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UTCANJ – OSHA

Construction Industry Safety Partnership
Utility & Transportation Contractors Association Occupational Safety and Health Administration

1 Executive Summary

1.1 The goal of this program is to develop a statewide industry partnership between the construction industry, labor and government, that will encourage New Jersey's contractors to improve their safety and health performance, assist them in their efforts, and recognize contractors with exemplary safety and health programs.

1.2 Specifically, the program has two overriding goals:
    1.2.1 To improve worker safety and health in the New Jersey construction industry; and

    1.2.2 To accomplish this goal in an environment of cooperation among the participating organizations.
1.3 The program is to be conducted within the state of New Jersey. The partnership will be available to all heavy-highway, marine, utility, and environmental remediation contracting firms that are members of the Utility and Transportation Contractors' Association of New Jersey (UTCANJ).

1.4 Expected outcomes of the program include: allowing OSHA to focus resources toward contractors who have ineffective safety and health programs for their employees; developing criteria for a model contractor safety and health program; mentoring of others in the state of New Jersey's construction industry by partnering with member contractors; and making new safety and health materials available to all contractors who are members of this partnership.

1.5 The partnership will provide incentives to participating contractors who voluntarily improve their safety and health performance. Incentives will include special recognition from OSHA, commensurate with their level of safety and health achievement.

1.6 This partnership program is consistent with OSHA's long-range efforts to develop a business/labor/government partnership approach to safety management. The partnership allows for better use of OSHA resources, fosters innovation in safety management, and encourages more participation in the safety process by employees and the New Jersey Heavy-Highway construction community.

1.7 Perhaps most importantly, this program will help create private and public sector incentives for improved safety. Owners may choose contractors who are participants in the partnership and have demonstrated their commitment to safety for their projects.

2 Utility and Transportation Contractors' Association of New Jersey (UTCANJ) – OSHA Construction Industry Safety Partnership (C.I.S.P.)

2.1 Program Expectations

2.2 Employers, Labor and other organizations are encouraged to endorse and participate as signatory partners in the C.I.S.P. They are encouraged for the following reasons:
    2.2.1 Implementation of this program is expected to result in decreased serious injuries, illnesses, and fatalities for participating contractors and improvement of the participant's existing safety and health programs.

    2.2.2 This agreement provides incentives for construction contractors that voluntarily participate in the C.I.S.P. and demonstrate implementation of effective safety and health programs.

    2.2.3 This agreement will not in any way affect employees' exercise of rights under the OSH Act and OSHA regulations including protection from discrimination for exercising such rights.
3 Background (UTCANJ/OSHA Partnership History)

Utility and Transportation Contractors Association of New Jersey and the United States Department of Labor, Occupational Safety and Health Administration have a history of cooperative efforts, strategic alliances, and partnerships dedicated to improving safety and health among contractors in New Jersey.

UTCANJ and OSHA have worked cooperatively, with other agencies and organizations, to establish the nationally recognized New Jersey Highway Workzone and New Jersey Pilot Silica Partnerships. The UTCANJ continues to work cooperatively in the development of the New Jersey Silica Engineering Control Research Alliance, the first of its kind in the Nation.

UTCANJ and OSHA believe jointly that cooperative efforts, willingness to listen to concerns of interested parties, willingness to learn from previous efforts and efforts to understand each partner's concerns, requirements and philosophy, will benefit the industry, the regulators, and ultimately will provide a safer and healthier work environment for the entire New Jersey heavy, highway, utility, marine and environmental remediation Construction Industry.

4 Goals

The expectations of the Partnership are:

4.1 To reduce by 4% annually the number of injuries and fatalities affecting participant employers, with an emphasis on reducing injuries and fatalities resulting from the four focused construction hazards (falls, struck-by, caught-in\between, and electrocutions).

4.2 Decrease contractors' EMR rates and/or workers compensation costs from the time of application throughout the term of the partnership.

4.3 Increase the implementation of effective contractor safety and health programs.

4.4 Increase accessibility to quality safety and health training and education, thereby raising safety and health awareness for both employees and contractors by:
    4.4.1 Providing OSHA 30-hour training to all field supervisory employees of participating contractors, throughout the term of the partnership, and

    4.4.2 Providing the OSHA 10-hour Construction Safety & Health course to a minimum of 10 % of all workers per year throughout the term of the partnership.
4.5 Provide a leadership role for the industry.

4.6 Allow OSHA to better focus resources on firms that require increased assistance, rather than firms that have implemented effective, meaningful safety and health programs for their employees.

All parties will be consulted on a continuing basis to assess progress in achieving these goals.

5 UTCANJ Commitment/Role

5.1 Representative(s) from the UTCANJ will administer this program as outlined herein and will serve as the primary safety and health resource, supporting the participating contractors and employees. To fulfill this Partnership, the UTCANJ will also provide the following services:
    5.1.1 Act as a liaison for UTCANJ members with OSHA. Members will be able to call the UTCANJ with questions and the UTCANJ will contact OSHA for responses, if required. This commitment does not negate members' rights to contact OSHA directly if they so choose.

    5.1.2 Provide up-to-date publications, brochures, and other informational materials (from OSHA, OSHA's New Jersey On-Site Consultation Services, and other appropriate organizations) to the UTCANJ Partnership members.

    5.1.3 Foster improvement and promotion of worker safety and health among UTCANJ membership by facilitating communications between OSHA and employers.

    5.1.4 Assist contractors of all sizes, especially small contractors, in understanding OSHA's requirements and emerging issues impacting workers' safety and health.

    5.1.5 Together with Participant Contractors, provide leadership, guidance, and a positive example to other contractors on issues relating to safety and health.

    5.1.6 Develop and build written safety and health policies and programs for participating contractors, including emphasis on contractor/employee responsibilities.

    5.1.7 Promote construction safety and health excellence through an annual UTCANJ-OSHA Partnership Safety and Health Recognition Program.

    5.1.8 Notify OSHA on a regular and recurring basis of the name(s) of contractor(s) that have met the partnership criteria.

    5.1.9 Conduct periodic audits to determine the impact and effectiveness of this partnership with OSHA.
6 OSHA's Commitment/Role

6.1 OSHA Incentives For All Platform Level Participant Contractors
    6.1.1 OSHA will conduct meetings quarterly with the UTCANJ and participating contractors, to provide information on emerging issues and to answer general and specific questions. Additionally, OSHA is committed to meeting quarterly with the UTCANJ as part of the Partnership Advisory Committee (see section 7 of this document for the PAC's commitment/role).

    6.1.2 To the extent resources allow, OSHA will provide training and technical support to partner contractors to assist them in developing safety and health management systems.

    6.1.3 To the extent resources allow, OSHA, through the New Jersey Department of Labor and Workforce Development-OSHA Consultation Program will provide free on-site consultation to those employers who qualify, to assist them in developing safety and health management systems.

    6.1.4 Other than Regulatory violations (e.g., 29CFR 1903 and 1904), no penalties will be assessed for other-than-serious violations provided they are abated the same day as the inspection.

    6.1.5 Participating contractors will receive the maximum allowable good-faith penalty discount as OSHA policy allows.

    6.1.6 Participating contractors will be given a penalty reduction for the "Quick Fix" of violations in accordance with OSHA Directive CPL 2.112.
6.2 OSHA Incentives for RED Platform Level Participant Contractors
    6.2.1 RED Platform Level Participant Contractors:

      6.2.1.1 Will be recognized by OSHA and UTCANJ by way of providing a certificate from the UTCANJ designating the contractor as a RED Platform Level Participant Contractor in the UTCANJ Partnership.
6.3 OSHA Incentives for WHITE Platform Level Participant Contractors
    6.3.1 WHITE Platform Level Participant Contractors:

      6.3.1.1 Will be recognized by OSHA and UTCANJ by way of providing a certificate from the UTCANJ designating the contractors as a WHITE Platform Level Participant Contractor in the UTCANJ Partnership.

      6.3.1.2 Will be eligible for a 35% discount on penalties, through the established OSHA Region 2 Expedited Informal Settlement Agreement (EISA) policy, instead of the 25% offered to some non-participants.

      6.3.1.3 In the event an OSHA inspection does occur, WHITE Platform Level Participant Contractors will be eligible for "Focused" inspection s in accordance with established OSHA policies for Focused Inspections (CPL 2.103, September 26, 1994, FIRM, Chapter II section A.1.b and OSHA Guidance to Compliance Officers for Focused Inspections, August 22, 1994 (Revision 2 (9/20/95)).
6.4 OSHA Incentives for BLUE Platform Level Participant Contractors
    6.4.1 BLUE Platform Level Participant Contractors: After successful conclusion of an OSHA verification inspection, OSHA and the UTCANJ will provide the following incentives:

      6.4.1.1 Recognition from OSHA and UTCANJ designating the contractor as a participant in the UTCANJ program by way of a job site sign for each site in the state, a plaque for the contractor's corporate office and a certificate to display on each job site inside the job site trailer or office. The cost of the above shall be borne by UTCANJ.

      6.4.1.2 BLUE Platform Level Participant Contractors within the jurisdiction of the OSHA Area Offices participating in this partnership, will not receive a programmed inspection within the twelve months following their verification inspection. BLUE Platform Level Participant Contractors who are General Contractors will qualify for construction site inspection deferrals if the conditions described in section 7.1.3 are met.

      6.4.1.3 During an OSHA inspection of other contractors at a site where a BLUE Platform Level Participant Contractor is not the General Contractor, the BLUE Platform Level Participant Contractor whose program has been verified by an OSHA inspection within the last twelve months will not be included unless the Compliance Officer documents that the participant is responsible for any employee exposures to serious hazards such as fall, struck by; caught in/between or electric hazards.

      6.4.1.4 Participants participating for two years or more at the BLUE Platform Level will be encouraged to apply for participation in the OSHA Challenge program or OSHA's VPP Program if the participant so desires.
6.5 Complaint / Referral Investigations
    6.5.1 This partnership provides for the immediate response to each allegation of a safety and/or health hazard brought to the attention of any participating contractor. Upon finding any valid allegations, the contractor shall promptly abate the hazard.

    6.5.2 OSHA agrees that a copy of each non-formal complaint/referral related to work sites of participating contractors will be forwarded by fax to the UTCANJ and the appropriate contractor.

      6.5.2.1 An investigation by the participating contractor will be conducted as soon as possible after receipt of the complaint/referral.

      6.5.2.2 A written response outlining the investigation findings and any corrective action taken will be faxed to OSHA and UTCANJ within two workdays.

      6.5.2.3 Failure to meet these time frames will place the complaint/referral beyond the scope of this partnership and OSHA will respond as it would any complaint/referral of a similar nature.
    6.5.3 All Participating Contractors recognize that OSHA will fully investigate formal complaints and complaints/referrals involving alleged imminent danger hazards. These investigations will be conducted outside of this partnership agreement in accordance with normal enforcement practices and may include the issuance of citations and penalties.
6.6 Accident Investigations
    6.6.1 Participating contractors recognize that OSHA will fully investigate accidents involving death or serious physical harm. These investigations will be conducted outside of this partnership agreement in accordance with established OSHA enforcement policy. Violations documented during such investigations may result in the issuance of citations and penalties.
6.7 Programmed Inspections
    6.7.1 Participating BLUE Platform Level Participant Contractor will not be subject to programmed inspections where a verification inspection has been successfully completed within the last 12 months.
6.8 On-Site Verification Inspections
    6.8.1 Prior to qualifying for inspection deferrals, each BLUE Platform Level Participant Contractor will have the effectiveness of its safety and health program as reported by its self-audit verified though one planned, on-site comprehensive inspection by the OSHA office having jurisdiction over the work site chosen. OSHA understands that unannounced inspections may result in the absence of key personnel important to a full and fair evaluation. OSHA will cooperate to allow the participant to have such personnel participate in the inspection. Additionally, OSHA will endeavor to conduct its verification inspections within 20 workdays of acceptance by UTCANJ of a BLUE Platform Level Participant Contractor. Verification inspections are focused inspections conducted by OSHA enforcement personnel, and therefore, may result in citations with corresponding penalties. Verification inspections are conducted in an enforcement capacity and as a result, citations and penalties may be issued as a result of these inspections. Enforcement inspections are performed in accordance with the applicable sections of the FIRM and other enforcement guidance documents. In addition to traditional enforcement issues, the inspection should assess the partner's progress in meeting the requirements of the partnership agreement. Thorough document review, visual observations and employee interviews, OSHA will assess the partner's commitment to the goal and strategies of this partnership, and evidence a systemic approach to safety and health management.

    For employers with multiple worksites, OSHA will conduct verification inspections at at least 10% of participants' worksites with a minimum of one inspection in the event the employer has less than 10 worksites. The minimum number of On-Site verification inspections needed for verification shall be based on the number of active worksites at which the partner currently performs work within the UTCANJ jurisdictional boundary:

    OSHA will conduct verification inspections as indicated in the table below:
     
    Number of Sites Number of Verification Inspections
    1-3 1
    7-13 2
    14-20 3
    20-26 4
    27-33 5
    34-40 6
    40-46 7
    47-53 8*
    54-60 9*
    51-66 10*
    67-73 11*
    74-80 12*
    81-86 13*
    87-93 14*
    94-100+ 15*

    *In the event the participating contractor successfully undergoes eight (8) enforcement verification inspections and OSHA determines that the contractor is effectively implementing their safety and health management system at all locations and no serious hazards are observed, OSHA may opt to discontinue conducting further verification inspections and recommend the contractor be accepted into the partnership at the Blue Level.

    OSHA understands that unannounced inspections may result in the absence of key personnel important to a full and fair evaluation. OSHA will cooperate to allow the participant to have such personnel participate in the inspection(s). Additionally, OSHA will endeavor to conduct its verification inspections within 30 workdays of acceptance by the committee of a Blue Level Participant Contractor. Upon completion of the inspection(s), OSHA will either accept or reject the contractor's application for inspection deferral and participation at the BLUE Inspection Defferal Level.

    Blue Level partners must re-apply and receive on-site verification inspections annually to maintain partnership with OSHA and to be eligible for partnership benefits.

    6.8.2 Blue Level partners must re-apply and receive on-site verification inspections annually to maintain partnership with OSHA and to be eligible for partnership incentives.

    6.8.3 Prior to qualifying for full site inspection deferrals where the participating BLUE Platform Level Participant Contractor is the General contractor at a site, in addition to the requirements in 6.8.1 above:

      6.8.3.1 The participating contractor must demonstrate during the verification inspection that it has safely and health responsibility for the job site including their subcontractors (i.e. job site control); and

      6.8.3.2 The participating contractor requires each subcontractor on site to have implemented a written comprehensive site-specific safety and health program.
Note that participating RED and WHITE contractors will not be granted deferrals from programmed inspection activity.

7 UTCA-OSHA Partnership Advisory Committee Commitment/Role

7.1 The UTCANJ and OSHA will form a UTCANJ-OSHA Partnership Advisory Committee (PAC) consisting of representatives from both the UTCANJ and OSHA. This role of this committee is to oversee partnership progress and activities, make recommendations of changes for partnership improvement and to take disciplinary action against participants if warranted. The PAC will meet quarterly to assess the progress of the partnership, discuss partnership activities and determine and schedule future partnership activities.

7.2 If necessary, the UTCANJ-OSHA Partnership Advisory Committee will terminate contractors from the partnership, if findings indicate unacceptable performance or submission of falsified application documentation. (Note: At the discretion of the UTCANJ-OSHA Partnership Advisory Committee, a participating contractor may be permitted to correct deficiencies within 30 days of notification and apply to the UTCANJ Partnership Advisory Committee for continued recognition as a partner in good standing before termination would take effect.)

7.3 The UTCANJ-OSHA Partnership Advisory Committee has the discretion to veto contractors from participating for just cause. OSHA also has the discretion to unilaterally veto contractors from participating in this Partnership, for just cause, upon providing notification and explanation to the UTCANJ-OSHA Partnership Advisory Committee.

8 Participating Contractor Commitment / Role

The UTCANJ partnership is a Multi-Platform Programs consisting of three levels or classifications based on each participant's level of achievement relating to safety and health. The three participant levels of the UTCANJ Partnership program: RED, WHITE and BLUE.

Program Implementation

8.1 Eligibility Requirements for the Multi-Platform Program: RED, WHITE and BLUE. Listed below you will find the eligibility requirements for each phase of the partnering program: RED, WHITE and BLUE Platforms:
    8.1.1 RED: Applicants seeking entrance onto the RED Platform Level must meet the following requirements:

      8.1.1.1 Develop and implement a written safety and health program;

      8.1.1.2 Conduct weekly employee safety meetings;

      8.1.1.3 Conduct and document self-audits under direction of a competent person*

      Competent person is defined by OSHA in 29CFR1926.32(f): A "competent person" means one who is capable of identifying existing and predicable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has the authorization to take prompt corrective measures to eliminate them      .

      8.1.1.4 Achieve a score of 94-108 points on their self-audit checklist.
    8.1.2 WHITE: Applicants seeking entrance onto the WHITE Platform level must meet all of the requirements for the RED level plus meet the following additional requirements.

      8.1.2.1 Develop and implement a comprehensive written safety and health program based on ANSI A10.38-1991 Guidelines or OSHA's 1989 Safety and Health Program Management Guidelines.

      8.1.2.2 Assign at least one competent person, who has had training equivalent to the OSHA 30-Hour Construction Safety and Health Outreach program, and who has the responsibility for employee safety and health;

      8.1.2.3 Ensure designated safety personnel at each site conduct and document daily inspections to identify and correct safety and health hazards;

      8.1.2.4 Conduct an orientation of all new employees on the contractor's safety and health programs and show evidence of effective employee training for avoidance of hazards specific to the contractor's work site(s);

      8.1.2.5 Conduct weekly employee safety meetings which, to the extent possible, include employee representatives;

      8.1.2.6 Show evidence of employee involvement in the safety and health program; for example, participation in self-audits, site inspections, job hazard analyses, safety and health program reviews, safety training, and accident investigations;

      8.1.2.7 Provide all field construction supervisory personnel with training equivalent to the OSHA 10-Hour Construction Safety training course;

      8.1.2.8 Maintain a Lost Workday Incidence Rate at or below the national average for their specific Standard Industrial Classification (SIC) as per the Bureau of Labor Statistics;

      8.1.2.9 Achieve a score of 109-125 from Part III of the Application Packet – Self Evaluation scoring at least half of the points available for each section.
    8.1.3 BLUE: Applicants seeking entrance onto the BLUE Platform level must meet all of the requirements for RED and WHITE levels plus meet the following additional requirements:

      8.1.3.1 Ensure all sub-contractors on the site for which the BLUE contractor has responsibility use a written site-specific safety and health program. If a subcontractor does not have a program, they shall adopt and implement the program written by the participant contractor;

      8.1.3.2 Assign a minimum of one competent person who will administer the contractor's safety and health program. This person must have attended the OSHA 500 Train the Trainer Course for the Construction Industry or equivalent within the previous four years;

      8.1.3.3 Designated site safety personnel, through training and experience, must be able to recognize hazards associated with various phases of construction and shall have the authority to take prompt corrective action. Training curriculum equivalent to the OSHA 30-Hour Construction Safety and Health Training Course will be deemed satisfactory;

      8.1.3.4 Implement a 6-foot Fall Protection Policy or a 100% Fall Protection Policy at the prescribed heights in accordance with specific OSHA Regulations;

      8.1.3.5 Have no Willful violations within the last three years;

      8.1.3.6 Have no Repeated Serious violations within the last three years;

      8.1.3.7 Have no fatalities or catastrophes within the past three years that resulted in Serious, Willful or Repeat citations related to the incident;

      8.1.3.8 Maintain an Experience Modification Rate at or below a 1.00.

      8.1.3.9 Achieve a score of 126-150 from Part III of the Application Packet for Self Evaluation scoring at least half of the points available for each section.
NOTE: This next section is only needed when the participant would like to apply for complete site inspection deferral.

In order to qualify for a complete site inspection deferral, the participant must be the General Contractor and assume a controlling contractor's role:
      8.1.3.10 General Contractors must have a written policy that addresses subcontractor safety to include requirements for assurance of compliance, safety training, site inspections, accident investigations, safety meetings, and other requirements of the Occupational Safety and Health Act of 1970;

      8.1.3.11 General Contractors shall involve subcontractors (and subcontractors of subcontractors) in identification and correction of safety and health hazards and concerns. General Contractors shall assure that root causes of fatalities and disabling injuries are identified and preventative action taken;

      8.1.3.12 General Contractors shall perform and document comprehensive safety and health audits of all subcontractors. Comprehensive audits shall address all aspects of all subcontractors' safety and health management programs including the extend of employee participation;

        8.1.3.12.1 Additional audits shall be conducted on a periodic basis to monitor the continued effectiveness of all subcontractors' programs. The frequency of the audits shall be determined by the general contractor, but will be conducted at least biannually.
      8.1.3.13 General Contractors shall conduct daily site inspections by a competent person and document those inspections. The results shall be made available to OSHA upon request;

      8.1.3.14 General Contractors shall establish an effective policy for dealing with non-complying contractors. Hazards will be documented including time, dates, contractor name and representative, and what action was taken to gain compliance. The general contractor must ensure that hazards with a high probability of causing serious injury are immediately corrected and action taken to ensure the condition does not recur;

      8.1.3.15 General Contractors agree to require that subcontractor's management officials participate during safety meetings and site inspections;

      8.1.3.16 General Contractors shall have at least one on-site safety coordinator with his/her only duties being safety and health compliance.
8.2 Application submission
    8.2.1 Applications will be accepted quarterly, beginning the first week of November 2004. Applications will only be accepted during the first week of the following months: November, February, May and August.

    8.2.2 All applicants shall:

      8.2.2.1 Complete the four-part UTCANJ program application form.

      8.2.2.2 The first part will request company information.

      8.2.2.3 The second part will request safety statistical data from the summary of the contractor's OSHA 200 log (for the year 2000 only and OSHA 300 log for calendar years beginning 2001) and 300 logs for the past three calendar years. If the employer has not been in business for the past three calendar years it may submit OSHA 300 data for the calendar years they have been in business. All applicants must have been in business long enough to have complete OSHA 300 data for at least one full calendar year.

      8.2.2.4 The third part will be a self-audit checklist, related to the company's written safety program.

      8.2.2.5 The fourth section of the application packet is to document that employee participation is an integral part of the employer's comprehensive safety and health management system.

        8.2.2.5.1 Applicant contractors who have agreements with recognized organized labor groups for work conducted under this partnership must submit a list of all labor organizations with which they have labor agreements. In addition, at a minimum, written evidence that organized labor is not opposed to contractor participation is required. Contractor submission of evidence of organized labor support of partnership participation, from at least the BA level, from all labor groups employed to perform work covered under this partnership, is preferred. Written support can be in the form of a letter of support from each labor group, or each group may fill out the Labor Support Form located in Part IV-A of the application packet.

        8.2.2.5.2 Applicant contractors who do not have agreements with recognized labor groups for work conducted under this partnership must certify that employee participation is an integral part of their safety and health management system by completing Part IV-B of the application packet.
      8.2.2.6 All applicants seeking WHITE and BLUE Level status must score at least half of the available points per section of the Self Evaluation. Applicants seeking RED Level status must score at least one point per section of the Self Evaluation. Additionally, the following minimum total scores must be attained for each of the levels listed below:

      RED Level: 94-108 points
      WHITE Level: 109-125 points
      BLUE Level: 126-150 points

      8.2.2.7 Additionally, each participating contractors will supply a list of pending and active sites annually to the UTCANJ. The UTCANJ will forward the BLUE Platform Level Participant Contractors' site locations to OSHA.
8.3 Program Verification and Acceptance
    8.3.1 The UTCANJ is responsible for the following program monitoring activities:

      8.3.1.1 Receive and maintain all application information submitted by Platform Participant contractors.

      8.3.1.2 Review applications submitted by perspective Platform Participants and determine their eligibility for the program. These applications shall be reviewed by the UTCANJ-OSHA Partnership Advisory Committee.

      8.3.1.3 Termination of a participant's current status and re-designation to the appropriate status, if any, in the even the UTCANJ discovers information that significantly contradicts the representations made by the participant in its application.

      8.3.1.4 Recommend program improvements to Platform Participant Contractors.

      8.3.1.5 Once the participant has been identified by the UTCANJ as a BLUE Platform Level Participant Contractor, the UTCANJ will provide to OSHA for each participant:

        8.3.1.5.1 The summary of the contractors' 300 Logs for the last three years and the total number of hours worked for each year. If the contractor has not been in business for the past three calendar years, UTCANJ may submit OSHA 300 data for the calendar years they have been in business. All applicants must have been in business long enough to have complete OSHA 300 data and hours worked for at least one full calendar year.

        8.3.1.5.2 A copy of the applicant's self-audit/evaluation forms used by the UTCANJ to verify BLUE status.

        8.3.1.5.3 A list of active sites for BLUE Platform Level Participant Contractors only. This list is not needed by the UTCANJ-OSHA Partnership Advisory Committee for the application review process and therefore will not be provided to the committee. The list will be provided directly to OSHA by the UTCANJ upon acceptance of the employer as a potential BLUE Platform Level Participant by the committee prior to the OSHA on-site verification inspection.
    8.3.2 OSHA will ensure the following monitoring activities are performed:

      8.3.2.1 Prior to qualifying for inspection deferral, each BLUE Platform Level Participant Contractor will have the effectiveness of its safety and health program verified though one verification inspection as defined in Section 6.8 of this agreement.
8.4 Maintaining Participant Status
    8.4.1 BLUE Level participants must re-apply and receive on-site verifications inspections annually to maintain partnership with OSHA and to be eligible for partnership incentives.

    8.4.2 RED and WHITE participants wishing to elevate to the next level (RED to WHITE or WHITE to BLUE) must re-apply.
9 Program Confidentiality

9.1 Information submitted by contractors as part of the application or renewal process, as well as obtained by virtue of the contractor's application or participation in the program, will be held in strict confidence within the confines of the partnership program. Information will be used only to measure the effectiveness of the partnership program.

10 Partnership Evaluation

10.1 It is the responsibility of the UTCANJ designated representative to gather required participant data to evaluate the overall success of the program. Aggregated data will be reported to the OSHA Area Directors during the quarterly meetings discussed in Sections 6.1.1 and 7 above.
    10.1.1 The aggregate data will include the following:

      10.1.1.1 The number of new RED, WHITE or BLUE Platform Level Participant Contractors;

      10.1.1.2 The number of 10 or 30 hour newly trained UTCANJ member's employees within the State of NJ during the previous year;

      10.1.1.3 The number of supervisory employees of participating members trained to the OSHA 30hr level;

      10.1.1.4 The number of participating UTCANJ members who have established written safety and health programs;

      10.1.1.5 OSHA 300 data from all participating contractors at all levels. This data shall included the aggregate totals for all OSHA Log columns for each calendar year as well as the aggregate total number of hours worked for each calendar year;

      10.1.1.6 Contractor Experience Modification Rate (EMR) aggregate average.
10.2 The partnership will be evaluated annually to determine if the annual goal of a 4% reduction in injury and illness rates has been met. The UTCANJ is responsible for collating the baseline and annual performance data. This information will be reported to the four OSHA Area Offices in New Jersey.

10.3 Participant aggregate Lost Workday Incidence Rates and Fatality Rates will be compared with participant baselines and BLS published data to determine if the goals have been met.

10.4 Participant incidence of injuries resulting fro the four leading construction hazards (falls, struck-by & caught between, excavations and electrocutions) will be measured and compared against the baseline established in the first year of the partnership.

10.5 If all signatory partners agree, partnership criteria may be revised annually based on recommendations for continuous improvement.

11 Contractor Termination

11.1 A contractor's participation will be referred to the UTCANJ-OSHA Partnership Advisory Committee for termination or reduction in platform level by the UTCANJ and OSHA will be informed, if one or more of the following occurs:
    11.1.1 Information is obtained and verified by the UTCANJ or OSHA that reveals a significant deviation from program criteria;

    11.1.2 The contractor has falsified information on the application or supporting records;

    11.1.3 If the contractor is a BLUE platform participant, the contractor's Lost Workday Incidence Rate rises above the most current national average for the SIC or NAIC classification to which the contactor belongs;

    11.1.4 The contractor takes other actions inconsistent with the goals and intent of this program.
11.2 Prior to final termination of a contractor's status, the following will occur:
    11.2.1 The contractor will be notified in writing of the intent to terminate;

    11.2.2 The notice will include an explanation of the reasons for termination;

    11.2.3 The contractor will have an opportunity to reply to the written notice within a period of thirty (30) days;

    11.2.4 The contractor will have the right to appear before the UTCANJ-OSHA Partnership Advisory Committee.
11.3 The UTCANJ-OSHA Partnership Advisory Committee will have the authority to reinstate the contractor for a 1-year probationary period if it determined that the contractor's experience was unusual and not necessarily inconsistent with a sound safety and health program. In this event, OSHA may conduct another verification inspection.

11.4 Any contractor may terminate participation in the program at any time.

12 Contractor/Employee Rights

12.1 As an integral part of an effective safety and health program, the ability of employees to exercise rights guaranteed under the OSH Act and other applicable regulations, (such as, but not limited to, the right to file a safety and health complaint and the right to information collected pursuant to OSHA requirements) will not be infringed.

12.2 Contractors retain all rights guaranteed under the OSH Act, including but not limited to the right to appeal or contest violations issued by OSHA.

12.3 Routine employee involvement in the day-to-day implementation of worksite safety and health programs is to be assures, including employee participation in contractor self-audits, site inspections, job hazard analysis, safety and health program reviews and near miss investigations.

13 Termination or amendment of this Partnership

13.1 This agreement will terminate 3 years from the date of signing. If any signatory of this agreement wishes to terminate their participation prior to the established termination date, the agreement will terminate upon receiving a written notice of the intent to withdraw from either signatory. However, individual BLUE participants seeking deferral from programmed inspections must have their programs verified through an on-site OSHA verification inspection each year to remain eligible for OSHA incentives.

13.2 OSHA may terminate the partnership with any individual contractor at any time via notification in writing to the management and labor representatives. However, the observation by OSHA from any public place of an imminent danger situation resulting in the issuance of a citation may result in the termination of any partnership with that contactor. OSHA's final decision on the status of the partnership with this contractor will take into account the recommendations of UTCANJ and the UTCANJ-OSHA PAC.

13.3 For non-signatory participants of this strategic partnership, OSHA may terminate the participant's involvement at any time with written notice. Additionally, any participant may withdraw their participation from the strategic partnership at any time with a written notice of the intent to withdraw to OSHA.

13.4 The UTCANJ-OSHA Partnership Advisory Committee may terminate an individual participant contractor from the partnership if the contractor fails to meet the qualifications or otherwise violates the terms and conditions of this Partnership.

13.5 Any party may propose modification or amendment to this Partnership subject to concurrence by all parties to the Partnership.

13.6 If OSHA chooses to withdraw its participation in the partnership, the entire agreement is terminated. Either party may also propose modification or amendment of the agreement.

14 Partnership Participant Annual Renewal.

14.1 Once accepted into partnership by all parties, contractor incentives will be effective for one year. Contractors must re-apply annually to maintain status in the partnership program. This re-application and acceptance process will be identical to the process stated in the above agreement and is based on the conditions set forth in this program. Contractors seeking re-application must do so sixty days prior to the expiration date of their current partnership agreement. Failure to re-apply within the sixty-day period will forfeit all incentives until all requirements of the above partnership are fulfilled and accepted by the UTCANJ, the UTCANJ-OSHA Partnership Advisory Committee and OSHA.

14.2 It is understood that BLUE level participants who seek deferral from OSHA planned inspections must apply for deferral annually.


Signed on this 7th day of March, 2008
 



 
Louis Ricca
Acting Regional Administrator
U.S. Department of Labor OSHA
Region II New York		  


 
Robert Briant Jr.
Chief Executive Officer
Utility and Transportation Contractors' Association of New Jersey		  



 
Philip M. Peist
Area Director
U.S. Department of Labor OSHA
Parsippany, NJ Area Office		  


 
Ed Nyland
President
Utility and Transportation Contractors' Association of New Jersey		  



 
Robert D. Kulick
Area Director
U.S. Department of Labor OSHA
Avenel, NJ Area Office		      



 
Lisa Levy
Area Director
U.S. Department of Labor OSHA
Hasbrouck, NJ Heights Area Office		      



 
Gary W. Roskoski
Area Director
U.S. Department of Labor OSHA
Marlton, NJ Area Office		      



 
Leonard Katz
Assistant Commissioner
Labor Standards and Safety Enforcement
NJ Dept of Labor and Workforce Development		      

 
APPENDIX

UTCANJ-OSHA
Construction Industry Safety Partnership

SUMMARY AND APPLICATION PACKET

This program was designed in conjunction with management, trade labor and OSHA representation all working together to create a program which will mutually benefit the membership of the UTCANJ, all corresponding trades which work with the UTCANJ, and the Occupational Safety and Health Administration.

The goals of this program are:
  • To reduce by 4% annually the number of injuries and fatalities affecting participant employers, with an emphasis on reducing injuries and fatalities resulting from the four focused construction hazards (falls, struck-by, caught-in\between, and electrocutions).

  • Decrease contractors' EMR rates and/or workers compensation costs from the time of application throughout the term of the partnership.

  • Increase the implementation of effective contractor safety and health programs.

  • Increase accessibility to quality safety and health training and education, including OSHA 10 and 30-hour courses, thereby raising safety and health awareness for both employees and contractors by:

  • Provide a leadership role for the industry.

  • Allow OSHA to better focus resources on firms that require increased assistance, rather than firms that have implemented effective, meaningful safety and health programs for their employees.
PARTICIPATION RECOGNITION:
 
RED LEVEL:  WHITE LEVEL: BLUE LEVEL:
     
- Certificates for all sites - Certificates for all sites
- Plaque for corporate office		 - Certificates for all sites
-Plaque for corporate office
-Jobsite Sign for all sites

In addition to the above, OSHA will remove BLUE Level contractors from the programmed inspection list for one year. All participants must re-apply annually to maintain status in the program.

An annual awards program will also be conducted, sponsored by the UTCANJ and OSHA, to acknowledge publicly those who participate in this program. Awards will be judged by the UTCANJ-OSHA Partnership Advisory Committee and given to members in the following categories:

1) Excellent Safety Performance   2) Most Improved Contractor   3) Safety Mentor of the Year

This is an exciting new venture for New Jersey=s construction industry. It promises to be an effective new communication tool between the membership of the UTCANJ, LABOR and OSHA in which all participants will benefit.

If you have any questions, please call the UTCANJ office at 732-292-4300.

The UTCANJ, LABOR and OSHA sincerely appreciate your interest and participation in this program.

 
UTCANJ-OSHA Construction Industry Safety Partnership
DIRECTIONS FOR ENROLLMENT INTO ALL LEVELS
Checklist and Mailing Address

All applicants must complete the following application to considered for participation in the partnership.

____Complete the UTCANJ-OSHA Construction Industry Safety Partnership Application Packet:

____Part I - Company Information

____Part II - Statistical Data

____Part III - Self – Evaluation

____Part IV – Labor Support / Involvement Documentation

____Attach a copy of your 300 for the previous three calendar years

____Attach a list of your current active job sites in New Jersey (BLUE Level Applicants only)

____Make sure all forms are signed

____Mail completed package to the Utility and Transportation Contractors' Association of New Jersey

NOTE: All application packets must be complete upon submission. Incomplete packets will be returned by UTCANJ unapproved.
 
Send completed package to:
Utility and Transportation Contractors Association of New Jersey
P.O. Box 728
Allenwood, NJ 08720
732-292-4300


 
New Jersey Heavy Highway Construction Industry Partnership Program
Application for Enrollment

Part I - Company Information

All companies wishing to participate in the UTCANJ-OSHA Construction Industry Safety Partnership must submit a completed application.

New Application OR Re-application (required annually to sustain participation)

Company Name:_________________________________________________________
Address: _________________________________________________________
City: _________________________________________________________
State:_______ Zip Code:_______________

Phone Number: ( )____________ Fax: ( )____________ E-mail:__________________
Please supply the following information:
Number of employees:________ (Include all field and office personnel)
Number of Safety, Health and Environmental Personnel within company: Full-Time:_____ Part-Time:_____
Do you subcontract safety responsibilities to an outside firm?   Yes   No
(If yes, please supply the following information)
Name of Consultant:______________________________________________________
Address: ______________________________________________________________
City: ______________________________________________________________
State:_______ Zip Code:_______________

Phone Number: ( )____________ Fax: ( )____________ E-mail:__________________
Do you have a substance abuse program? (If yes, please provide copy with application.)    Yes    No
Number of Recordable Injuries/Illnesses in current and past two calendar years:___________
Have you, or any of your sub contractors had any fatalities in the past 3 years?   Yes   No
Number of Fatalities:
If so, did you receive OSHA citations?   Yes   No

What were the citations you received?

I have supplied the above information to the best of my ability and have not knowingly made any false representation of the above stated company applying for enrollment Into the UTCANJ-OSHA Construction Industry Safety Partnership.

Completed by:_______________________________________________________________________

Title: ______________________________________________________________________________

Signature:___________________________________________________________________________

Confirmed by:________________________________________________________________________
                   (President/CEO)

Title:_______________________________________________________________________________

Signature:___________________________________________________________________________


Part II - Statistical Data

Company Name:__________________________________________

 
For Each of the Previous Three Calendar Years

You may photocopy this form and submit one form with data from each of the previous calendar years

1. _______ Average Number of Employees - (an average number of persons on your payroll for each of the previous calendar years)

2. _______ Total Hours Worked - (the total of all hours worked for each of the previous three calendar years by all employees in the company, including office personnel, not including hours for vacation or sick leave).

Number of Work-Related Injury or Illness Cases*

a._______ Total number of work-related deaths (report all deaths which were the result of any injury or occupational illness). See OSHA Log Form 300, Column G (OSHA Log Form 200 Columns 1+8).

b._______ Total number of recordable cases with days away from work, days of restricted work activity, or job transfer (DART). See OSHA Log Form 300, Sum of Columns H+I (OSHA Log Form 200 Sum of Columns 2+9).

c._______ Total number of non-fatal cases without lost workdays, restricted work activity, or job transfer. See OSHA Log Form 300, Column J (OSHA Log Form 200 Columns 6+13).

d._______ Total number of recordable cases with days away from work. See OSHA Log Form 300 Column H.

3. _______ Total Number of recordable Cases (a+b+c).

Number of Lost Workdays Due to Work Related Injuries or Illnesses*

a._______ Total number of workdays lost (Days away from work, do not include day of injury). See OSHA Log Form 300, Column L (OSHA Log Form 200 Sum of Columns 4+11)

b._______ Total number of, days of restricted work activity, or job transfer. See OSHA Log Form 300, Column K (OSHA Log Form 200 Sum of Columns 5+12).

4. Total Number of Workdays Lost (a+b).

*NOTE: If you are not required to maintain OSHA Log Form 300 (or OSHA Log Form 200 prior to calendar year 2001), refer to your insurance records to obtain the information requested above.
 
Current Information

Contractor Experience Modification Rate:______________

Completed by (print name):__________________________________________________________

Signature: _____________________________________________________________________

Date: __________________________


Part III - Self Evaluation

Directions: Place a check next to all items which apply to your program. Each checked item represents one point unless otherwise specified. Please write the number of points for each section into subtotal column. Once complete, add subtotals to get your total score. Your total score will help you determine what level your company should apply for in the UTCANJ-OSHA Construction Industry Safety Partnership Program.

Company Name: _______________________________________________________

A. SAFETY & HEALTH PROGRAM (15 points possible)
 
_____ Is in writing

_____ Has been read by all employees

_____ Is site specific

_____ Addresses major hazards on the site

_____ Details consequences of violating safety rules

_____ Copies of Subcontractors' Safety & Health
         programs kept on file

_____ Is shared with subcontractors

_____ Program reviewed at least annually and revised
         as needed		 ______ Gives direction of Safety Program

______ Emphasizes management approach

______ Signed by CEO/President

______ Specifies management accountability

______ Is reviewed by the Safety Director

______ Is shared with employees before job begins

______ Sub's programs reviewed and feedback provided

Subtotal ______


B. MANAGEMENT COMMITMENT (6 points possible)
 
_____ Participates in Safety Committee activities

_____ Sets safety objectives

_____ Budgets funds for safety activities		 _____ Makes safety part of performance reviews

_____ Makes safety a percentage of total salary

_____ Requires regular feedback on safety activities

Subtotal ______


C. SUPERVISOR MEETINGS (5.5 points possible)
 
____ Weekly meetings including safety (2 pts.)

_____ Monthly meeting including safety

____ Quarterly meetings including safety (.5 pt.)		 _____ Safety Training is conducted at this time

_____ Accident/Injury records reviewed

Subtotal ______


D. Contractor RESPONSIBILITY (5.5 points possible)
 
____ Provides job site specific safety training

____ Provides all necessary Personal Protective
       Equipment

____ Trains employees in the hazards of jobs		 Participates in safety meetings including:

Tool Box Talks: ____Weekly ____ Monthly (.5 pt.)


______ Corporate Safety Meetings

Subtotal ______


E. EMPLOYEE PARTICIPATION (7 points possible)
 
____ Participates in Safety Program

____ Participates in tool box talks weekly

____ Participates in safety training

____ Reports hazards to management		 ______Is aware of all hazards present in work area

______Participates in safety committee activities

______Has been trained in emergency procedures

Subtotal ______


F. PROJECT PRE-PLANNING (7 points possible)
 
_____ Pre-Bid Safety Assessment is completed


_____ All potential hazards are recognized


_____ Monies allocated for safety on project

_____ Hire a Jobsite Safety Coordinator if Project bid is
         over $ 1 million		 _______ Supervisors are involved with process at bid
            stage

_______ Safety equipment is mobilized prior to start of
            project

_______ Employee safety orientation mandated

Subtotal ______


G. ANNUAL SAFETY BUDGET (4 points possible)
 
_____ Is established yearly

_____ Is based on planned programs		 _______ Is derived from safety program savings

_______ Management is aware of budget

Subtotal ______


H. GOALS OF SAFETY PROGRAM (7 points possible)
 
______ Goals and objectives defined in program

______ Program developed to attain goals

______ Management responsible for feedback from
           reports

______ Employees are aware of goals		 ______ Audits conducted to assess performance

______ Long term goals set

______ Short term goals set

Subtotal ______


I. SAFETY ORIENTATION (11 points possible)
 
_____ Orientation is conducted for all new hires

_____ Orientation conducted when employee transfers
         to a new jobsite

_____ Employees sign orientation roster

_____ Recordkeeping activities are performed

_____ Management participates in Orientation		 Orientation includes: (but is not limited to)

_____ Hazard Communication Training

_____ Rules and Regulations Training

_____ Jobsite Hazard Exposure Training

_____ Personal Protective Equipment Training

_____ Fall Protection

_____ Emergency Action Procedures

Subtotal ______


J. SAFETY TRAINING AND EDUCATION (15 points possible)
 
_____ All field employees have had a 10-hour OSHA Construction Safety Course
 
_____ Site specific training

_____ Training includes hazard recognition

_____ First aid and CPR

_____ Fire protection and prevention

_____ Housekeeping

_____ Sanitation

_____ Training is documented (Date, Subject, Trainer)		 _____ Personal protective equipment

_____ Trade specific training

_____ Material handling techniques

_____ Tool safety

_____ Scaffold safety

_____ Fall protection

_____ Motor vehicle safety training

Subtotal ______


K. RULES and REGULATIONS (6 points possible)
 
_____ Rules and regulations are published and posted on
         site

_____ Enforcement policy in place

_____ Subcontractors are expected to follow rules and
         enforcement policy is the same

_____ Rules are clear, concise and easy to read		 ______ Rules are updated at least annually


______ Rules are enforced equally among all employees

Subtotal ______


L. SUPERVISOR/PROJECT MANAGER TRAINING (13 points possible)
 
_____ All supervisors/project managers trained with a 30-hour OSHA Construction Safety Course
 
_____ Accident investigation training

_____ Company has in-house Safety Director

_____ Training conducted by Safety Director or
         outside agency

_____ Conducts jobsite safety inspections

_____ Has ability to recognize hazards

_____ Has ability to stop project for safety violations		 ______ First Aid/CPR Trained

______ Conducts safety meetings

______ Is involved with Safety Committee


______ Supervisory skills training

______ Management skills training

______ Emergency reporting procedures training

Subtotal ______


M. TOOL BOX TALKS (9.5 points possible)
 
_____ Meetings held weekly

_____ Meetings held monthly (.5 pt)

_____ Conducted by supervisor or safety coordinator

_____ Attended by management (Project Engineer at
         least monthly)

_____ Talks are site specific		 ______ Attendance and topic records kept

______ Employee participation in meetings

______ Employees pick topic and conduct meetings

______ Meetings are attended by subcontractors


______ Talks are timely

Subtotal ______


N. PERSONAL PROTECTIVE EQUIPMENT AND ITS USE (9 points possible)
 
_____ Determination made to find PPE needs

_____ Employees receive training on specific equipment
         use and maintenance

_____ Regular inspections conducted on PPE

_____ Respiratory Protection Program in place

_____ Task specific PPE requirements are documented		 _____ Employees aware of enforcement policies

_____ PPE is provided in accordance with OSHA
         standards

_____ Only approved PPE is used

_____ PPE use is regularly enforced

Subtotal ______


O. JOBSITE INSPECTIONS/AUDITS (11.5 points possible)
 
_____ Inspections are conducted daily (3 pts)

_____ Inspections are conducted weekly (2 pts)

_____ Inspections are conducted monthly

_____ Inspections are conducted quarterly (.5 pt)

_____ Results are documented		 ______ Management analyzes inspection reports

______ Management acts on continuing problems

______ Abatement dates are set

______ Follow up inspections are conducted

Subtotal ______


P. ACCIDENT INVESTIGATION (7 points possible)
 
_____ Employees trained in Investigation Procedures

_____ All near misses are investigated

_____ Analysis of all accident information is conducted
         and corrections are made

_____ Management reviews all documentation		 ______ Conducted by employee/management team

______ Reports are made of all accidents and
          documented

______ Follow up inspections are completed

Subtotal ______


Q. RECORDKEEPING REQUIREMENTS (11 points possible)
 
_____ Employee Training

_____ Medical Records

_____ Accident Investigations

_____ OSHA 300 Log

_____ Inspections Reports

_____ Records of periodic site inspections		 _____ Material Safety Data Sheets

_____ First Aid Log

_____ Orientation Records

_____ Respiratory Fit Testing Records

_____ Respiratory Medical Evaluations

Subtotal ______
 
TOTAL POINTS SCORED: ______________

 
TOTAL POINTS NEEDED FOR EACH LEVEL:
 
Red Level:

94-108		 White Level:

109-125		 BLUE Level:

126-142

Level Applied For:

RED
WHITE
BLUE

I have read, understand and answered the above questions to the best of my ability. I have not knowingly made any false representation of this company applying for the UTCANJ-OSHA Construction Industry Safety Partnership.

Company Name:____________________________________________________________________

Address:___________________________________________________________________________

City:_______________________________ State: ______________ Zip:__________________________

Phone Number:_____________________ Fax Number:______________ E-mail:__________________

Name of person completing Self Evaluation:

Title:_______________________________________________________________________________

Signature:__________________________________________________________________________

Date:_________________________
 
Confirmation of Information

Company President/CEO:____________________________________________________________

Signature:_______________________________________________ Date:_____________________


Part IV-A – Written Documentation of Organized Labor Support.

Directions: To participate in the Partnership, written documentation of organized labor support is required for all applicants that have agreements with organized labor. All applicants who do not have agreements with organized labor must complete Part IV-B of this part of the application only. Documentation of labor support must be signed by a union official who is at least at the BA level. Applicants may either obtain separate letters of support from each Union from which it employs labor in New Jersey, or it may have each union complete a copy of this form. Written support is required from all organized labor groups applicants utilize in New Jersey for this application to be considered complete.
 
Organized labor written documentation of support of employer's participation in the
UTCANJ-OSHA Construction Industry Safety Partnership

The undersigned labor group fully supports, or at a minimum, is not opposed to, the participation of ________________________________________ (name of company) in the UTCANJ-OSHA Construction Industry Safety Partnership and we agree that this applicant includes employee involvement as part of its overall safety and health management system. We fully understand support of the above-mentioned employer's participation in this partnership, in no way, diminishes any employees' rights under the Occupational Safety and Health Act (e.g., employees' right to file complaints).

Name of Organized Labor Group__________________________________________________________________

Name of Authorized representative________________________________________________________________

Signature of Authorized representative_____________________________________________________________

Title of Authorized Representative_________________________________________________________________

Date________________________


Part IV-B – Written Documentation of Employee Involvement for applicants who do not have agreements with organized labor groups.

Directions: To participate in the Partnership, written certification of employee involvement in the applicant's safety and health management system is required. All applicants do have agreements with organized labor must complete Part IV-A of this part of the application only. The following certification must be executed by an officer representing the applicant contractor for the application to be considered complete.

Written certification of employee participation in the applicant's safety and health management system.

The undersigned applicant contractor representative certifies that employee involvement is an integral part of the applicant's safety and health management system. Furthermore, the aforementioned employee involvement meets or exceeds the employee involvement requirements outlined in Section 7 of this partnership for the level of participation the applicant is applying for.

Name of applicant contractor__________________________________________________________________

Name of Authorized Representative____________________________________________________________

Signature of authorized representative__________________________________________________________

Title of authorized representative_______________________________________________________________

Date-_______________________