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Subcontractor Safety Evaluation

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					                                      Health, Safety, and Environment                        Attachment 46-1A
                                    SUBCONTRACTOR SAFETY
                                                                                            Issue Date: Sept 2008
                                        EVALUATION FORM
                                  (<$1,000,000 in value; High Risk)                               Revision: 0


It is the policy of URS to provide a safe and healthful environment for all of its employees
through the prevention of occupational injuries and illnesses. As such, URS considers safety as
paramount and requests the following information of all subcontractors.

Company Name:                                                    Date:
Address:                                                         Contact Name:
                                                                 Title:
City:                                                            Telephone:
State:                                                           Fax:
Zip:                                                             Email:


Type of services performed:

North America Industry
Classification System
(NAICS) Code:
       If you are in need of assistance with your company’s NAICS Code, please visit
       http://www.osha.gov/oshstats/naics-manual.html or http://www.osha.gov/pls/imis/sicsearch.html.


Has your company performed work as a subcontractor to URS previously?                    Yes                    No
If “Yes”, explain the nature of the work, project location and project date, URS Project Manager and
telephone number.




How many years has your organization been in business under your firm’s name?

If applicable, what was your organization’s previous name(s)?


1. WORKER’S COMPENSATION EXPERIENCE INFORMATION

Insurance Carrier(s):

Contact for Insurance Information:
Title:                                  Telephone:                              Fax:




                                                                                                                 1
                                   Health, Safety, and Environment            Attachment 46-1A
                                SUBCONTRACTOR SAFETY
                                                                              Issue Date: Sept 2008
                                    EVALUATION FORM
                              (<$1,000,000 in value; High Risk)                      Revision: 0


 A. List your firm’s Interstate Worker Compensation Experience Modification Rate (EMR) for
    the three most recent years: (Information is available from your workers compensation
    insurance carrier.)
                    Year                              EMR Interstate




 B. We require verification of your EMR. Please attach the endorsement page from your
    policy listing your EMR, or have your insurance carrier or broker provide this information
    on their letterhead.

 C. If your EMR is 1.0 or exceeds 1.0 for any one or more years above, please explain:

     Comments:




2. SAFETY PERFORMANCE
 A. Please consolidate your firm’s injury and illness data for the last three years and complete
    the table below. The information provided must be for your company as a whole, not an
    individual office location. Provide copies of your OSHA 300 and 300A logs for the last
    three years.
                                                                       YEAR   YEAR          YEAR

   A. Average Number of Employees
   B. Number of Fatalities
      (Totals from Column G of OSHA 300 log)
   C. Number of cases that involved days away from work,
      or cases with job transfer or restriction, or both
      (Totals from Columns H and I of OSHA 300 log)
   D. Other Recordable Cases – Medical Only
      (Number of cases without lost or restricted workdays)
      (Totals from Column J of OSHA 300 log)
   E. Total Recordable Cases
      (Totals from columns G + H + I + J of OSHA 300 log)
   F. Total hours worked
   G. OSHA Total Recordable Incident Rate
             (E above) x 200,000
      Employee Hours Worked (Given Year)
   H. OSHA Lost Workday Case Incident Rate
                                                                                                   2
                                     Health, Safety, and Environment                       Attachment 46-1A
                                 SUBCONTRACTOR SAFETY
                                                                                           Issue Date: Sept 2008
                                     EVALUATION FORM
                               (<$1,000,000 in value; High Risk)                                  Revision: 0


                                                                          YEAR             YEAR          YEAR

               (C above) x 200,000
       Employee Hours Worked (Given Year)


 B. For each fatality, please attach a description of the accident, including cause, lessons
    learned, actions taken resulting from that fatality, actions taken to prevent future fatalities,
    and corporate management summary of their actions and attitudes.

 C. Has your company been issued any health and safety related                                Yes               No
    citations from any federal, state, or local regulatory agency during
    the past three years?
     If “Yes”, please explain the nature of the citation, classification, and final fine. Describe the
     resolution of any serious violations. Please feel free to attach separate statements where more
     space is required.




3. RISK MANAGEMENT / INSURANCE DATA

 A. Does your firm have insurance coverage for commercial liability                           Yes               No
    and automobile liability with limits of at least $1,000,000 per
    occurrence?
     1. Employee Liability of at least $1,000,000 per occurrence.                             Yes               No
     2. Commercial General and Contractual Liability of at least                              Yes               No
        $1,000,000 per occurrence.
     3. Automobile Liability of at least $1,000,000 per occurrence.                           Yes               No
     4. Umbrella Liability of at least $2,000,000 aggregate (in excess                        Yes               No
        of (1); (2); and (3) above).
 (Note that certain URS client contracts require insurance in excess of the levels noted
 above. Inability to supply insurance at levels required by URS’ client contract could
 result in disqualification.)

 B. Are you able to provide URS with insurance certificates naming                            Yes               No
    URS and, if requested, URS’ client as an additional insured?
 C. Please provide proof of current Workers’ Compensation and
    Employers Liability Insurance coverage. (Attach certificate).

7. MEDICAL / DRUG TESTING

 A. Does your company have a Drug/Alcohol policy or program?                                  Yes               No
                                                                                                                 3
                                 Health, Safety, and Environment             Attachment 46-1A
                              SUBCONTRACTOR SAFETY
                                                                             Issue Date: Sept 2008
                                  EVALUATION FORM
                            (<$1,000,000 in value; High Risk)                     Revision: 0



       If “Yes”, does your drug and alcohol program include the following:
        Pre-employment testing                                                  Yes             No
        Testing for Cause                                                       Yes             No
        Post-accident testing                                                   Yes             No
        Random testing                                                          Yes             No


VERIFICATION OF DATA

Please have an officer of the Company sign below certifying that the information provided in this
document is current and correct. Misrepresentation of data requested is grounds for immediate
termination of contracts and disqualification from future consideration.


Name                                                        Title




Signature                                                   Date

            THIS SECTION IS TO BE COMPLETED BY URS CORPORATION

Subcontractor
Name:



Program or Site Manager Evaluation:

         Pass       Subcontractor meets the criteria established in Attachment 46-2 and no
                    further action is required.

         Fail       Subcontractor does not meet the criteria established in Attachment 46-2. If a
                    unique business need exists then a subcontractor variance must be initiated
                    using Attachment 46-3. The variance must be submitted to a Division or
                    Strategic Business Unit (SBU) HSE Manager for evaluation.

                    Project or Site Manager Name:

                    Signature:

                    Date:

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