Common use of Safety Supervisor Clause in Contracts

Safety Supervisor. office - 250- or cell 250- Safety Coordinator – office 250- or cell 250- City of Terrace Representative Name City of Terrace Representative Signature Contractor Acknowledgement of Receipt of This Form Contractor Representative Name Contractor Representative Signature Schedule 4 CONTRACTOR COORDINATION CONFIRMATION OF CONTRACTOR RESPONSIBILITIES This form must be completed and signed before work begins Date Project Description: LABELLEAVENUE (XXXXXX STREET TO XXXXXX STREET) Tender Ref # PWA-09-2291 Please select one of the following and complete the relevant section(s) of this form Type A Prime Contractor Single Employer Workplace Type B Prime Contractor – Multiple Employer Workplace / Includes Sub-Contractors Type C No Prime Contractor Appointed - Municipal Qualified Coordinator Contractor Contractor Representative: Job Title Person Designated Responsible for Coordination of Safety Job Title Contact # City of Terrace Representative Job Title Contact # Type A & B - Prime Contractor Appointed – The Contractor Yes No N/A Acknowledges the appointment as Prime Contractor Attends necessary pre-construction safety meetings (documented) Determines the boundaries of the workplace, and ensure that only workers of one employer perform duties with-in those boundaries (Type A only) Is responsible for identifying and complying with any and all applicable Acts, Regulations, Standards and Bylaws. The Contractor shall also understand that the WSBC OH&S Regulation and/or any other applicable Acts or Standards shall be adhered to at all times and supersede any direction from the City and it representatives. Shall immediately notify The City of Terrace of any conflict between directions given to them and any applicable Acts, Regulations or Standards & Bylaws.

Safety Supervisor. office - 250- or cell 250- Safety Coordinator – office 250- or cell 250- City of Terrace Representative Name City of Terrace Representative Signature Contractor Acknowledgement of Receipt of This Form Contractor Representative Name Contractor Representative Signature Schedule 4 CONTRACTOR COORDINATION CONFIRMATION OF CONTRACTOR RESPONSIBILITIES This form must be completed and signed before work begins Date Project Description: LABELLEAVENUE 0000 XXXXX XXXXXX (XXXXXX SPARKS STREET TO XXXXXX KALUM STREET) Tender Ref # PWA-09-2291 2290 Please select one of the following and complete the relevant section(s) of this form Type A Prime Contractor Single Employer Workplace Type B Prime Contractor – Multiple Employer Workplace / Includes Sub-Contractors Type C No Prime Contractor Appointed - Municipal Qualified Coordinator Contractor Contractor Representative: Job Title Person Designated Responsible for Coordination of Safety Job Title Contact # City of Terrace Representative Job Title Contact # Type A & B - Prime Contractor Appointed – The Contractor Yes No N/A Acknowledges the appointment as Prime Contractor Attends necessary pre-construction safety meetings (documented) Determines the boundaries of the workplace, and ensure that only workers of one employer perform duties with-in those boundaries (Type A only) Is responsible for identifying and complying with any and all applicable Acts, Regulations, Standards and Bylaws. The Contractor shall also understand that the WSBC OH&S Regulation and/or any other applicable Acts or Standards shall be adhered to at all times and supersede any direction from the City and it representatives. Shall immediately notify The City of Terrace of any conflict between directions given to them and any applicable Acts, Regulations or Standards & Bylaws.

Safety Supervisor. office - 250- or cell 250- Safety Coordinator – office 250- or cell 250- City of Terrace Representative Name City of Terrace Representative Signature Contractor Acknowledgement of Receipt of This Form Contractor Representative Name Contractor Representative Signature Schedule 4 CONTRACTOR COORDINATION CONFIRMATION OF CONTRACTOR RESPONSIBILITIES This form must be completed and signed before work begins Date Project Description: LABELLEAVENUE (XXXXXX STREET TO XXXXXX STREET) GRAND TRUNK PATHWAY EXTENSION 2021 Tender Ref # PWA-09PWA-05-2291 2211 Please select one of the following and complete the relevant section(s) of this form Type A Prime Contractor Single Employer Workplace Type B Prime Contractor – Multiple Employer Workplace / Includes Sub-Contractors Type C No Prime Contractor Appointed - Municipal Qualified Coordinator Contractor Contractor Representative: Job Title Person Designated Responsible for Coordination of Safety Job Title Contact # City of Terrace Representative Job Title Contact # Type A & B - Prime Contractor Appointed – The Contractor Yes No N/A Acknowledges the appointment as Prime Contractor Attends necessary pre-construction safety meetings (documented) Determines the boundaries of the workplace, and ensure that only workers of one employer perform duties with-in those boundaries (Type A only) Is responsible for identifying and complying with any and all applicable Acts, Regulations, Standards and Bylaws. The Contractor shall also understand that the WSBC OH&S Regulation and/or any other applicable Acts or Standards shall be adhered to at all times and supersede any direction from the City and it representatives. Shall immediately notify The City of Terrace of any conflict between directions given to them and any applicable Acts, Regulations or Standards & Bylaws. Accepts that written documentation (e.g. notes, records, inspections, meetings etc.) on all health and safety issues must be made available upon request to the City of Terrace. Has (or will before work starts) received a completed Job Site Hazard Identification Form from a representative of the City of Terrace. Yes No N/A Will conduct an inspection of the worksite to identify any hazards before starting any work on site. Shall communicate all known hazards to any person who may be affected and ensure that appropriate measures are taken to effectively control or eliminate all hazards Must ensure that all workers on site are suitably trained, orientated and competent to perform the duties for which they are assigned. Must submit a Notice of Project to WorkSafeBC (WSBC )and submit a copy to the City of Terrace as required Shall report any and all injuries or incident required by regulation to WorkSafeBC. The contractor shall also report these incidents to the City of Terrace Contract Administrator. The Contractor must be on the City of Terrace approved contractor list and will submit a copy of their formal Occupational Health and Safety program and site specific safe work procedures where required.

Safety Supervisor. office - 250- or cell 250- Safety Coordinator – office 250- or cell 250- City of Terrace Representative Name City of Terrace Representative Signature Contractor Acknowledgement of Receipt of This Form Contractor Representative Name Contractor Representative Signature Schedule 4 CONTRACTOR COORDINATION CONFIRMATION OF CONTRACTOR RESPONSIBILITIES This form must be completed and signed before work begins Date Project Description: LABELLEAVENUE BIRCH HILL AVENUE SLOPE REPAIR (XXXXXX STREET ST TO XXXXXX STREETXXXXXXX ST) Tender Ref # PWA-09-2291 2187 Please select one of the following and complete the relevant section(s) of this form Type A Prime Contractor Single Employer Workplace Type B Prime Contractor – Multiple Employer Workplace / Includes Sub-Contractors Type C No Prime Contractor Appointed - Municipal Qualified Coordinator Contractor Contractor Representative: Job Title Person Designated Responsible for Coordination of Safety Job Title Contact # City of Terrace Representative Job Title Contact # Type A & B - Prime Contractor Appointed – The Contractor Yes No N/A Acknowledges the appointment as Prime Contractor Attends necessary pre-construction safety meetings (documented) Determines the boundaries of the workplace, and ensure that only workers of one employer perform duties with-in those boundaries (Type A only) Is responsible for identifying and complying with any and all applicable Acts, Regulations, Standards and Bylaws. The Contractor shall also understand that the WSBC OH&S Regulation and/or any other applicable Acts or Standards shall be adhered to at all times and supersede any direction from the City and it representatives. Shall immediately notify The City of Terrace of any conflict between directions given to them and any applicable Acts, Regulations or Standards & Bylaws. Yes No N/A Accepts that written documentation (e.g. notes, records, inspections, meetings etc.) on all health and safety issues must be made available upon request to the City of Terrace. Has (or will before work starts) received a completed Job Site Hazard Identification Form from a representative of the City of Terrace. Will conduct an inspection of the worksite to identify any hazards before starting any work on site. Shall communicate all known hazards to any person who may be affected and ensure that appropriate measures are taken to effectively control or eliminate all hazards Must ensure that all workers on site are suitably trained, orientated and competent to perform the duties for which they are assigned. Must submit a Notice of Project to WorkSafeBC (WSBC )and submit a copy to the City of Terrace as required Shall report any and all injuries or incident required by regulation to WorkSafeBC. The contractor shall also report these incidents to the City of Terrace Contract Administrator. The Contractor must be on the City of Terrace approved contractor list and will submit a copy of their formal Occupational Health and Safety program and site specific safe work procedures where required.