Injury Illness Prevention Plan - Flipbook - Page 77
Health and Safety Program Manual
Teamwrkx
Construction, Inc.
Issue Date: 10/16/23
Revision Date: 10/16/23
Subcontractor Safety Management
Reference: S-1
REFERENCES
Bank Reference
Name
Contact Person
Telephone
Bonding Reference
Bonding Company:
Bonding Agent:
Name
Address
Phone #
Bonding Capacity: $ ______________ Per Project
$ ______________ Aggregate
Date, amount, and type of last bond issued:
Bond Rate:
Credit References
Name
Contact Person
Telephone
CONTRACTOR PROFILE
Current Number of workers:
Office_____________ Field _____________
Does your firm operate as a Union shop? ( ) Yes ( ) No
Merit shop? ( ) Yes ( ) No
SAFETY, HEALTH AND ENVIRONMENTAL
Please list your firm’s Workers Compensation Interstate Experience Modification Rate.
Does your company have a written safety program? ( ) Yes ( ) No
INSURANCE
6
