your organization does not pass our safety criteria, you are invited to explain why, and the steps
being taken to improve your safety performance. Vectren safety pass / fail criteria are as follows:
Pass – The organization's current Worker's Compensation Insurance Experience
Modification Rate (EMR) is less than or equal to 1.20, and the Total Recordable Incident
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Rate (TRIR) for the last calendar year is less than 20% above the industry average for the
organization's specific SIC, for OSHA Recordable injuries and illnesses per 200,000 hours.
Pass – The organization's current EMR is greater than 1.20 and the trend for the last
three years is downward, and no single EMR in that period is above 1.40, and the
OSHA Incident Rate for the last calendar year is less than 20 % above the industry
average for the organization's specific SIC, for OSHA Recordable injuries and
illnesses per 200,000 effort hours.
Fail – The organization cannot meet the criteria listed above.
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**Contractor Work Location (Please mark the appropriate Vectren location) –
*Power Plants ______ Gas _____ Electric _____
Other _________ (Designate area)
*Type of Work Performed/Services Rendered: __________________________________
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*If you marked “Power Plants” as your work location please read the following:
Vectren is an “owner member” of the Tri-State Industrial Safety Council (TSISC). Vectren is
one of many area companies in the Tri-State representing the TSISC. The TSISC is a
member of the Association of Reciprocal Safety Councils, Inc. (ARSC). ARSC is a national
organization supporting councils like the TSISC here in Evansville, IN. More information on
ARSC can be found at www.arsc.net.
Starting March 31, 2004 Vectren will be requiring all contractors and subcontractors engaging
in any electrical, mechanical, laboring, excavating, heavy equipment operating, steel erecting,
and/or other construction related work to have successfully completed and passed the “Basic
Orientation Plus” or the “Basic Orientation Plus-Refresher” course. NOTE: The “Basic
Orientation Plus-Refresher” has to be taken within a year after taking the “Basic Orientation
Plus.” If not taken within a year the employee will have to retake the “Basic Orientation Plus.”
Any persons supervising any of the work mentioned above will also be required to attend the
course (i.e. Foremen, General Foremen, Superintendent, Supervisor, Site Construction
Management)
The courses are held at the University of Southern Indiana. The cost to the employee is
$100.00 for the “Basic Orientation Plus” and $75.00 for the “Basic Orientation Plus-Refresher.”
Class size is limited. Participants must register and pay for their course by 2:00 pm one
business day prior to the class session. Register by phone or fax using VISA, MasterCard,
or Discover—call 812/464-1989 or fax registration to 812/465-7061. Upon completion and
passing the class the employee(s) will be issued a picture ID card. This card is good at other
representative companies of the TSISC.
Exemption: Some contracting work at our power plants will not benefit from the ARSC
training. At this time that work includes any pick-up/drop-off, clerical work, and office
cleaning/janitorial services. Visitors (i.e. upper management, sales representatives,
consultants, etc.) who are only visiting for a short time and not engaging in any work activity
nor supervising any work activity will not have to attend the course. Contact your project
manager if you are unsure about attending the course. If a contractor has completed the
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course from another ARSC represented council location (i.e. Kentuckiana Construction Users
Council – Louisville, KY) and can show an up-to-date card, Vectren will accept it.
If you have any questions regarding the required course contact Jason Street at 812/491-5397
or Bill Brown at 812/491-4160. If your company is interested in joining the TSISC call 812/4641816 for more information.
CONTRACTOR’S PAST PERFORMANCE AND
HEALTH & SAFETY PROGRAM INFORMATION
Worker's Compensation Insurance – Experience Modification Rate (EMR)
Please obtain from your insurance agent (or state fund, if applicable) your interstate
EMR for the last three (3) rating periods. If you do not have an interstate rating,
obtain your intrastate EMR. Then complete the following data:
Effective Dates
Modification Rates
Current policy year
1 year previously
2 years previously
Is your firm self-insured for Worker's Compensation Claims?
YES___ NO___
OSHA Recordable Incidents
Use your organization's OSHA 200/300 Log for the last three years to complete
the information below.
Some firms are not required to complete the OSHA 200/300 Log because they
have too few employees (less than ten at any time during the calendar year) or
are exempted by virtue of the services they perform. If you do not complete an
OSHA 200/300 Log, is it because your organization has too few employees?
YES___ NO___ N/A___
Does your organization perform a service, which is exempted from completing an
OSHA 200/300 Log?
YES___ NO___ N/A___
If you do not complete an OSHA 200/300 Log and you answered "No" to the
above questions, please explain
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Last full
calendar
Year
1 Year
Previous
2 Years
Previous
Fatalities
Injuries/Illnesses
with Lost Work
Days
Injuries/Illnesses
without Lost
Workdays
Total Number of
Injuries/Illnesses
___________Employee Hours
(Total employee hours worked last year (field, supervisory and clerical)
___________Last Calendar Year Total Incident Rate
(Total OSHA recordables x 200,000 / Employee hours)
_______________________________________________________________
Signature of person completing form:
______________________________________________________________
Date
By signing this document or typing my name and sending it electronically, I
am verifying that the foregoing information is true and accurate to the best
of my knowledge.
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GENERAL SAFETY REQUIREMENTS & RULES OF CONDUCT
THIS DOCUMENT DOES NOT REPLACE THE CONTRACTORS EXISTING SAFETY AND HEALTH
PROGRAM(S), PROVIDED THAT THEIR PROGRAM(S) MEET OR EXCEED THESE MINIMUM
REQUIREMENTS. CONTRACTOR’S EMPLOYEES NOT FOLLOWING THESE RULES WILL BE
REPORTED TO THE CONTRACTORS SUPERINTENDENT FOR THE JOB AND BE SUBJECT TO
REMOVAL FROM THE JOB SITE.
GENERAL SAFETY REQUIREMENTS & RULES OF CONDUCT
1. Contractors will comply with all applicable federal, state and local codes and regulations. Contractors
will also comply with site specific safety rules and programs provided by VECTREN relevant to the
work performed. The most stringent of these are applicable. Should VECTREN standards be more
stringent than federal, state or local codes, VECTREN standards shall govern.
2. Contractors will be responsible for providing their employees, and any subcontracted employers, with
all information provided by VECTREN. Contractors are responsible for establishing control measures
to protect their employees, and/or employees under their control, from exposures to hazards
(chemical, atmospheric health and physical) present at the work location.
3. The following activities are prohibited on the part of Contractor’s employees, agents or
representatives while on Vectren property or at a Vectren work site:

Possession, use or being under the influence of alcohol or illegal drugs.

Possession of firearms or other weapons.

Threatening or disorderly behavior, including but not limited to conduct that presents a danger to
persons or property, is detrimental to the reputation of Vectren, or is in violation of any local, state or
federal laws or regulations.

Theft, unauthorized use, or willful or careless damaging or destruction of Vectren property, or
property of another person.

Unauthorized solicitation, distribution of materials or other unwarranted interference with Vectren
employees or Vectren business operations.
The Contractor will be expected to take immediate appropriate action when made aware of any of the
above activity or conduct on the part of it’s employees, agents or representatives, including the
removal of the person or person’s involved from Vectren property or Vectren work site.
4. VECTREN policy prohibits contractor’s employees, agents or representatives from: Allowing
employees to perform work, while using prescribed or over-the-counter medication that can impair the
employee’s ability to perform work in a safe manner, i.e. operating heavy machinery or working at
elevations.
5. All contractors performing work regulated by the Department of Transportation that mandates drug
and alcohol testing shall comply with the guidance set forth in the DOT Safety Regulations. Failure to
comply with the program may result in removal from the project.
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6. The contractor will report any contractor personnel accidents, including vehicle and property damage,
requiring medical attention to the VECTREN project engineer or field representative immediately.
7. The Contractor will provide a copy of the accident investigation upon completion. Serious injuries
must be reported within 15 minutes even during off shifts to the plant contact.
8. Any contractor’s employee, who is unable to perform his/her job in a safe manner will be reported to
the contractor’s supervision for evaluation and possibly removed from the site.
9. Contractors will provide a competent person to the job site when performing scaffolding, fall
protection, excavations and/or trenching operations as required by State and Federal OSHA
standards. Documentation must be available.
10. Nothing in this document or in the project Scope of Work relieves the contractor from fully
understanding and complying with the Federal Occupational Safety and Health Act (OSHA), and all
other applicable laws, regulations, and standards.
11. Failure to comply with the VECTREN rules or Federal or State regulations may be cause for
termination of contract and disqualification for future bidding.
12. Any additional costs for safety and health by the contractor will be born by the contractor.
Contracts: Safety Considerations
All contracts must be evaluated for their potential to create a safety liability for VECTREN.

Each contractor will be required to submit a Contractor Safety Evaluation and Compliance Review
prior to the issuance of a Purchase Order or the commencement of any work activities at Vectren.

A Contractor’s safety history and performance, overall safety program, training, policies and
procedures, and management support are evaluated to be Approved or Not-Approved.

For the purpose of the Safety Evaluation, a CONTRACTOR is defined as a person and/or company
hired by Vectren to perform work on or off Vectren Property (including customer premises and right of
ways).
This definition does not include delivery personnel (i.e., vending machines,
rug/rag services, UPS or postal delivery services, or vendor service companies
delivering repaired parts, etc.) or utility/telephone service companies or
consulting/engineering contractors working only in offices, training rooms, etc.
and not directing or performing physical work.
Included in this definition are personnel who work periodically or regularly on
Vectren property (i.e., cleaning services, tree trimming, mechanical or electrical
contractors, gas construction, heavy equipment operators, etc.).
Any problems or questions will be handled by the Vectren Safety Department.
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