Capital Program Management

Safety Bulletin 2OO7-1, Rev. #10, 4lA$ CHECK OFF

Track Safetv & Flaooino Verification Ghecklist (Cont) YES NO N/A
TRACK ACCESS o Locate nearest ET to each work zone and verify that it is working (check for dial tone -
VERIFICATION See DOS Procedure 2.1)
(coNT.) 10 Did the Engineer-in-Charge (ElC) verify with the RCC that the track has been secured for
G.O. access to the tracku/av (i.e. power off and switches blocked & clamped)?
Record the followinq:
a name & pass # of RCC representative spoken to:
b. ime of power off : AM/PM I\
c. time switches blocked & clamped: AM/PM
11 lf work area is in CBTC mainline territory. has employee in charge of flagging contacted
the RCC to establish the work zone. inhibit Automatic Train Operation (ATO) and set
primary and auxiliarv traffic to same direction?
a. Did the EIC verify that the CBTC work zone is properly established per ltem 10 and
that workers are properly notified of the exact limits of established CBTC work zone?

12 ls power ON? lf yes. verifu a. belov/.

Are proper 3'" rail prolective rubber mats used? (See DOS Procedure 6.'1 : required
length; mustbeTypel, Class2; datestamped. notolderthan 18 months)
13 ls power OFF? If yes, verifu a. & b. belour.
a. Are there an edenlralp nrrmhcr nf ?'J r:il alrrm hnycs in nl al paeh urnrk sitc?
b. Have all 3'3 rail alarm boxes been tested?
DURING WORK 14 Are all personnel observed (includinq NYCT/CPM):
SHIFT Weannq Dro0er basic PPE (e.o.: safetv vest. helmet. safetv olasses. safetv shoes)?
b. ln possession of appropriate PPE for specific job task hazards lhey are exposed to
(e.9.: Respirators, Hearing Proteclion. Face Shield, Electrical lnsulating Gloves,
PtrAE\?
15 Did the EIC and the Contractor's / Consultant's safety representative conduct a job site
inspection prior to the start of the task and verify required equipment and safety devices
(i e.: light. gas. & noise meters; rubber mats. temporary tie-bumper components, fire
extiguishers) are on-site and in qood condition?
16 Have adequate clearance areas been identified?
17 lf barriers were approved and are being used to isolate the work area from an active
track. have they been inspected and found free of defects and are installed per the most
recent Desiqn Guidelines?
18 lf used. are all components of the Temporary Tie Bumper in place? (2 red lights and/or
flags. chains/padlocks, porlable trips, white bank of lighls, & T rubber mat - See CPM
Safetu Rr rllaiin 2OO5-3 latoct r.viqinn)
19 Confirmed lvith contractors/consultant safety representative that work areas are
ilftrminaied lo 5 foot-candles /minimrrm\?
20 lf GPE is in use, has the CPM/CCM EIC conducted and documented the inspection(s) as
required by the GPE Guidelines?
21 lsjob site housekeeping satisfactory in accordance with the requiremenls for establishing
the "BOX' [work area belween flaos)?
AT THE END OF 22 Fias tne worK tratn Deen rnspected pflor t0 leavtng the worl( site ('.e.: no overhangtng
WORK SHIFT material, material not piled too high and in danger of falling off, material & equipment f
properlv secured)? - See NYCT Pll#23.0
ll a test trarn has been requested. has the contractor / consultant been dtrected to 4
rernain onsite to make corrections if needed?
24 lf multipie shifts are involved, was all required G.O. work information and status, ,-r
includinq Diqqvbackinq. oassed from the current EIC to the new EIC?
25 Was the G.O. imolemented / closed in accordance with PMG 123?
DOS z6 Are Safety Rule Dispute Resolution (SRDR) forms available?
RESPONSIBILITIES
(ln-House Projects) 27 ls the Joint ManaqemenUUnion Safetv lnspection Placard available?
COMPLETE PAGE 3 --+
 Capital Program Management
Safety Bulletin 2007-1, Rev.#10, 4lA$ CHECK OFF
Tr"ack Safety & Flaqqinq Verification Ghecklist YES NO N/A
Does the properly compleled GO and/or flagging request with supporting documentation
,1
PRIOR TO TRACK
ACCESS reflect lhe limits of the work required?
2 Are any Emergency Alarm Boxes (EA) / Emergency Telephones (ET) listed on the
Trouble Ticket Report in the work area(s)? (Access via TENS at
htlp://wadinternalapps.transit.nyct,com/froubleTicket/Login.asp ; User Name &
Password: cpmso or via the Department of Subways / Maint. of Wav webpaqe)
a. lf EA is listed on the outaqe repori:
i ls the work to be performed under flaqqinq? lf yes, NOT allowed to work.

ls the work under G.O. with power off? lf yes, allowed to work ONLY if the nearesl ET
ii
works or other communication to RCC exists. (See DOS Procedure 2.'1 )
It ls the work under G.O. with power on? lf yes, NOT allowed to work.
Has the CPM office in-charge coordinated with other G.O.'s that may be working in the
area (during planning and on-site; piggybacking)?
Are all required / necessary environmental metering equipment on site and avarlable for
immpdiaie r rqe?
Have the environmental meters been calibrated? Noise and emission levels of
equipment been determined and OSHA required noise suppression provided?
a
Carbon Monoxide (CO) - 35ppm. Nitrogen Dioxide (N02) -1ppm, Noise - variable
refer io OSHA. CFR1926.52.
ls Gasoline Powered Equipment (GPE) being used? If yes, verify a. and b, below.
a. ls the APPROVED GPE Placard, posted or readily available for inspection?
b. Are fire extiguishers available as required under the GPE Guidelines and applicable
GPE SWP?
6 Pri0r to each work shift, did the Contractor's / Consultant's safety representative confrrm
lhat all their personnel have the track training and task training needed to pedorm the
work, including the original qualification cards (e.9. track safety, OSHA, welding, fire
iua rd. other certifications)?
7 Did the CPM/CCM ElC, Field lnspector witness the Coniractor's Daily Safety Briefing?
(Verify that topics shown below were discussed) lf "No," use the Notes section tc
indicate who verified that the meetinq was held.
a. Discussion of Fitness for Dutv and PPE requirements
b. ldentifvinq NYCT Emplovee in Charqe (ElC)
c. New lssues or Safetv Advisories
Review of the task specific sate worl( Plan. (lJiscussions include - uommunlcalron
and identification of hazards; unusual hazards, hazard correctionimitigation:
d.
tool/equipment condition, usage and storage; worksite access and egress; worksite
mainlenance
e Fvanrralinn Plans
t Type of flaqqinq and requirements (equipment and personnel)
q. Limits of flaqoinq. work area, CBTC areas
h. ldentify nearest operating EAB/ET, clear up locations, expected direction of traffic
l. Discuss electrical protection (GFCI, 3rd Rail Alarm Boxes, 3rd Rail Mats. .
TRACK ACCESS 8 Did the CPM /CCM Rep. discuss/review with Service Delivery (S/D) Point Flagger the
VERIFICATION followinq: (Needs to be documented, including name and pass number of Point Flagger)
a work to be oerformed includinq locations
b. flaqqinq arranqements (AS DETERMINED BY SUB-DlVlSlON C)
if work is under a power off GO. discuss power-off limits
d orooer clearinq uo Drocedures
location and ooeration of nearest EA/ET
t safe iob site access and egress
o discuss expected direction of train traffic/work train movements

h. discuss what to do & where to qo (meet) in case of necessary evacuation of tlaCk

discussion of safety concerns in relation to the task or work site and any hazards that
I mav be created bv CPM contractor
COMPLETE PAGE 2 -.->
 Capital Program Management
Safety Bulletin 2007-1, Rev. #10,412118
Track Safety & Flagging Verification Checklist (Cont)
CONTRACT#: A-36622D ESI Package 4
LOCATION: 28th SV6th Ave
WORK SHIFT: Night Shift - 22:00 - 06:00
Mohammed Choudary / FE
NAME /TITLE:

PMG 123 TRAINING

EXP. DATE:

TRACK SAFETY
TRAINING EXP. DATE:

Name and Pass#of

Point Flagger spor(en
to in ftem#

SIGNATURE:

DATE:

NOTES:

Revised 4/218