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| Exhibit 2.6.3
DOE-HDBK-1101-96
Sample Subcontractor Safety Program Evaluation and Criteria
Subcontractor: ________________________________________________________________
Address: ________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Point of Contact_____________________________________ PhoneNumber _________________
I. Safety Program Evaluation Rating
Circle the number which best represents this evaluation 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 Reportin 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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