Competent/Qualified Person Designations

Form 000.653.F0310 Competent/Qualified Person Designations

An evaluation has determined that the person named below has knowledge of the systems, equipment, conditions and procedures, proper use, inspection, manufacturer’s recommendations, and maintenance for the activities designated below. Consequently, this person has been designated as a “Competent and/or Qualified Person” per OSHA/state-plan/USACE/in-country requirements and delegated the responsibility and authority for coordinating activities and operations covered by the designation(s). Company: Name: Employee ID No.: Competent Person Designation(s) Demolition Lead Abatement check as appropriate: Environmental Management Respiratory Protection Aerial Lift Trainer Excavation, Trenching, & Shoring Rigging Inspector Asbestos Fall Protection Equipment Inspection Roof Inspection Cadmium Fall Protection User Training Safety Monitor (roof) Compressed Air (tunneling) Hazardous Materials Usage Scaffolds – Erection/Inspection Confined Space Entry Ionizing Radiation Scaffolds – Erection Only Crane Operator Ladder Inspection (portable) Steel Erection Other Qualified Person Designation(s) check as appropriate: Fall Protection System Design (excavation/trenching) Shoring Design Personnel Platform Design Scaffold Design Concrete and Masonry Construction Crane Maintenance/Repair Other Credentials Reviewed and Verified for Designation Union Apprenticeship Formal Training (describe, with year completed) Years of Experience (give number of years) Informal Training (describe) On-The-Job Performance (OJT, OJE) The employee has reviewed the following standard(s) and safety and health practice(s), and understands the roles, responsibilities, and authority he/she will be expected to execute in accordance with the standard(s) and practice(s). check as appropriate: Standard P2S Practice Aerial Lift Trainer 000.653.3204 Asbestos 000.653.2006 Concrete and Masonry 29 CFR 1926, Subpart Q (Qualified Person Only) 000.653.3312 Confined Space Entry 000.653.3322 Crane 000.653.3201 Demolition 000.653.3313 Environmental Management 000.653.4000 Excavation, Trenching, and Shoring 29 CFR 1926, Subpart P (Qualified Person Only) 000.653.3311 Fall Protection and Safety Monitor 29 CFR 1926, Subpart M (Qualified Person Only) 000.653.3001 Forklift 000.653.3203 Hazardous Materials Usage 000.653.3102 Heavy Equipment Operator/Inspector 000.653.3200 Ladders 000.653.3302 Lead Abatement 000.653.2005 Respiratory Protection 000.653.3002 Rigging/Rigging Inspection 29 CFR 1926.753 000.653.3201 Scaffolds (all designations) 29 CFR 1926, Subpart L (Qualified Person Only) 000.653.3303 Steel Erection 29 CFR 1926, Subpart R 000.653.3317 Signatures: Date: Competent/Qualified Person Date: Foreman/General Foreman/Superintendent/Supervisor Date: Construction Manager/Project Manager/Engineering Manager

COMPETENT/QUALIFIED PERSON DESIGNATION FORM INSTRUCTIONS

Read the statement at the top of the Competent/Qualified Person Designation Form.

Employee Information:

Company: Write the name of the company. Name: Print the employee’s full name. Employee ID No.: Clearly write the employee’s Company ID, Social Security number, or other personal identifier in the space provided.

Competent Person Designation(s):

Check the box to indicate which area the employee is being designated as a “Competent Person.” (More than one box may be checked.)

Qualified Person Designation(s):

Check the box to indicate which area the employee is being designated as a “Qualified Person.” (More than one box may be checked.)

Credentials Reviewed and Verified for Designation: (Completion of this section is mandatory. Be as detailed as possible — list specifics.)

Review and verify the credentials of the employee.

List any applicable formal training in the space provided.

List the number of years of experience the employee has relevant to the Competent and/or Qualified Person designations marked above.

Check the appropriate box if the employee has completed a union apprenticeship.

List any applicable informal training.

Check the appropriate box if the designation is based on “On-The-Job” Performance.

Standards and Practices Training: (Completion of this section is mandatory.)

Ensure the employee has read the relevant standards and safety and health practices governing the designations marked in the sections above.

Ensure the employee fully understands the roles, responsibilities, and authority he/she will be expected to execute.

Check the box indicating which standards and practices the employee read during the designation process.

Signatures:

The Competent/Qualified Person must sign and date the form accepting the responsibilities associated with the designations.

The employee’s foreman, general foreman, or superintendent should sign and date the form acknowledging the designation. (This signature is not mandatory.)

The construction, project, or engineering manager must sign and date the form.

COMPETENT PERSON STRATEGY BACKGROUND

1. Competent Person is a specifically defined designation from the U.S. Army Corps of Engineers, federal OSHA, state-plan OSHA standards, and in-country standards and MUST NOT BE CONFUSED with a person who is competent or qualified (proficient and/or trained) to perform a job/activity. The same is true for a Qualified Person.

2. Competent Persons must be designated in accordance with safety and health practice 000.653.1000 for the following tasks/activities: . Aerial Lift Trainer . Ladder Inspection (portable) . Asbestos . Lead Abatement . Cadmium . Respiratory Protection . Compressed Air (tunneling) . Rigging Inspector . Confined Space Entry . Roof Inspector . Demolition (large scale) . Safety Manager . Environmental Management . Safety Monitor (roof) . Excavation, Trenching and Shoring . Safety Officer . Fall Protection – Equipment Inspection . Safety Technician . Fall Protection – User Trainer . Safety Trainer . Hazardous Materials Usage . Scaffold Erection . Hearing Protection/Conservation . Scaffold Inspection . Ionizing Radiation . Steel Erection 3. Qualified Persons must be designated for the following tasks/activities:

. Concrete/Masonry Construction . Crane Maintenance/Repair Person . (excavation and trenching) Shoring Design . Fall Protection System Design . Hoisting and Rigging – Personnel Platform Design . Scaffold Design

4. A Competent/Qualified Person designation is predicated on an individual being exceptionally well qualified in his/her subject area, and NOT SIMPLY training, education, experience, or on-the-job training in and of themselves.

5. A Competent/Qualified Person must demonstrate he/she is (a) highly knowledgeable on the subject, and (b) capable of using consistently good judgment in carrying out the appointed responsibilities in the subject area; one may be competent, and not be a Competent Person.

6. We should LIMIT THE NUMBER of Competent Persons to no more than three per craft, per subject area, per project – less if possible/appropriate. An exception may be in the subject areas such as scaffold inspection and excavation, trenching and shoring.

7. In most cases, a Competent/Qualified Person should be considered Competent from one project to another – however, this is the project/construction manager’s call.

Note: This form is referenced in Practice 000.653.1000.