Carson, CA Inland Star Distribution Centers, Inc. PSM/CalARP
PSM: 8 CCR 5189(h) | CalARP: 19 CCR 2760.12 CONT | 1
CONTRACTOR PROGRAM
Revision History
Rev. #
Description of Change
Date
Revised By
0
Initial Issues
July 2016
PSM RMP Solutions
Purpose
The purpose of this contractor program is to ensure that contractors, subcontractors, and their
employees are fully aware of the potential dangers involved with the storage of hazardous
chemicals. This awareness should lead to reduced risks of accidents, and thus improved safety,
for both contract employees and Inland Star Center Distribution Centers, Inc. employees.
This document summarizes how Inland Star Distribution Centers, Inc. complies with the contractor
program requirements for the storage of hazardous chemicals. Inland Star Distribution Centers,
Inc. has established this contractor program for all contractors and subcontractors performing work
such as maintenance, repair, or renovation on or near the storage of hazardous chemicals. While
incidental work such as janitorial or food service is not covered, any work that may affect the safety
of the system should be included in the program.
Examples of contractors or subcontractors who could potentially affect process safety could include
fork lift maintenance/repair operators working in the area of the storage of hazardous chemicals, as
well as many others.
Responsibilities
The General Manager, Operations has overall responsibility for the contractor program at the
facility including:
• Ensuring that contractor’s safety performance and programs are evaluated when
selecting contractors.
• Ensuring that contract employees are informed of potential fire, explosion or toxic release
hazards related to the storage of hazardous chemicals.
• Developing and implementing safe work practices for controlling the entrance, presence,
and exit of contract employees into the process area.
Carson, CA Inland Star Distribution Centers, Inc. PSM/CalARP
PSM: 8 CCR 5189(h) | CalARP: 19 CCR 2760.12 CONT | 2
• Establishing procedures to periodically review the work and safety performance of
contract employers working at the facility.
• Developing a contract employee injury and illness log relating to the contract employer’s
work in the process area.
The contractor’s responsibilities are:
• Filling out the contractor qualifications and references questionnaire and returning it to
the General Manager, Operations.
• Participating in pre bid and post bid meetings.
• Ensuring that their employees and any subcontractor employees have been trained.
• Ensuring that their employees and any subcontractor employees follow the safety rules
of the facility including the site’s safe work practices.
• Advising facility personnel of any unique hazards at the facility.
Contractor Program Steps
Specific procedures that should be followed are provided below:
Contractor Selection
When selecting a contractor or subcontractor, Inland Star Distribution Centers, Inc. evaluates
information regarding the contractor’s historical safety performance and current safety
programs. The Contractor Qualification Form CQ1, included Attachment A, is used to obtain this
information. The form is sent to each contractor who will be working on or near the storage of
hazardous chemicals with instructions to fill it out and then return it to the General Manager,
Operations.
The information obtained on Form CQ 1 and any previous work experience may be used to
evaluate a contractor’s safety performance and programs during the selection process. Issues
which may be considered during the qualification process include:
• Does the contractor have knowledge of storage of hazardous chemicals?
• Does the contractor have any experience working on or around hazardous chemicals
which are regulated under PSM and CalARP?
• How does the contractor’s Experience Modification Rating (EMR) compare to other
contractors?
• How does the contractor’s accident record compare to other contractors?
• Has the contractor received any recent OSHA citations (and how were the citations
resolved)?
• Do the contractor’s written safety programs meet government and Inland Star
Distribution Centers, Inc. standards?
• Has the contractor successfully implemented the programs and procedures described in
their written safety programs?
Carson, CA Inland Star Distribution Centers, Inc. PSM/CalARP
PSM: 8 CCR 5189(h) | CalARP: 19 CCR 2760.12 CONT | 3
If a contractor has previously worked at the facility, and the work to be bid is similar to the
previous work, the contractor evaluation may be based upon the contractor’s prior performance.
Contractor qualifications and their respective safety records and programs should be kept on file
with the General Manager, Operations.
Contractor Awareness
Before any work is performed onsite, the contractor and subcontractor is informed of the
potential hazards associated with the storage of hazardous chemicals, facility safe work practices,
and emergency notification and evacuation procedures. The information may be given to a
contractor during a meeting and/or site walkthrough. Alternatively the information may be
mailed to a contractor.
The information that is reviewed with each contractor includes:
• General facility safety rules.
• Safety rule enforcement procedures.
• Procedures to control the presence, entrance and exit of contract employees in the area
of the storage of hazardous chemicals.
• Facility Good Manufacturing Practice (GMP) procedures.
• Safety rules that apply to the area where work will be done.
• Proper personal attire and personal protective equipment required.
• Plot plans and Safety Data Sheets.
• Potential hazards associated with the storage of hazardous chemicals including the
potential hazards associated with exposure to those chemicals.
• Fire and explosion prevention procedures including the location of firefighting equipment
and the location of emergency exits.
• Unique hazards of the job including concealed dangers, toxic release hazards, and process
hazards.
• Site specific safe work practices including lockout/tagout procedures, hot work permit
procedures, and confined space entry procedures.
• Procedures which should be followed to report any chemical releases or other hazards
contractors discover while they are on site.
• Applicable sections of the Emergency Action Plan.
The confirmation letter (Form CQ2) in Attachment A is typically used to document the
information which was provided to each contractor and to specify the actions which should be
taken by the contractor. Contractor awareness records should be kept on file by the General
Manager, Operations. The contractor awareness information should be re-supplied on an annual
basis.
Carson, CA Inland Star Distribution Centers, Inc. PSM/CalARP
PSM: 8 CCR 5189(h) | CalARP: 19 CCR 2760.12 CONT | 4
Contractor Responsibilities
Each contract employee and each subcontractor employee should be made aware of the
potential hazards of the storage of hazardous chemicals, the work practices necessary to safely
perform their job, and the applicable portions of the Emergency Action Plan. Contractors are
responsible for providing training to their employees and to subcontractor employees.
The Contract Employee Acknowledgment Record (Form CQ3), included in Attachment A, should
be filled out to document that each contract employee and subcontractor employee has been
trained and understood the training. Typically one record should be filled out for each employee
trained. If the contractor conducts the training of the contract employees, then the contractor
should fill out and maintain the records. If the training is conducted by the facility personnel, the
training records should be filled out and maintained at the facility.
The contractor should assure that each contract employee follows the safety rules of the facility
including the site’s safe work practices. The assurances can be provided by the contractor
conducting documented regular site inspections and conducting documented regular meetings
with their employees. The contract employer must advise appropriate facility personnel of any
unique hazards presented by the work it will perform and alert facility personnel to any hazards
discovered during the contract employer’s work.
The contractor should tell appropriate facility personnel of any hazards that they introduce to
the facility, for example any hazardous chemicals which are used by their employees.
Periodic Evaluations
The General Manager, Operations regularly evaluates each contractor’s performance to ensure
they are meeting their PSM/CalARP obligations, including training, following safety procedures,
and informing employees of hazards. This evaluation is conducted using the Contract Employer
Evaluation Form CQ4 in Attachment A. An evaluation should be completed for each contract
employee at least once every year and kept in the contractor files at the facility, maintained by
the General Manager, Operations.
Contractor Injury and Illness Log
The facility maintains an injury and illness log related to the contractor’s employees working on
or in the vicinity of the storage of hazardous chemicals. These injuries and illness are typically
documented through the incident investigation procedures. The General Manager, Operations
is responsible for maintaining the contractor injury and illness log at the facility.
Carson, CA Inland Star Distribution Centers, Inc. PSM/CalARP
PSM: 8 CCR 5189(h) | CalARP: 19 CCR 2760.12 CONT | A1
Attachment A
Form CQ1: Contractor Qualifications and References Questionnaire
Form CQ2: Confirmation Letter
Form CQ3: Contract Employee Acknowledgment Record
Form CQ4: Contract Employer Evaluation
Inland Star Distribution Centers, Inc.
Form CQ1: Contractor Qualifications and References Questionnaire
Page 1 of 4
Name of person completing this form:
Date completed:
I.
Organization
A.
Name of Business:
Address:
Year Established:
Partnership:
Corporation:
Sole
Proprietorship:
Other:
Officers:
Name
Title
Name
Title
II.
Bidding Interest
A.
What percentage of your work is:
Commercial:
Industrial:
Other (Specify):
B.
Type of work you are interested in bidding:
Construction
General Contractor
Design/Build
Other (Specify):
C.
List current related projects in process or completed in the past five (5) years (attach additional sheets as
needed):
Inland Star Distribution Centers, Inc.
Form CQ1: Contractor Qualifications and References Questionnaire
Page 2 of 4
III.
References
A.
Previous work: (Completed for
Inland Star Distribution Centers, Inc.)
1. Location:
Date:
Type of work:
Value:
2. Location:
Date:
Type of work:
Value:
B.
Other Work: (Completed for other clients)
1. Client:
Contact:
Value:
Telephone #:
2. Client:
Contact:
Value:
Telephone #:
3. Client:
Contact:
Value:
Telephone #:
4. Client:
Contact:
Value:
Telephone #:
5. Client:
Contact:
Value:
Telephone #:
Inland Star Distribution Centers, Inc.
Form CQ1: Contractor Qualifications and References Questionnaire
Page 3 of 4
IV.
Safety
A.
Experience Modification Rating (EMR):
This is an annual safety rating of how a specific contractor compares to other contractors, in the same type
of work, in the state where the Contractor is working. (Contractor should have this rating, since it is provided
by his insurance company).
Show your EMRs as applicable for this current year and for the last two (2) years, as follows:
EMR for
This Year Last Year Year Before
Home State:
Interstate:
Other States (List)
B.
Accident Experience
Summarize the data shown on your OSHA Form 300 and OSHA Form 300A for all
construction-related (not
shop) injuries for year-to-date and for last year. All jobs.
This Year
Last Year
Recordable (Medical)
Restricted Duty
Lost Time
# of Days Lost
List construction related injury incidence rates for
year-to-date and for last year:
Rate
= Number of injuries x 200,000 divided by Total Man-Hours Worked
Severity
= Number of lost days x 200,000 divided by Total Man-Hours Worked
Note: The number of recordable injuries includes the number of light duty plus lost time injuries.
This Year Last Year
Rate
Recordable
Lost Time
Severity
Have you experienced any construction fatalities within the past three (3) years?
Yes No
If yes, attach a full discussion of cause and results.
Have you received an OSHA (or State OSHA) citation within the last three (3) years? Yes No
If yes, attach a full report on event and results.
Inland Star Distribution Centers, Inc.
Form CQ1: Contractor Qualifications and References Questionnaire
Page 4 of 4
IV.
Safety
C.
Safety Program
Do you have a written:
Safety Program?
Yes No
HAZCOM Program?
Yes No
HAZWOPER Program? Yes No and/or Emergency Action Plan? Yes No
Please submit them for our file.
(Note: The safety plan will be evaluated per ANSI A10.38)
D.
Process Safety Management
Do you have experience working on or around process systems which
contain:
Regulated Chemicals? Yes No
Any other material regulated under PSM, RMP, and/or CalARP? Yes No
(If yes, please list below)
Any flammable material process covered by the OSHA PSM Standard?
Yes No
(If yes, please list below)
E.
Qualifications
Do you have written documentation which demonstrates that you are trained and qualified to perform the
following work (if applicable):
Welding on Pressure Vessels Yes No
Other
Yes No
(If yes, please list below)
Inland Star Distribution Centers, Inc.
Form CQ2: Confirmation Letter – Safety Communications with Contract Employers
Note: To be printed on Inland Star Distribution Centers, Inc. letterhead.
Page 1 of 2
By certified mail, return receipt requested
Date:
To: Contractor Name & Address
Attn:
Re: Employee Safety at Inland Star Distribution Centers, Inc. per the PSM/CalARP Program
This letter is intended to summarize our discussions with representatives of Contractor Name on Date,
regarding safety issues at the Inland Star Distribution Centers, Inc. that may be encountered by your employees
and by our own employees in connection with your work on our premises.
In our meeting(s) with you, we have specifically discussed the need to provide adequate warning and training
to our own employees and to contract employees regarding workplace safety. Our concern is both for the
safety of all employees, and documenting compliance with the OSHA Process Safety Management (PSM)
Standard and California’s Accidental Release Prevention Program (CalARP).
In order to ensure training and establish a safe workplace, we have taken the following actions and have agreed
as follows:
1) Contractor Name on Date received from Inland Star Distribution Centers, Inc. a copy of the following
materials:
a. General facility safety rules.
b. Safety rule enforcement procedures.
c. Procedures to control the presence, entrance and exit of contract employees in the area of
the storage of hazardous chemicals.
d. Facility Good Manufacturing Practice (GMP) procedures.
e. Food Safety Program rules.
f. Proper personal attire and personal protective equipment required.
g. Plot plans and Safety Data Sheets.
h. Potential hazards associated with the hazardous chemicals including the potential hazards
associated with exposure to those chemicals.
i. Fire and explosion prevention procedures including the location of firefighting equipment and
the location of emergency exits.
j. Unique hazards of the job including concealed dangers, toxic release hazards, and process
hazards.
k. Site specific safe work practices including lockout/tagout procedures and hot work permit
procedures.
l. Procedures which should be followed to report any chemical releases or other hazards
contractors discover while they are on-site.
m. Applicable sections of the Emergency Response Plan.
Inland Star Distribution Centers, Inc.
Form CQ2: Confirmation Letter – Safety Communications with Contract Employers
Note: To be printed on Inland Star Distribution Centers, Inc. letterhead.
Page 2 of 2
Contractor Name agrees that Inland Star Distribution Centers, Inc. conveyed all appropriate information
concerning the known potential fire, explosion, and toxic release hazards, the relevant portions of the
Emergency Response Plan, and the safe work practices prior to the start of any work on or near the storage of
hazardous chemicals.
2) Inland Star Distribution Centers, Inc. assures that each contract employee is trained in the work practices
necessary to safely perform his or her job, assures that each contract employee is instructed in the known
potential fire, explosion, or toxic release hazards related to the work he or she will perform in this facility and
in the applicable provisions of the emergency response plan of this facility; and documents that each employee
has received and understood the training and instructions.
3) Contractor Name will be responsible for relaying the information listed in item (1) to its individual employees
before they come on premises.
4) In addition, Contractor Name will be responsible for instructing its employees to consult the information in
item (1) before they begin work, and for checking that such consultation actually occurs.
5) In accordance with our contract, Contractor Name will advise Inland Star Distribution Centers, Inc. prior to
beginning work, of any hazardous substances it will bring on premises and/or any safety issues that could be
created by its work. Such information will be communicated in writing to the General Manager, Operations.
If your (contractor’s) work will pose any safety issues for your employees, you will discuss those issues with the
Owner’s Representative before commencing that portion of the work.
6) The arrangements set forth in this letter will apply to all specific jobs currently under contract or negotiation
with respect to the Inland Star Distribution Centers, Inc. and to all future jobs that involve the presence of
Contractor Name employees on the Inland Star Distribution Centers, Inc. premises.
Very truly yours,
Daniel Alvarado
General Manager, Operations
Inland Star Distribution Centers, Inc.
Inland Star Distribution Centers, Inc.
Form CQ3: Contract Employee Acknowledgment Record
Page 1 of 1
I. Company Information
Contractor Company Name:
Name of Employee:
II. Review of Inland Star Distribution Centers, Inc. Programs & Policies
Check applicable items reviewed with employee. Employee to initial each box when instruction is
completed and understood.
Employee
Initials
1. General Facility Safety Rules
2. Safety Rule Enforcement Procedures
3. Procedures to Control the Presence, Entrance and Exit of Contract Employees
4. Facility GMP Procedures
5. Food Safety Program rules.
6. Proper Personal Attire and Personal Protective Equipment Required
7. Plot plans, Safety Data Sheets
8. Potential Hazards Associated with the hazardous chemicals
9. Fire and Explosion Prevention Procedures
10. Unique Hazards of the Job
11. Site Specific Safe Work Practices
12. Procedures to Report Chemical Releases
13. Applicable Sections of the Emergency Action Plan
III. Contractor Employee Acknowledgment
I have reviewed the above checked items relating to the safety rules and sa
fe work procedures for work at
Inland Star
Distribution Centers
, Inc.
Employee Name (Print):
Employee Signature:
Date:
IV. Contractor Certification
I certify that the above named employee has received and understood the training described above.
Supervisor Name
(Print):
Supervisor Signature:
Date:
Inland Star Distribution Centers, Inc.
Form CQ4: Contract Employer Evaluation
Page 1 of 2
Section I: Information
Contractor Company Name:
Date:
Prepared By (Name & Title):
Facility: Inland Star Distribution Centers, Inc.
Process:
Section II: Project Description
Project Description:
Section III: Evaluation
Question
(Note: For all “no” answers, provide comments in space below.)
Acceptable?
(Check Answer)
Contractor consistently adhered to facility safety policies and
procedures?
Yes No N/A
Contractor obtained all necessary permits prior to initiating
work?
Yes No N/A
Contractor completed all monitoring as required by permits (i.e.
- hot work, confined space, etc.)?
Yes No N/A
Contractor followed facility access control procedures?
Yes
No
N/A
Contractor used required personal protective equipment (PPE)
at all times?
Yes No N/A
Contractor provided adequate staffing to complete the job
safely?
Yes No N/A
Contractor provided adequate supervision to complete the job
safely?
Yes No N/A
Contractor used proper tools for all tasks as required?
Yes
No
N/A
Contractor informed Inland Star Distribution Centers, Inc. of any
project changes?
Yes No N/A
Contractor informed Inland Star Distribution Centers, Inc. of any
hazardous substances it will bring on premises and/or any safety
issues that could be created by its work?
Yes No N/A
Contractor maintained a clean job site (i.e.-demonstrated good
housekeeping)?
Yes No N/A
Inland Star Distribution Centers, Inc.
Form CQ4: Contract Employer Evaluation
Page 2 of 2
Question
(Note: For all “no” answers, provide comments in space below.)
Acceptable?
(Check Answer)
Contractor hand tools and equipment are in good repair (no
frayed cords, bypassed safeties, etc.)?
Yes No N/A
Contractor advised Inland Star Distribution Centers, Inc. of any
injuries to contract employees as a result of their work at this
facility?
Yes No N/A
Comments:
Section IV: Contractor Rating
Overall Contractor Safety Rating: (Check Answer)
Satisfactory
Unsatisfactory
