Office of Environmental Health & Safety CONTRACTOR SAFETY CHECKLIST & ORIENTATION CONTRACTOR INFORMATION Contractor Name: Project Services Planned: Duration of Project Services: Application Date: Contractor’s On-Site Responsible Representative: Name: Method(s) of communication: Signature: Pager Cell On-Site Office Other: Pager Cell On-Site Office Other: Olin College Representative/Host: Method(s) of communication: Instructions: Check “yes” when requirements are applicable and arrangements/details have been discussed/ reviewed. Check “no” if not applicable to work area or scope of project/service. Orientation must be completed before work begins. Distribution: Please forward this Contractor Safety Checklist form to the Assistant Director of Facilities Services via email russell.zacharias@olin.edu or bring the completed form to the Campus Center, Suite 332. 1 Building Access? Yes No Parking? Yes No Security/Access? Yes No Restricted Area(s)? Yes No 2 Emergency Procedures, Signals, Assembly areas? Yes No 3 Spill/Leak reporting procedures? Yes No 4 MSDS’s for all Hazardous materials are available? Yes No 5 Restrooms/Lunch Facilities/Storage facilities? Yes No Work Area Isolation? 6 Including but not limited to safe routing and Placement of cords, hoses, equipment, and tools Yes No 7 Welding/Cutting/Open flames? (Review Hot Work/Permit Procedures) Yes No 8 Hazardous tools to be used: (Power equipment, etc., Compressed gas cylinders? Describe: Yes No 9 Personal protective equipment needed to enter work area? Yes No 10 Work in confined space(s) (Program review required)? Yes No Document1 Page 1 of 3 Office of Environmental Health & Safety CONTRACTOR SAFETY CHECKLIST & ORIENTATION 11 Lock out/tag out? (Program review required)? Yes No 12 Demolition Activities? Yes No 13 Work area/activities requiring Fall Protection? Yes No 14 Heavy lifting/Hoisting/Rigging? Yes No 15 Work on electrical systems/equipment? Yes No 16 Removal of excess materials/wastes (hazardous or otherwise)? Yes No 17 Clearance or check in with IT required? Yes No 18 Ladder(s)/Platform(s)/staging/Lift(s) to be used? Yes No 19 Work effecting fire detection/suppression equipment (alarms/sprinklers/ fire pump)? Yes No Yes No Note: Coordinate as appropriate with Needham Fire Department & Facilities Services. 20 Interruption of emergency equipment use/accessibility? (Eyewashes/showers, Exhaust ventilation, Phone service, Egress routes) 21 Describe potential impacts & accommodations (noise, dust, odors, etc.) associated with the project/work: SIGNATURES The undersigned have reviewed & participated in the contractor safety checklist and orientation concerning hazards in the facilities in which work is to be performed. The opportunity to review Material Safety Data Sheets (MSDS’s) for hazardous materials in work areas has been provided. MSDS’s for materials associated with the work will be made available on site and have been discussed. The scope and schedule of services to be performed have been reviewed and discussed to minimize the potential for accidents, injuries, impacts to the environment, and workplace disruptions & interruptions. Individuals below have received & reviewed information regarding the location of emergency safety equipment as well as the procedures to follow in the event of an emergency evacuation. i Name Document1 Signature Employer Page 2 of 3 Office of Environmental Health & Safety Name i Signature Employer Add additional sheet(s) as necessary Document1 Page 3 of 3