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DOE-HDBK-1101-2004
Exhibit 2.6.3
Sample Subcontractor Safety Program Evaluation and Criteria
Subcontractor:
________________________________________________________________
Address:
________________________________________________________________________
________________________________________________________________________
_____
Point of Contact_____________________________ Phone Number _________________
I. Safety Program Evaluation Rating
Circle the number which best represents this evaluations based on the criteria for rating purposes
attached.
A
B
C
D
Comment
Safety Program
1.
Policy Statement
0
3
7
10
2.
Safety Manual
0
3
7
10
3.
Emergency Response Procedures
0
3
7
10
4.
Basic Safety Rules
0
3
7
10
5.
Accident Reporting Procedure
0
3
7
10
6.
Employee Orientation Program
0
3
7
10
7.
Safety Meeting Program
0
3
7
10
8.
Safety Training Program
0
3
7
10
9.
Safety Inspection Program
0
3
7
10
10.
Professional Safety Support
0
3
7
10
11.
Alcohol/Drug Control Policy
0
3
7
10
Total Rating
__ + __ + __ + __x.60 = Rating
57


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