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Programmatic Safety Plan (PSP): Required for High Risk Routine &
Repetitive Work
Contractor Name:

Our company is committed to Safety, Quality & Customer Service. More specifically, we are committed to perform work on behalf of PG&E in a
manner which ensures Public & Worker safety at all times as well as to providing a quality work product which meets or exceeds PG&E's
expectations. We will work in a manner which meets all of PG&E Standards and Procedures as well as all applicable regulations, ordinances &
permit conditions. This programmatic safety plan outlines, but does not limit, the specific measures we will be utilizing on a daily basis to
identify and mitigate hazards on PG&E work as well as ensuring worker and public safety. I am accountable on behalf of our organization for
ensuring that all requirements below are met anytime work is performed on behalf of PG&E, either directly or through a contractor.

Signed: Print name: Date:

 

Title: Responsible Person for implementing PSP/Title:

Accountable
Item # Action Description
Person

No work is started on behalf of PG&E without having clearly defined & established scope of work through a CWA,
1 contract or other written & signed PG&E contractual document. This scope of work is clearly communicated to our Owner
site supervision and is used in the process of preparing daily JHA.

Our company and our personnel have reviewed, understand and will follow all applicable safety regulations,
including but not limited to all PG&E, OSHA & all other applicable safety regulations. This specifically includes
2 Owner
being familiar with PG&E hazards associated with the SOW, our facilities, assets and the Contractor Safety
Standard (Utility Standard SAFE-3001S).

Our company will provide competent and experienced supervision and oversight for all personnel 100% of the time
3 while working on behalf of PG&E. In the case where we are performing work that requires additional qualifications Owner
(e.g. excavation work, fall protection, etc.) we will ensure that a competent or qualified person is present.
 Our company will ensure that only experienced, qualified and properly trained personnel are assigned to work on
4 behalf of PG&E. We will maintain training records for all personnel as required by OSHA regulations. Training Owner
records shall be made available to PG&E upon request.

Our company clearly understands and commits to subcontracting portions of our work only with the written
permission of PG&E. In cases where PG&E agrees to subcontract work, only PG&E qualified subcontractors will be
5 Owner
used. Approval includes the requirement of an A or B rating in ISN as well as a Gold Shovel Certification if the work
involves excavation.

Safety hazards are identified, communicated and mitigated. This involves all employees working on behalf of
PG&E
(1) This includes specifically holding an initial contract pre-start meeting and requiring a daily JHA and tailboard, to
review:
· The project scope of work
· All hazards associated with the work and mitigations
· Permit conditions
· Applicable PG&E safety policies
· The emergency response plan
Owner & Job
6 · Applicable Company IIPP sections associated with the work
Foremen
(2) Special emphasis includes communicating to all our employees:
· The right, obligation and responsibility to stop unsafe work
· Requirements for completing and documenting a JHA and holding safety tailboards with the entire job crew on a
daily basis, at the start of a new shift, or more frequently whenever conditions or the scope of work changes
· The requirement to keep records of all safety tailboards, JHAs and safety plans and make them available to PG&E
upon request
· An emergency response plan for each project, including providing closest medical facility and jobsite address.
This notification may take the form of one or more white board placards posted where they are visible to all
employees working at the site
· The obligation to immediately report to PG&E all safety incidents; including those involving the public

Every employee working on behalf of PG&E will have completed the appropriate personnel on-boarding, as
7 prescribed by PG&E, prior to starting work. Our company will maintain records of this onboarding. No personnel Owner
will be assigned to work on behalf of PG&E without having completed the assigned onboarding.

We will Conduct a JHA and safety tailboard with all construction personnel at a minimum once daily at the
Owner & Job
8 beginning of every shift and whenever new shifts start, new crews arrive, or conditions or scope of work changes.
Foremen
We will maintain JHA copies for a period of three years following the work.

SCOPE OF WORK: The standard scope of work performed on behalf of PG&E is ________________ (Add
9 Owner
typical scope of work performed by company here).
 HAZARD IDENTIFICATION: The hazards encountered as part of this scope could include, but are not limited to:

GENERAL HAZARDS GAS HAZARDS CRANE

 Uneven Ground/ Slips/ Trips &  Oxygen Deficient Atmosphere  Crane Capacity
Falls  Explosive Atmosphere - Burns /  Crane Size
 Confined Spaces Explosions  Load Weight
 Driving  Clearance Procedures / LOTO  Lift Plans
 Power Tool / Equipment Use  Dig-Ins / Line Strikes  Traffic / Transport
 Ergonomics  Unmarked or Mismarked Utilities  Setup/Access
 Loading / Off-loading Equipment  Stability / Terrain
and Material PUBLIC SAFETY  Rigging
 Unstable Ground Conditions  Distracted, Impaired, Unsafe  Cribbing
 Safety-At-Heights / Scaffolding / Motorists  Dangerous Operations
Ladders  Vehicular Traffic (Work Area  Driving
 Cave-ins/ Excavating / Trenching Protection)  Equipment Certification
/ Shoring  Pedestrian Traffic  Operational Certification
 Welding / Oxy Acetylene /  Proximity to Railroads  Electrical Hazards
Grinding  Equipment Grounding
 Fires/ Hot work EXCAVATION  Clearances
 Aggressive Animals / Dogs / Etc.  Access / Proximity to Energized  Environmental issues
 High Crime Areas Equipment Proximity to Energized
 Experience
Circuits
 PPE
10 HEALTH HAZARDS  OH/UG Energized Lines Owner
 Suspended Loads
 Chemical Exposure / Burns  Overhead Objects
 Weather Conditions
 Noise Exposure  Appropriate Tools & Equipment
 Pesticides / Fumigation  Equipment Certifications
TRAFFIC CONTROL / FLAGGINIG
 PCB / Lead / Mercury  Blasting Safety / Certification  Environmental Conditions
 Asbestos  Confined Space  Non-Compliant Drivers
 Other Soil Contaminants  Driving  Pedestrian Safety
 Hazardous Material  Environmental Issues  Permits
Transportation  Open Excavation / Fall Restraint  Public Safety
 Hazardous Waste Transportation  Fire Protection  Qualifications / Certifications
 Radioactive Exposure  PPE  Site Specific Hazards
 Proper Lifting / Ergonomics  Traffic Control Plan
ENVIRONMENT HAZARDS  Public Safety /Sidewalks / Roads  Low Light Conditions
 Weather Conditions  Soil Type / Conditions / Shoring /  Weather
 Poison Oak Sloping
 Work Site Protection
 Bees, Wasps, Snakes, Spiders  Site Safety
 Heat Illness  Slopes / Terrain
 Spoils Management
ELECTRICAL HAZARDS  Traffic / Transport / Flagging
 Clearance Procedures / LOTO /  USAs
Grounding  Work Site Protection
 Underground / Overhead Utilities  Weather
 Proximity to Energized
Equipment
 Induction

HAZARD MITIGATION: In addition to the safe work practices included in our Injury & Illness Prevention Program,
11 the specific hazard mitigation measures used on PG&E work will typically include: Add task, hazard, mitigation and
required training below for each major task performed on behalf of PG&E:

Task Description Hazard Description Hazard Mitigation Required Training Owner

   
Task 1
 

 
Task 2    
   
 Task Description Hazard Description Hazard Mitigation Required Training

   
Task 3    
   

   
Task 4    
   

   
Task 5    
   

   
Task 6    
   

We will regularly update this safety plan anytime our scope of work, hazards or mitigations change. We will ensure
12 Owner
all of our employees are briefed on this plan and are adhering to it at all times.

All of our employees working on behalf of PG&E will know and understand that they have the right, obligation and
13 Owner
the responsibility to stop and report any unsafe work.

All of our employees working on behalf of PG&E will have this safety plan readily accessible to them for their
review. Additionally, the emergency plan will be at the job location. All employs shall understand and follow this
14 safety plan and emergency plan. The emergency plan shall cover such items as emergency communication Owner
protocols, phone numbers, escape routes, emergency equipment, muster points, closest hospital and medical
facilities.

15 Note: This Programmatic Safety Plan is in addition to our existing IIPP.

16 Any additional items add below: