NAME: Contractor Safety & Environmental Procedure

SCHNEIDER ELECTRIC Procedure Number: North American Division PAGE 1 OF 25 Safety, Health and Environmental Procedures DATE EFFECTIVE:

NAME: Contractor Safety & Environmental Procedure SUPERSEDES: New Approval Initials Date Approva Initials Date PURPOSE: To ensure Contractors perform work on our sites l without posing a threat to their Safety or the Safety of our employees. They will also take all necessary measures to ensure the protection of human health and the environment. Safety and Environmental performance is a consideration in the Contractor administration and selection process. ISSUED BY: Corporate DEPT: SH&E DISTRIBUTION: Non-Limited

ATTACHMENTS Attachment A Additional Site Requirements Attachment B Contractor Approval Checklist Attachment C Contractor Safety Information Data Sheet Attachment D Contractor Orientation Checklist Attachment E Contractor Site Safety Representative Attachment F Sample – Letter of Approval Attachment G Contractor Job Site Safety Checklist Attachment H Contractor Safety Report Attachment I Contractor Safety Program Training Log Attachment J Contractor Hold Harmless Agreement

1. SCOPE

This policy applies to Schneider Electric North American Division and its subsidiaries and affiliates in North America (referred to collectively in this policy as “Schneider Electric”). Schneider Electric has prepared this Contractor Safety & Environmental Program to provide specific guidelines for determining the suitability of service providers relative to safety, health and environmental (SH&E) performance. This program applies to the following specific service providers:

 Equipment installation or repair companies  Electrical Services Companies  Rigging/Crane Companies  Building construction or repair companies  HVAC service and repair  Mechanical and Plumbing installation and repair  Food service organizations  Custodial service companies 2  Any other contractor or subcontractor used on site

Service providers contracted directly to Schneider Electric are evaluated and selected using the guidelines established in this Program. Each contractor utilized by Schneider Electric is evaluated to determine adherence to the intent and compliance with the requirements of this program. Contractor personnel at the site must comply with all applicable SH&E regulations and Schneider Electric’s SH&E policies and procedures.

2. PROCEDURE

This section describes the process for bidding and performing work for Schneider Electric. Service providers (as listed in the Scope) that will perform work on our site are subject to the requirements detailed in this section. The process of managing the Contractor Safety & Environmental Procedure is divided into three steps: A. Approval, B. Orientation, and C. Training, followed by audits. Each of these steps is described below.

A. Safety & Environmental Approval of Contractors Each Contractor is reviewed and approved before being allowed to bid work that will be contracted directly to Schneider Electric. Approval consists of the following steps:

1) Each prospective Contractor is provided a copy of the Contractor Safety & Environmental Program and instructed to complete and submit the following:  Contractor Approval Checklist (Attachment B)  Contractor Safety Information Data Sheet (Attachment C)  Contractor Site Safety Representative (Attachment D) 2) The Contractor completes the required forms and submits these along with a copy of any specific written safety programs that will be used as part of the work (i.e., hazard communication, lockout/tagout, confined spaces, etc.) 3) The Schneider Electric representative (Safety & Environmental Mgr., Plant Engineer, Project Supervisor, etc.) reviews each Contractor’s submittal to determine if the company meets the minimum criteria for approval. Approval is based on the following:  Workers’ Compensation Experience Modification Rating (EMR) of 1.0 or less.  OSHA Recordable of less than 10.0 and Lost Time Accident frequency rates less than 3.0.  Hold Harmless Agreement from Contractor. (Attachment J)  Certificates of Insurance for WC, Auto, and General Liability (Attachment J)  Contractor Safety Programs contain the following: Safety & Environmental Policy Environmental Awareness (General) Hazard Communication/WHMIS Safety Rule Enforcement Employee Rights & Responsibilities Housekeeping Employee Access to Employee- Infectious Control Exposure and Medical Records Accident Reporting & Investigation Machine Guarding Alcohol and Drug policy 3 Material Handling (Manual Lifting) Unsafe Act/Condition Reporting Driving Safety Parking Lot Safety Electrical Safety Personal Protective Equipment Emergency Procedures Fall Prevention Ergonomics Lockout/Tagout

Where applicable, the programs should also include: Confined Spaces Hearing Conservation Respiratory Protection Industrial Truck Operations Electrical Safety Work-Related Practices

 For Contractors renewing approval, review of completed Contractor Job Site Safety Checklist forms indicates positive findings during previous work.  Compliance with any additional site-specific SH&E requirements (Attachment A).  Understanding that all jobs bid will include an on-site supervisor.  Contractor will supply all necessary tools and equipment for the job. Schneider Electric tools and equipment will not be used by the contractor except in an emergency situation where human life is in danger. 4) Following the review, the Schneider Electric representative notifies the Contractor regarding the result of the approval process using the Letter of Approval form (Attachment F). 5) Each Contractor must renew approval at the beginning of each calendar year. With each bid, the Contractor submits a copy of the Letter of Approval (to verify prior approval) and an updated Contractor Site Safety Representative (Attachment E) form. When approval expires, the process outlined above is repeated.

B. Contractor Orientation

1) Prior to beginning work, the Contractor Site Safety Representative receives an orientation briefing from the Schneider Electric representative regarding requirements for working at the site. This briefing would include the following:  Emergency Contact Information  All work on site requires the contractor to provide an on-site supervisor.  All work performed on-site will be with contractor’s tools and equipment. Schneider Electric tools and equipment will not be used.  Site Smoking Policy  Site Housekeeping Requirements  Parking and Site Access Restrictions  Schneider Electric’s Safety &Environmental Rules and Practices (Location SH&E Handbook)  Overview of the plant Environment policy including management of all generated wastes. 4  Overview of Zero Tolerance Policy regarding harassment and use of alcohol and/or drugs  Emergency response information (alarm signals, location of shelter areas, etc.)  Notification requirements regarding accidents, incidents and near misses  Requirements regarding use of chemicals at the site and means of obtaining a Material Safety Data Sheet.  Required Personal Protective Equipment (PPE) while on the site  Required permits for performing the work and means of obtaining permits, i.e. hot work permit.  Use of ladders, scaffolding or rigging.  Fall protection policy at heights of 6 feet or higher.  Requirements regarding lockout/tagout  Electrical safety requirements, including no live work and appropriate PPE.  Location and hazards of confined spaces in the vicinity of the work area(s)  Use of electrical equipment and Ground Fault Circuit Interrupters (GFCI)  If there are any hazardous materials, i.e. PCBs or ACM’s, or noise control areas in the building.

Site-specific requirements regarding these items are outlined on the attached Contractor Orientation Checklist (Attachment D). The Contractor’s Site Safety Representative is responsible for training all onsite Contractor personnel in these and other site-specific requirements.

2) Contract Administration

Once work has begun, the onsite activity of each Contractor performing work for Schneider Electric is periodically reviewed to document compliance with provisions of the safety program. The Schneider Electric representative performs this review using the Contractor Job Site Safety Checklist (Attachment G). These reviews are performed according to the schedule presented below.

Project Duration Review Schedule Up to one day . Immediately prior to the conclusion of the work Up to one week . At least once during the work . At the conclusion of the work More than one week . At least twice during the first week of work . At least once per additional week of work . At the conclusion of the work Ongoing . At least once per month 5 For work that lasts one week or more, the Contractor must submit a report of onsite activities to the Schneider Electric representative using the Contractor Safety Report form (Attachment H).

The results of each review are communicated to the Contractor Site Safety Representative for corrective action. Results of these reviews are considered when determining whether to renew or maintain approval for the Contractor.

3) Withdrawing Approval for a Contractor

Schneider Electric reserves the right to terminate any approved Contractor for failure to comply with site rules and regulations and/or to correct unsafe conditions or practices.

Schneider Electric reserves the right to remove any approved Contractor from the “Approved Contractor List” for failure to comply with established safety rules and regulations or for allowing an unsafe condition to exist in the workplace. Upon correction of the deficiency, the Contractor’s name may be reinstated on the “Approved Contractor List.” Additionally, Schneider Electric reserves the right to terminate any agreement according to the terms and conditions of such agreement.

C. Training

The Schneider Electric Representative, during a Toolbox meeting, will communicate to Schneider Electric employees the requirements of the Contractor Safety &Environmental Program as well as any potential hazards introduced to their work area by the Contractor.

Employees who are involved in the evaluation process must be knowledgeable regarding the specific work that is to be performed. For example, employees who are qualified under the electrical safe work practices would review Contractor electrical safety programs.

Employees who perform reviews of the Contractor’s onsite activities shall be trained to recognize hazardous conditions and to complete the Contractor Job Site Safety Checklist (Attachment G).

All training shall be documented using the Contractor Safety Program Training Log (Attachment I).

3. DEFINITIONS

A. Contractor: A business that is in contract with Schneider Electric to perform a service or provide a product. B. Experience Modification Rate (EMR): An evaluation of a company’s last three full years of workers’ compensation losses based upon payroll amount and their Standard Industrial Clas- sification (SIC) Code. This evaluation compares the anticipated losses for a particular firm versus the actual losses experienced by the firm. An EMR of 1.0 means that actual losses were equal to anticipated losses. 6 C. Hazardous Conditions: Any existing or potential condition in the workplace, which, by it- self or by interacting with other variables, can result in deaths, injuries, property damage, or other losses. D. Lost-Time Accident Frequency Rate: The number of lost workday cases per 100 employees. These cases include recordable injuries that involve days away from work. To determine the frequency rate, multiply the total number of cases by 200,000 and divide the answer by the total employee hours worked. E. OSHA Recordable Injury Frequency Rate: The number of OSHA recordable injuries per 100 employees. These injuries include all work-related deaths and illnesses and those work- related injuries that result in loss of consciousness, restriction of work or motion, transfer to another job, or medical treatment beyond first aid. To determine the frequency rate, multiply the total number of recordable cases by 200,000 and divide the answer by the total employee hours worked. F. SIC (Standard Industrial Classification) Code: Classification system used by the Bureau of Labor Statistics, which groups business operations under a two, three or four-digit code. The Bureau associates vital statistics with each defined code. Injury rates compiled by the Bureau and associated with particular industries are used as baselines for determining performance against similar workplaces.

4. RESPONSIBILITIES

A. Location Plant Engineer  Maintains a current list of approved Contractors for use at his/her account locations  Authorizes, in consultation with SH&E, approval of any Contractor failing to meet the minimum valuation criteria as outlined in this Program.  Administers the written Contractor Safety Program.  Requires evaluation of all Contractors submitting bids for work.

B. Schneider Electric Representative (Usually the SH&E Manager)  Ensures that Schneider Electric employees are trained and aware of potential hazards introduced to their work area by the Contractor (Documented in Toolbox meeting).  Ensures that all Schneider Electric employees understand and comply with the requirements of this Program.  Identifies Contractors whose work on-site could impact the environment and/or health and safety of employees at the site.  Provides or arranges a site orientation briefing for the Contractor Site Safety Representative regarding environmental health & safety requirements specific to the location and the Contract (Attachment D).  Informs Contractor Site Safety Representative of presence of toxic or hazardous chemicals and provides Material Safety Data Sheets (MSDS) as requested.  Coordinates appropriate safety procedures, e.g. lockout/tagout, hot work permits, access to restricted areas, etc. with Contractor Site Safety Representative. 7  Performs general review of Contractor activities to document adherence with applicable SH&E requirements (Attachment F). All noted deviations from site requirements by Contractor personnel are reported directly to Contractor Site Safety Representative for correction.  Maintains copies of all documentation submitted by each Contractor related to approval, orientation and review of onsite work

C. Buyers

 Use only approved Contractors from updated list.  Assist with identification of prospective Contractors for performing work at the site.

D. Employees

 Notify immediate supervisor of any Contractor employee action that has or may result in a hazardous condition or behavior.

E. Contractors

 Designate a “Contractor Site Safety Representative” who has responsibility and authority for ensuring compliance with the requirements of this Program.  Comply with current federal Safety and Environmental regulations and all applicable state and local laws, codes, rules, regulations or ordinances governing the work.  Ensure that all Contractor employees comply with applicable site SH&E requirements.  Ensure Contractor provides all necessary and appropriate tools and equipment, including personal protective equipment, required for safe completion of required tasks.  Utilize a workforce that is appropriately trained in all SH&E aspects of the job.  Provide documentation of employee training, as requested.  Maintain all equipment, tools and work areas in a clean and safe manner.  Obtain necessary permits for performing the work.  Provide for onsite first aid and emergency medical services.  Notify Schneider Electric’s Representative of any injury, incident or near miss involving Contractor employees while at the project location.  Perform inspection of work activities and areas for compliance with SH&E standards and procedures.  Inform Schneider Electric of any subcontractors to be used as part of the work and ensure these subcontractors comply with all SH&E requirements.  Provide a copy of the Contractor Safety Report (Attachment H) weekly and/or monthly according to the requirements of Schneider Electric.  Ensure that no Contractor activities endanger other personnel working at the site. 8  Participate in all evacuation drills.  Accept that failure to comply with SH&E requirements, including failure to correct unsafe practices and conditions, are sufficient grounds for Schneider Electric to require work stoppage or termination of the contract agreement.

5. AUTHORITY

A. The Plant Engineer or Project Manager has the authority to implement this procedure and to review and audit the implementation of this procedure. B. The SH&E Manager has the authority to update and audit this procedure. 9 Attachment A Date: ADDITIONAL SITE REQUIREMENTS This attachment outlines SH&E evaluation and approval requirements which are in addition to those presented in the Schneider Electric Contractor Safety Program. These requirements include: (List or Attach Additional SH&E Approval Criteria)

Example: Additional requirement for electrical subcontractors:

Fire retardant PPE, CAT III measurement equipment, voltage rated gloves, 4/0 grounding cable with permanent connections, GFI in use

Evaluation, orientation and review additional service providers subject to these requirements:

Attachment B Date:

CONTRACTOR APPROVAL CHECKLIST Yes No N/A 1. Has Schneider Electric’s Contractor Safety Information Data Sheet been completed? 2. Are all applicable Licenses / Permits completed and on file? (Attach copies) 3. Have all affected employees received appropriate training, including Hazard Communication Training as required by OSHA 29 CFR 1910.1200 or WHMIS? 4. Have any Safety or Environmental regulatory citations been issued to this company in the last 3 years? (If yes, attach a summary describing the inspection and resultant citation.) 5. Does this company have a mandatory substance abuse program? . Pre-employment Screening? . Random Testing? . Testing for Cause? 6. Is there a light duty / restricted work policy? 7. Do all new employees complete Safety & Environmental Orientation prior to performing any work activities? 8. Are routine safety inspections conducted?

9. Are safety and environmental program audits routinely conducted? 10. Are on-site “toolbox” safety meetings routinely conducted? 11. Are accident investigations conducted and documented? 12. Does this company employ a Safety Coordinator, Safety Supervisor, or Director of Environmental, Health & Safety? (Please circle all that apply.) 13. Is a Safety / Health incentive program provided? 14. Is there a written Environmental, Health & Safety Program? 15. Does the program address the following key elements: . Management commitment and expectations? . Employee participation? . Accountability / responsibility for managers, supervisors and employees? . Resources for meeting safety and health requirements? 11

Attachment B (cont.) Date:

CONTRACTOR APPROVAL CHECKLIST Yes No N/A . Periodic safety and health performance appraisals for all employees? . Hazard recognition and control? . A Confined Space Entry Program? . A “Hot Work” Permitting Program? . A Hazardous Energy Lockout / Tagout Program? . A Medical Surveillance Program? . A Personal Protective Equipment Program? . A Respiratory Protection Program? . A Fall Protection Program with employees tied off at 6ft. or higher? . Worker Exposure Monitoring Program? . A Powered Industrial Vehicle Program (Cranes, forklifts, JLGs, etc.)? . A Housekeeping Program? . An Emergency Preparedness & Evacuation Program? . A Waste Disposal Program? . A Fire Protection and Prevention Program? . A Recordkeeping Program (Training, inspections, audits, etc.)?  An Electrical Safety Program with “No Live Work Policy”?  A Tool and Equipment Inspection Program?    Do employees read, write and understand English such that they can perform their job tasks safely without an interpreter?

______Signature of Contractor Signature of Contractor Safety Site Representative

______Phone Number Contact Phone Number 12

Attachment C Date:

CONTRACTOR SAFETY INFORMATION DATA SHEET

Name of Vendor: ______SIC Code: ______

Man-hours Worked (for past three years): ______

Total OSHA Recordable Rate (for past three years): ______Rate Year Rate = (Total Recordable Injuries) x 200,000/ ______Total Employee Hours Rate Year ______Rate Year Industrial average: ______Year: ______

Lost Time Accident Rate (for past three years): ______Rate Year Rate = (Total Lost Time Accidents) x 200,000/ ______Total Employee Hours worked Rate Year ______Rate Year Industrial average: ______Year: ______

Number of Fatalities(for past three years): ______Number Year ______Number Year ______Number Year Industrial average: ______Year: ______

______Signature of Contractor Safety Representative Date 13 Attachment D Date: CONTRACTOR ORIENTATION CHECKLIST 1.0 Emergency Contact Information  Completed Schneider Electric/Customer Resources: Office # Pager # Schneider Electric Project Manager Contractor’s Safety Coordinator Schneider Electric’s Facility Engineer

External Resources Office # Pager # Police/ Fire Department 911 or 9-911 Local Medical Facilities Security HAZMAT Response Team

2.0 Site Smoking Policy  Completed ___ Smoking is not permitted anywhere at this site. ___ Smoking is permitted ONLY in the following areas:

3.0 Parking and Site Access Restrictions  Completed Contractor employees are restricted from parking personal vehicles on site unless authorized by a Site Representative. Parking is available at ______. (This is /is not a secure lot that is patrolled regularly by site security.) Shuttle/bus service is available from the hours of ___:___ AM/PM to ___:___ AM/PM. Parking on-site is limited. If driving a company vehicle, arrangements for parking on site must be made with a Site Representative.  Speed Limit --- ______mph  Sit only in seats that are provided and have seatbelts  Yield to pedestrians approaching the service roads  Come to a complete stop at Stop signs.  Park only in approved, designated parking spots as authorized by the Site Representative 14 Attachment D (cont.) Date: CONTRACTOR ORIENTATION CHECKLIST 4.0 Site Housekeeping Requirements  Completed It is the responsibility of the Contractor employees to maintain a clean and orderly work area to minimize fire and fall hazards. It has been proven through OSHA statistics that poor housekeeping leads to slips, trips, and falls on construction sites. Therefore, when contracted work has been completed or at the end of the work day/shift, Contractor ensures that the area is clean. Employees shall immediately notify their Supervisor of any perceived fire or fall hazards. Clear access shall always be maintained in Contractor working areas to electrical panels, fire extinguishers, safety showers and eyewash stations, and fire hydrants. Non-compliance with this policy may impede the response time of emergency responders and cause unnecessary delays in the event of an emergency. 5.0 Schneider Electric’s Safety & Environmental Rules and Practices (Location SH&E Booklet)  Completed A copy of this document may be obtained from the Schneider Electric representative. 6.0 Overview of Zero Tolerance Policy regarding Sexual Harassment and Discriminatory Behavior  Completed Schneider Electric has a ZERO TOLERANCE policy for both sexual harassment and discriminatory behavior. Unprofessional behavior that creates a hostile work environment for individuals with regard to Age, Race, Religion, Physical Disabilities, or Sexual Orientation will not be tolerated. Both types of behavior are very subjective and difficult to defend against. If a complaint is registered, by law Schneider Electric will pursue that complaint to the extent that the law requires. Violators will be removed from the site. 7.0 Overview of Zero Tolerance Policy regarding Alcohol and Drug Use  Completed Employees and visitors shall not report to work at the site under the influence of any substance that may affect their ability to safely perform their work, operate equipment, make conscientious decisions, or that may in any way jeopardize the health and safety of other employees. If there is reason to believe that someone is under the influence of such a substance, that person may be asked to submit to drug testing or leave the site. If a controlled or illegal substance is suspected, the proper authorities will be contacted. Illegal substances shall not be brought to the site. Anyone taking prescribed medication and/or who is under the care of a doctor shall notify their immediate supervisor who will then tailor their work assignment accordingly. 8.0 Emergency response information (alarm signals, shelter areas, etc.)  Completed A copy of this document may be obtained from the Site Representative. 9.0 Notification requirements regarding accidents, incidents and near misses  Completed A copy of this document may be obtained from the Site Representative. 10.0 Requirements regarding the use of chemicals at the site and means of obtaining a Material Safety Data Sheet.  Completed A copy of this document may be obtained from the Site Representative. 15

Attachment D (cont.) Date: CONTRACTOR ORIENTATION CHECKLIST 11.0 Required Personal Protective Equipment (PPE) while on the site  Completed Contractors are responsible for providing their employees with proper Personal Protective Equipment (PPE) to protect them while they are working and must train them in the proper inspection, maintenance, and safe use of that equipment. Contractors are responsible for conducting job assessment to determine the proper PPE necessary for each job. At a minimum, construction employees are expected to wear hard hats and appropriate work boots, plus ANSI Z-87-approved safety glasses with safety frames and side shields at all times. Additionally, harnesses, respirators, gloves, face shields, and hearing protection are typically required in most construction zones. In plant areas, steel-toed shoes are required, and strongly recommended in construction areas. Fall Protection  100% tie-off  6’ tie-off required in all circumstances (Steel Erection, Scaffold Erection, etc.)  5,000 lb. Anchorage required  Employees must be trained in proper inspection, maintenance and safe use of equipment. Respirators  Require written program  Medical approval for all employees utilizing respirators  Training Hearing Conservation  If the work area is above 90dB on the TWA, a written program and hearing protection is required. 12.0 Required permits for performing the work and means of obtaining permits  Completed _____ Hot Work Permit Anything that generates heat, flame or spark, OR any electrical hot work (Live electrical panels or circuits) requires a hot work permit. An appropriate Fire Extinguisher, dedicated trained fire watch person (who understands elements, stages, and causes of fire, etc.), and an evaluation of explosive/flammable atmospheres is necessary. _____ Confined Space Entry Permit This requires a site-specific program. All companies conducting confined space entries must submit a written program and documented evidence that their employees have been adequately trained in their duties and hazards associated with their work. Contractors must provide their own calibrated monitors and rescue equipment. _____ Lockout/Tagout Permit This requires a site-specific program. Contractors must coordinate their Lockout/Tagout procedures with those existing on-site. Once affected circuits, piping, dissipated hazardous energy, switches, valves and/or other processes have been identified by the Customer and/or Schneider Electric, contractor personnel shall place their own lock on the Customer’s lock to ensure against accidental start-up. 16

Attachment D (cont.) Date:

CONTRACTOR ORIENTATION CHECKLIST 13.0 Use of ladders, scaffolding or rigging  Completed _____ Ladders See Fall Protection Procedure for ladder and scaffolding safety.

_____ Scaffolding All cross braces and handrails must be installed. A competent person is required for scaffold erection and inspection. Scaffolding is to be inspected daily by a competent person and the inspection tags signed. Tagging systems are site-specific.

_____ Rigging All rigging must have a legible load tag and must be inspected before each pick. Riggers shall be designated as competent persons. Chains are not allowed except for use with a chain fall. Only synthetic or wire rope slings are allowed.

Information regarding Other Permits as required by site and the means for obtaining these permits is available from the Site Representative. 14.0 Requirements regarding lockout/tagout. A copy of this document may be obtained from the Site Representative.  Completed 15.0 Location and hazards of confined spaces in the vicinity of the work area(s)  Completed A copy of this document may be obtained from the Site Representative. 16.0 Use of electrical equipment and Ground Fault Circuit Interrupters (GFCI) All electrical equipment must be connected to a GFCI. Tools shall be regularly inspected for defects (cuts, exposed insulation, missing ground pin, etc.). Tools  Completed with damaged cords or plugs shall be removed from service immediately. Other Site Specific Requirements  Completed  Completed  Completed  Completed  Completed

______Signature of Contractor Signature of Contractor Site Safety Representative

______Phone Number Contact Phone Number 17 Attachment E Date:

CONTRACTOR SITE SAFETY REPRESENTATIVE

Name of Contractor:

Project Identification:

The following named person is the Contractor Site Safety Representative for the above referenced contract. He/she is capable of identifying existing and predictable hazards in the surroundings or working conditions that are unsanitary, hazardous, or dangerous to employees. In addition, this employee is the contact person between Schneider Electric and ______(insert name of Contractor), in the event that Schneider Electric personnel observe any unsafe condition, practice, etc.

Name of Contractor Site

Safety Representative: ______

Appointed by: ______

Title: ______

Signature: ______

Date: ______

Submit this form with each bid. 18

Attachment F Date:

SAMPLE – LETTER OF APPROVAL

(Date)

Contractors Name Address 1 Address 2 City, State - Zip Code

Dear :

Thank you for submitting application for approval to work for Schneider Electric.

Our review indicates that your past safety performance, based on OSHA frequency rates and experience modification rate (EMR), meets (does not meet) our criteria for approval. Reviews of Environmental, Health & Safety (HAZCOM, Bloodborne, etc.) programs submitted by your firm indicate that they are acceptable (not acceptable).

This letter is valid through the end of the calendar year. Should your firm demonstrate non-compliance to established site safety rules and regulations, revocation of approval status may result.

During this period, you are approved to submit bids for and perform contract work at the Schneider Electric Site located at: (Location). You need only to attach a copy of this letter to your bid.

Thank you for committing to “Working together – SAFELY.”

Sincerely,

Schneider Electric Name Title 19

Attachment G Date:

CONTRACTOR JOB SITE SAFETY CHECKLIST

Contractor: ______Date: ______

Job Location: ______

Project Title: ______

Evaluated by: ______

Some of the questions in the checklist may not apply to all job sites; conversely, additional questions may be necessary. Category Acceptable N/A Remarks PERSONAL PROTECTION Head Protection Hearing Protection “Safety” Glasses Face shield Respiratory protection Safety full-body harness (man-lifts, above grade, personnel baskets) Protective clothing Equipment guards on equipment Foot protection Gloves ELECTRICAL TOOLS/EQUIPMENT Covers on boxes, switches, receptacles (tight-fitting) or double insulated Power tools and appliances grounded Welding machine grounded Ground fault interrupters Ground extension cord with good connectors PNEUMATIC TOOLS/EQUIPMENT Power tools secured to hose Device at air source to reduce pressure if hose fails PERMITS Confined Space Standby personnel Hot Work Fire extinguisher Appropriate permit for work displayed Permit has appropriate signatures EXCAVATIONS AND TRENCHING Sloping, stair-stepping or shoring of walls Ladder or steps in hole/trench for quick exit Warning tape or barriers installed All nails on boards removed or bent over 20 Attachment G (cont.) Date:

CONTRACTOR JOB SITE SAFETY CHECKLIST Category Acceptable N/A Remarks SCAFFOLDS/LADDERS Ladders meet construction standards Adequate footings Scaffolds are plumb and secured Toe boards/guard rails in place Access ladder to elevated work platform Ladders tied off Adequate working platforms on scaffolds COMPRESSED GAS CYLINDERS Secure in an upright position Metal valve caps must be in place on all cylinders not in use Store spare oxygen and combustible gas cylinders 20 feet apart or separated by a five foot high barrier SUSPENDED LOADS Secured by tag line to prevent swinging No personnel working beneath load Wire lines and connectors inspected/certified FUEL CONTAINERS Approved cans properly labeled Storage of flammable liquids in designated areas only Bulk storage of fuels vented, labeled VEHICILE AND MOBILE EQUIPMENT Backed-up alarms on mobile equipment Load chart displayed inside equipment Overhead guards on forklifts WORKING SURFACES Clear of tripping hazards Non-slip surfaces on floors or ramps Floor openings guarded Stairs designed with hand rails, treads, risers, angles that meet standards WASTE DISPOSAL Trash and rubbish removed daily Hazardous wastes segregated for proper disposal OTHER

COMMENTS 21

Attachment H Date:

CONTRACTOR SAFETY REPORT

Contractor’s Name ______Month Ending ______

Project Manager / Project Safety Superintendent ______Coordinator ______

Safety Representative ______Project ______

INSTRUCTIONS: Complete Sections 2, 3 and 4. The Contractor Project Manager or Superintendent must sign the report and return to the Schneider Electric Project Manager. 1. SIGNIFICANT ACCOMPLISHMENTS, INCIDENTS, NEAR MISSES, OR ISSUES REQUIRING SPECIAL ATTENTION (log daily activities here)

2. HAZARDOUS MATERIALS USED ON SITE/SHIPPED OUT

Date(s) Substance Unused Total Gallons of Total Gallons of Description In Storage Waste Generated Waste in Storage

3. SAFETY MEETINGS/TOOL BOX TALKS

Date(s) Conducted by Topic Description No. of Participants

4. INJURY ANALYSIS STATUS TOTAL MAN-HOURS NUMBER OF EMPLOYEES TOTAL OSHA RECORDABLES TOTAL LOST TIME ACCIDNTS TOTAL LOST TIME WORKDAYS SIGNATURES Contractor Site Superintendent ______Date ______

Contractor Safety Project Safety Representative ______Coordinator ______NOTE: Please attach additional information with this form as needed. 22

Attachment I Date: CONTRACTOR SAFETY PROGRAM TRAINING LOG

Instructor: ______

I have trained the employees listed below on the Contractor Safety Program.

Instructor Signature: ______

Employee Name Employee Signature Department Date 23

Attachment J Date: Hold Harmless Agreement

To: ______

Subject:

Enclosed are our insurance requirements and a copy of our Indemnification and Hold Harmless Agreement. Prior to any ______work being started, the Contractor(s) must comply with our insurance requirements, as evidenced by them forwarding a Certificate of Insurance meeting the amounts outlined on the enclosed, and they must execute the Hold Harmless Agreement, and forward it to my attention. They can fax them to me at (847) 925- 7378.

Thanks for your help with this matter.

Sincerely,

______cc: 24 Attachment J (Cont.)

(Page 1 of 3) INDEMNITY AND SAVE HARMLESS AGREEMENT

The undersigned party (hereinafter the CONTRACTOR), as inducement for, and as consideration for, the execution by SCHNEIDER ELECTRIC/SQUARE D COMPANY (hereinafter the COMPANY) of the purchase order or agreement identified below (hereinafter the CONTRACT) and notwithstanding any terms or conditions of the Contract to the contrary, agrees to protect, defend, indemnify and save harmless the COMPANY and its parent, subsidiary and affiliated companies, if any, from and against any and all liability, loss, damage, expense, claims and demands of every kind and character (hereinafter damage claims), arising from the negligence of the CONTRACTOR, whether due to the CONTRACTOR’S joint or sole negligence, provided, however, that the Contractor shall not be liable by reason of this agreement for any payment of damages to the extent arising out of damage claims resulting from the negligence of the COMPANY. The CONTRACTOR shall at its own expense investigate all damage claims, except those damage claims resulting from the negligence of the COMPANY, and shall defend any and all actions based thereon and shall pay all costs, damages, awards and expenses of whatever nature, including attorney’s fees arising from the joint or sole negligence of the CONTRACTOR. For the purpose of this agreement, violation of an applicable safe place statute by the CONTRACTOR will constitute negligence and any damage claims arising out of such negligence shall be subject to the provisions of this agreement. The CONTRACTOR agrees to furnish the COMPANY with a certificate, in a form satisfactory to the COMPANY, evidencing that the foregoing obligations are adequately covered by policies of insurance issued by a carrier satisfactory to the COMPANY.

Identification of Contract:

Name of Contractor

(Authorized Signature)

Title:

ISHA~SQD.doc 1/9/18 25 Attachment J (Cont.) (Page 2 of 3)

Contractor shall maintain in force at all times during the course of this work at least the following types and amounts of insurance with insurance companies rated A or better and financial size not less than X by A. M. Best Company:

Contractor Category A Contractor Category B Description of Coverage Amount of Insurance Amount of Insurance

Workers' Compensation (U.S. Only) Statutory Statutory (Alternatively Contractor can supply proof as a state qualified self- insured company)

Employers' Liability (U.S. Only) $100,000 $500,000 Each Accident and Each Accident and Disease Disease

Comprehensive General Liability Combined Single Limit Combined Single Limit Insurance (Written on a Bodily Injury and Property Bodily Injury and Property Comprehensive Occurrence Form) Damage Damage including the following: $500,000 Per Occurrence $2,000,000 Per Occurrence

• Premises/Operations Liability

• Products/Completed Operations Liability

• Contractual Liability (To cover the Indemnity and Save Harmless Agreement)

• Broad Form Property Damage

• Independent Contractors (Required if Contractor employs subcontractors for work or service)

Automobile Liability Insurance for Combined Single Limit Combined Single Limit any Auto Owned, Non-owned, Bodily Injury and Property Bodily Injury and Property Leased, Rented or Hired and used Damage Damage in the fulfillment of this agreement $500,000 Per Occurrence $2,000,000 Per Occurrence 26

Attachment J (Cont.) (Page 3 of 3)

An Umbrella or Excess Liability policy may be used to increase basic limits to the required levels.

Contractor Category A:

Contractors who provide work or service (including work or service on electrical systems less than 110 volts) which does not involve the use of ladders over 8’ in length, scaffolding, power tools (other than small power hand tools), cutting/welding equipment or heavy machinery.

Contractor Category B:

All other categories of work or service as defined in this procedure including Contractors who do not qualify under Contractor Category A above.

Certificate of Insurance:

Prior to commencing work, and thirty (30) days prior to the expiration of any insurance required herein, Contractor shall furnish Square D Company with a Certificate of Insurance, in a form acceptable to Square D Company. The Certificate of Insurance must be signed by an authorized representative of Contractor’s insurance company and show that the insurance coverages and limits of liability shown above are being provided by Contractor’s insurance company, showing the effective and expiration dates, policy numbers and insurer, acknowledging Contractual Liability Insurance for this Agreement, name Square D Company, its parent company and subsidiaries, and their directors, officers and employees as an additional named insured under their Comprehensive General Liability Insurance policy and waive right of subrogation against Square D Company under Workers’ Compensation Insurance. The Certificate of Insurance shall also contain the following statement: “No reduction, cancellation or expiration of any of these insurance policies shall become effective until at least thirty (30) days written notice thereof is received by Square D Company.”

Contractor hereby agrees to execute the Indemnity and Save Harmless Agreement attached hereto and made a part of this Agreement, prior to commencement of the work.

The insurance requirements shall survive this Agreement. Square D Company shall have no obligation to review or verify the existence of Contractor’s insurance. The consent of Square D Company to the insurance and limits shown above shall not be considered as a limitation of Contractor’s liability under this Agreement nor an Agreement by Square D Company to assume liability in excess of said amounts or for risks not insured hereunder. Failure of Contractor to maintain complete insurance does not lessen Contractor’s liability and may be deemed a material breach allowing Square D Company to terminate this Agreement.

1/9/18 ContractorA.DOC