Get Designated Safety Representative Form

Form Contractor Designated Safety Representative CONTRACTOR DESIGNATED Safety Representative This form shall be completed in its entirety by a Principal/Owner of the General Contractor identifying the Safety Representative that he/she has assigned to the project. This form shall also be posted on site. General Contractor School Project Contract I have determined that will act as my designated Safety Representative for the above referenced project. The General Contractor must include appropriate certifications training documentation s or other information specifying why and how the stated employee meets the requirements of Safety Representative. This document shall be submitted to the SCA Project Officer and SCA Safety Unit prior to commencing work activities. He/she shall be responsible and accountable for all safety related matters. Mr. /Ms. has my explicit authority to take prompt corrective action s as necessary including stopping the work to eliminate hazards at risk conditions unsafe acts or any other condition that affects the safety or well-being of an employee or the general public and/or the safety of property and/or equipment. He/she will be responsible for representing our company during all safety meeting and shall maintain all records/documentation mandated by Contractor and/or governing codes and standards. 1. The following information and/or attached documents s support our selection of the above named individual as Safety Representative at the aforementioned project. Note minimum requirement is OSHA 30-Hour Construction Safety Health Certificate issued within the last 5 years and a 7 hour site safety manager certification from the NYC Department of Buildings Print Name Company Name Signature Title Date. The General Contractor must include appropriate certifications training documentation s or other information specifying why and how the stated employee meets the requirements of Safety Representative. This document shall be submitted to the SCA Project Officer and SCA Safety Unit prior to commencing work activities. He/she shall be responsible and accountable for all safety related matters. Mr. /Ms. has my explicit authority to take prompt corrective action s as necessary including stopping the work to eliminate hazards at risk conditions unsafe acts or any other condition that affects the safety or well-being of an employee or the general public and/or the safety of property and/or equipment. He/she will be responsible for representing our company during all safety meeting and shall maintain all records/documentation mandated by Contractor and/or governing codes and standards. He/she will be responsible for representing our company during all safety meeting and shall maintain all records/documentation mandated by Contractor and/or governing codes and standards. 1. The following information and/or attached documents s support our selection of the above named individual as Safety Representative at the aforementioned project. 1. The following information and/or attached documents s support our selection of the above named individual as Safety Representative at the aforementioned project. Note minimum requirement is OSHA 30-Hour Construction Safety Health Certificate issued within the last 5 years and a 7 hour site safety manager certification from the NYC Department of Buildings Print Name Company Name Signature Title Date.