Palmdale City Council
August 19, 2025

RESPONDENT SIGNATURE / COVER PAGE
RFP No.

Exhibit B
Title: The City of Palmdale

1. RESPONDENT
Fax:

Firm Name:

Contact Name:

Principal Address:

Local Address:

Phone:

Email:
[ ] Sole Proprietor [ ] Partnership [ ] Corporation [ ] Joint Venture Structure:

Tax ID No: California Contractor License No:

Department of Industrial Relations (DIR) Registration No.

Registration Date: Expiration Date:

2. Proposed working relationship between Respondent and subcontractor (if applicable):

3. Prices:

A. Prices shall be F.O.B. Destination or for the service rendered.

B. Payment Terms: Net 45
C. Proposers shall honor proposal prices for one hundred twenty (120) days or for the stated contract period whichever is longer.

4. All forms, certificates, and compliance requirements included in this RFQA are completed and duly submitted in the proposal response.

THIS PROPOSAL IS BEING SUBMITTED BY:

The undersigned offers and agrees to furnish the goods or services at the price(s) entered herein subject to the terms and conditions attached hereto. I CERTIFY that (1) the proposal document has been read and understood and that all of the conditions contained therein are acceptable, (2) I have thoroughly examined and become familiar with the specifications and/or scope of services outlined in this solicitation and further, to the best of my knowledge the information contained in this bid proposal is accurate and complete and that (3) I have the legal authority to commit this firm to a contractual agreement, (4) I acknowledge that all documents submitted pursuant to this RFQA will become a matter of public record.

Printed Name: Title:

Signature: Date:

Exhibit C

AFFIDAVIT OF NON-COLLUSION and NON-DISCRIMINATION
Exhibit D
I hereby swear (or affirm) under the penalty of perjury:

A. The prices in this proposal have been arrived at independently without collusion, consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other bidder/proposer or with any competitor; B. Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the bidder/proposer and will not knowingly be disclosed by the proposer prior to opening, directly or indirectly, to any other prop oser or to any competitor; and
C. No attempt has been made or will be made by the bidder/proposer to induce any other person, partnership, or corporation to submit or not submit a proposal for the purpose of restricting competition.

D. The Bidder/Proposer does not discriminate against any employee or applicant for employment or person to whom it provides services because of race, color, religion, age, sex, sexual orientation, gender identity, national origin, or disability, and that it complies with all applicable Federal, State and local laws and executive orders regarding employment.

In connection with the performance of work under this contract, the Bidder or Proposer agrees as follows:

1. The Bidder or Proposer agrees not to discriminate against any employee or applicant for employment because of race, creed, color, sex, sexual orientation, gender identity, national origin, or ancestry. The Bidder or Proposer shall take affirmative action to e nsure that employees are treated without regard to their race, creed, color, national origin, sex, sexual orientation, gender identity, or ancestry.

2. In the event of the Bidder’s or Proposer's non-compliance with this non-discrimination clause, the Bidder or Proposer may be canceled or terminated. The Bidder or Proposer may be declared ineligible for further contracts with the City of Palmdale until satisfactory proof of intent to comply shall be made by the Bidder or Proposer.

3. The contract agrees to include this non-discrimination clause in any sub-contracts connected with the performance of this agreement.

I have read the above stated clauses and agree to abide by its requirements.

Authorized Signature: Printed Name/Title:

Company Name:

Doing Business As:

CERTIFICATION OF INSURABILITY
Exhibit E
I hereby swe
ar (or affirm) under the penalty of perjury:

As an authorized representative of the proposing company, should our Company be determined to be the Successful Proposer, our Company will promptly provide such proof of insurance to the City within five (5) business days in reply to the CITY’s Notice of Intent to Award. The CITY will remind the Apparent Successful Proposer in the Notice of Intent to Award letter. Proof of insurance requirements may be submitted electronically to the email address below with the RFP Number and Title referenced in the Subject field:

To: [email protected]
Contracts will not be executed until formal proof of all required insurance(s) pursuant to Attachment B – Sample Contract for Services for RFP No. Title:
have been received and approved by the CITY. It is agreed that the Apparent Successful Proposer shall maintain in force at all times during the performance of the engagement all policy or policies of insurance.

If the CITY requires corrections (i.e., limits, endorsements) the Successful Proposer has five (5) days from suc
h request to complete all corrections. Failure to meet these deadlines will allow the CITY the right to reject the Proposer’s proposal as non-responsive and proceed to the next finalist.

I hereby assure City of Palmdale that the company has or is able to procur e the insurance coverage(s) required should the Company be awarded the Contract and shall maintain all the insurance requirements by the submission of this offer.

Proposer Company Name
Signature of Authorized Representative signing on behalf on Proposer Print Name of Authorized Representative of Proposer Company Date

BIDDER DISCLOSURE STATEMENTS
Exhibit F
The Bidder must provide a declarative (yes/no) answer regarding the following questions. If any answer is affirmative, the Bidder must provide full details about the matter. While not an automatic cause for disqualification, an affirmative answer may result in an evaluation of the Bidder’s responsibility. A decision will then be made based on the seriousness of the matter, the matter’s possible impact on the performance of the contract, and the best interests of the City of Palmdale.

Within the past five (5) years:

ITEM DISCLOSURE STATEMENT YES NO
A. Has the Bidder and/or subject company had a contract terminated for default or cause?
B. Has the Bidder and/or subject company been assessed any penalties, including liquidated damages, under any of its existing or past contracts with any organization or governmental entity?
C. Has the Bidder and/or subject company been the subject of any governmental action limiting the right of the Bidder and/or subject company to do business with that entity or any other governmental entity?
D. Has trading in the stock of the subject company ever been suspended? Give date and explanation.

E. Has the Bidder and/or subject company previously operated as a like-kind business under any other business name and/or taxpayer identification number?
F. Has the Bidder and/or subject company, any company officer, or any owner of a twenty (20%) percent interest or greater in the subject company, filed bankruptcy, reorganization, a debt arrangement, moratorium, or any proceeding under any bankruptcy or insolvency law, or any dissolution or liquidation proceeding?
G. Has the Bidder and/or subject company, any company officer, or any owner of a twenty (20%) percent interest or greater in the company, been convicted of a felony or is currently under indictment on any felony charge?
By the signature affixed to Exhibit B – Offer Signature / Cover Page of this Solicitation, Respondent hereby certifies that the above inf ormation is t rue and accurate.

This completed form must be returned as part of the bid response. Failure to complete this page may deem your bid not responsive.

Page
7 of 14

CLIENT REFERENCES
Exhibit G
The following is a list of four (4) references that most closely reflect similar projects to the scope of services/work of the City of Palmdale within the past three (3) years. References will be asked to complete a questionnaire and asked to return it to the Purchasing Division directly by a designated date and time .

It is the Respondent’s responsibility to ensure that Reference Contacts are willing to provide a reference.

To expedite the evaluation process the City requests accurate email and/or fax number information be provided.

Reference #1
Name of Organization:

Address:

Email Address: Fax:

Telephone:

Contact Name:

Contact Title: Service Dates:

Project Manager: Bid No. (if applicable)
Summary of Project:

Project Cost:

Reference #2
Name of Organization:

Address:

Email Address: Fax:

Telephone:

Contact Name:

Contact Title: Service Dates:

Project Manager: Bid No. (if applicable)
Summary of Project:

Project Cost:

Ref
erence #3
Name of O
rganization:

Addres
s:

Email Addre
ss: Fax:

Telephone:

Contact Name:

Contact Ti
tle: Service Dates:

Project
Manager: Bid No. (if applicable)
Summary
of Project:

Project
Cost:

Reference #
4 Name of Org
anization:

Addres
s:

Email Addre
ss: Fax:

Telephone:

Contact Name:

Contact Ti
tle: Service Dates:

Project
Manager: Bid No. (if applicable)
Summary
of Project:

Project
Cost:

DEVIATIONS and/or EXCEPTIONS FORM
Exhibit H
[ ] Specifications and/or Requirements
[ ] Contract for Services Provisions (No exceptions and/or deviations to insurance requirements allowed) All deviations and/or exceptions to the requirements of this solicitation m ust be noted below. The City will consider any deviations and/or exceptions indicated in its award decisions. The City reserves the right to accept or reject any and all responses based on any deviation and/or exception indicated on this form.

Respondents are cautioned that by taking any exception they may be materially deviating from the RFP .

Please do not attach a company letterhead in lieu of any entry on the section below. In the absence of any entry on the section below, the bidder assures the City of their full compliance with the specification and conditions as listed in this solicitation. The page number, paragraph, and item number should be referenced when deviating from the specification and must be included.

The City reserves the right to reject any or all cost proposals as a result of this RFP and to waive any informality or irregularity in any bid proposal received and to be the sole judge of the merits of the respective cost proposals received, and to accep t or further negotiate cost, terms, or conditions of any cost proposal determined by the City to be in the best interest of the City even though not the lowest cost proposal. This form may be duplicated if additional pages are needed.

Reference No. Description
Company Name
Printed Name and Title
Authorized Signature

IRAN CONTRACTING ACT VERIFICATION
Exhibit I
(Public Contract Code sec�ons 2202-2208)
Prior
to bidding on, submi�ng a proposal or execu�ng a contract or renewal for goods or services of $1,000,000 or more, a Supplier must either: a) cer�fy it is not on the current list of persons engaged in investment ac�vi�es in Iran created by the California Department of General Services ("DGS") pursuant to Public Contract Code sec�on 2203(b) and is not a financial ins�tu�on extending twenty million dollars ($20,000,000) or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is iden�fied on the current list of persons engaged in investment ac�vi�es in Iran created by DGS; orb) demonstrate it has been exempted from the cer�fica�on requirement for that solicita�on or contract pursuant to Public Contract Code sec�on 2203( c) or (d).

To com
ply with this requirement, check the correct op�on below and insert your supplier or financial ins�tu�on name and Federal ID Number. Please note: California law establishes penal�es for providing false cer�fica�ons, including civil penal�es equal to the greater of $250,000 or twice the amount of the contract for which the false cer�fica�on was made; contract termina�on; and three-year ineligibility to bid on contracts. (Public Contract Code sec�on 2205.)
☐ OPTION #
1 - THIS PROJECT IS LESS THAN $1,000,000.

By (Authorized Signature) Date Executed
Printed Name and Title of Person Signing
☐ OPTION #
2 – CERTIFICATION
I, the official named below, cer�fy I am duly authorized to execute this cer�fica�on on behalf of the suppler/financial ins�tu�on iden�fied below, and the vendor/financial ins�tu�on iden�fied below is not on the current list of persons engaged in investment ac�vi�es in Iran created by DGS and is not a financial ins�tu�on extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is iden�fied on the current list of persons engaged in investment ac�vi�es in Iran created by DGS.

Supplier Name/Financial Institution Federal ID Number (or n/a) By (Authorized Signature) Date Executed:

Printed Name and Title of Person Signing:
(Con�nued on Next Page)

☐ OP
TION #3 - EXEMPTION
Pursuant to Public Contract Code sec�ons 2203( c) and ( d), a public en�ty may permit a vendor/financial ins�tu�on engaged in investment ac�vi�es in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or to enter into or to renew, a contract for goods and services.

Supplier Name/Financial Institution Federal ID Number (or n/a) By (Authorized Signature) Date Executed
Printed Name and Title of Person Signing

COST PROPOSAL
Exhibit J
Create/Dev
elop this to meet the needs of the RFP

State of California
Department of Industrial Relations
Division of Labor Standards Enforcement
Licensing & Registration Unit
1515 Clay Street, Ste. 1902
Oakland, CA 94612

Janitorial Services Registration

REGISTRANT WITH EMPLOYEES

Effective Date
9/14/2024
Expiration Date
9/14/2025

Servicon Systems, Inc.
3965 Landmark Street
Culver City, CA 90232

Workers Compensation Insurance Expiration Date:

May 1, 2025

Having paid to the Labor Commissioner of the State of California the required Registration Fee is hereby granted a registration to conduct the business of Janitorial Services in the State of California at the location(s) listed above and effective for the period designated above in conformity with the provisions of Chapter 4, Part 4.2, Division 2 of the Labor Code and the rules and regulations issued thereunder by the Labor Commissioner.

THIS REGISTRATION IS NOT TRANSFERABLE AND IS VALID ONLY AT THE REGISTERED OPERATING LOCATION

INDICATED ABOVE

POST IN A CONSPICUOUS PLACE

ALTERATIONS WILL VOID THIS REGISTRATION

Registration Number:

JS-LR-000017134

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE
INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #
NAME:

CONTACT
(A/C, No):

FAX
E-MAIL
ADDRESS:

PRODUCER
(A/C, No, Ext):

PHONE

INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY
Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-

STATUTE
PER

LIMITS(MM/DD/YYYY)

POLICY EXP
(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR

CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE

DAMAGE TO RENTED
$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED

AUTOS ONLY
5/13/2024
Andreini & Company
220 West 20th Avenue
San Mateo CA 94403
Laura Brugger
650-573-1111
714-327-1499
[email protected]
Federal Insurance Company
20281
SERVI-7
Safety National Casualty Corp.
15105
Servicon Systems, Inc.
3965 Landmark Street
Culver City CA 90232
853444901
B
X
1,000,000
X
100,000
X
$100,000 Ded.
10,000
1,000,000
2,000,000
X
Y
GL6676249
5/1/2024
5/1/2025
2,000,000
B
2,000,000
X
X
X
X
X
X
$0 Ded.

CA6676517
5/1/2024
5/1/2025
A
X
5,000,000
X
79888868
5/1/2024
5/1/2025
5,000,000
X
0 B
X
LDS4066506
5/1/2024
5/1/2025
1,000,000
1,000,000
1,000,000
Customer Name
123 Main St.

Any City, ST 00000

hereby grants
to
Servicon Systems, Inc.
who has successfully met WBENC's standards as a Women's Business Enterprise (WBE). This certification affirms the business is woman-owned, operated and controlled and is valid through the date herein.

Certification Granted: October 13, 2023Expiration Date: October 31, 2025WBENC National Certification Number: WBE2302921 WBENC National WBE Certification was processed and validated by Women's BusinessEnterprise Council - West, a WBENC Regional Partner Organization.

Authorized by Pamela Williamson, President &CEO Women's Business Enterprise Council -West National Women's Business Enterprise Certification
NAICS: 561720 UNSPSC: 14111701, 14111702, 14111703, 14111704, 47131800

is hereby certified with honors to the ISSA Cleaning Industry Management Standard Green Building Criteria
Having undergone a comprehensive assessment of its management structure and green cleaning operations by an independent accredited CIMS-GB Assessor and has succesfully demostrated a commitment to the delivery of enviromentally preferable services designed to meet customer needs and expectations This certification expires
John H. Barrett
ISSA Executive Director
Servicon
Systems,
Inc.

June
30,
2025

Proposal for Professional Custodial/Janitorial Services RFP NO. 25-002-3400

69 Appendix: Injury & Illness Prevention Program
(IIPP)
Please find Servicon’s IIPP attached to this section.

INJURY AND ILLNESS PREVENTION PROGRAM
(IIPP)
Revised by CJ – 03/21/2024

SERVICON SYSTEMS, INC.

INJURY ILLNESS PREVENTION PROGRAM

TABLE OF CONTENTS

1. Introduction

2. Statement of Safety Policy

3. Identification of Administrator(s)

4. Recordkeeping and Documentation

5. Posting Requirements

6. Communication

6.1 Employer Responsibilities

6.2 Department Manager’s and Supervisor’s Responsibilities

6.3 Employee’s Responsibilities

7. Code of Safe Practices and Procedures

7.1 Code of Safe Practices Agreement

8. Self-Inspection

8.1 Inspection Checklist

9. Accident Investigations and Injury Reporting

9.1 Department Manager Accident Investigation Report Form

10. Hazard Identification and Mitigation

10.1 Correction of Unsafe Conditions

10.2 Employee Safety Suggestion Form

10.3 Safety Committee Responsibilities

10.4 Safety Committee Meetings

11. Safety Training

11.1 Safety Orientation Checklist

11.2 Initial Training

11.3 Employee Transfer

12. Emergency Procedures

12.1 Emergency Evacuation Plan

12.2 Fire/ Emergency Drill and Procedures
Revised by CJ – 03/21/2024

13. Hazard Communication

14. Lockout / Tagout Procedures

15. Bloodborne Pathogen Program

16. Forklift Safety Program

17. Heavy Equipment Operator Safety

18. Fall Protection

19. Electrical Safety and Assured Grounding Procedures

20. Hot Work / Welding / Compressed Gas

21. First Aid Treatment and Reporting Forms

22. Confined Space Entry

23. Scaffold and Ladder Safety

24. Respiratory Protection Program

25. Hearing Conservation Program

26. Fleet (Vehicle) Safety Program

27. Hand and Power Tool Safety

28. Substance Abuse Policy

29. Personal Protective Equipment

30. Disciplinary Policy

31. toolkit / Tailgate Meetings
Revised by CJ – 03/21/2024

1. INTRODUCTION
The Occupational Safety and Health Act of 1970 clearly state all companies must have a common goal of safe and healthful working conditions for its employees. California Senate Bill 198 outlines what an Injury and Illness Program should entail, while CAL OSHA enforces the mandates of Senate Bill 198. The safety and health of SERVICON SYSTEMS INC . employees continues to be the first consideration in operating its business.

Safety and health at SERVICON SYSTEMS INC. must be part of every operation. Without question, safety is every one of SERVICON SYSTEMS INC. employee’s responsibility.

It is the intent of SERVICON SYSTEMS INC. to comply with all laws. To do this, we must constantly be aware of conditions in all work areas that can result in injuries. No employee is required to work at a job he/she knows is not safe or healthful. Your cooperation in detecting hazards and in turn controlling them is a condition of your employment. Inform your supervisor immediately of any situation beyond your ability, or authority to correct.

At SERVICON SYSTEMS INC. the personal safety and health of each employee is of primary importance. Prevention of occup ationally induced injuries and illnesses is of such consequence that it will be given precedence over operating productivity whenever necessary. To the greatest degree possible, SERVICON SYSTEMS INC. management will provide all mechanical and physical safe guards required for personal safety and health in keeping with the highest standards.

It is the policy of SERVICON SYSTEMS INC . to maintain a safety and health program conforming to the best practices of organizations of this type. To be successful, su ch a program must embody proper attitudes toward injury and illness prevention on the part of SERVICON SYSTEMS INC. Supervisors and employees, but also between each employee and his/her co-workers.

The objective of SERVICON SYSTEMS INC. is to have a safety and health program that will reduce the number of injuries and illnesses to an absolute minimum, not merely in keeping with, but surpassing the best experience of operations similar to ours. SERVICON SYSTEMS INC.’s goal is to prevent accidents and injuries. This program has been designed to be in compliance with California Code of Regulations, Title 8 Subchapter 7 General Safety Orders Group 1 section 3203 and Subchapter 4 Construction Safety Orders Article 3 section 1509.

Revised by CJ – 03/21/2024

SERVICON SYSTEMS INC.

Safety and Health Program will include, but is not limited to:

1. Providing mechanical and physical safeguards, as well as setting examples of safe work practices to the maximum extent possible.

2. Conducting safety and health program inspections to find and eli minate unsafe working conditions or practices, to control health hazards and to comply fully with safety and health standards for every job.

3. Training and communicating to all of SERVICON SYSTEMS INC.’s employees, good safety and health practices.

4. Providing necessary personal protective equipment and instructions for use and care.

5. Developing and enforcing a Code of Safe Practices and requiring that SERVICON SYSTEMS INC. employees cooperate with these rules as a condition of employment.

6. Investigating, promptly and thoroughly every occupational accident and every occupational illness to find out what caused it and correct the problem, so it won’t happen again.

7. SERVICON SYSTEMS INC. management accepts responsibility for the leadership of the safety and heal th program for its effectiveness and improvement, and for, providing the safeguards required to ensure safe conditions.

8. SERVICON SYSTEMS INC. supervisors are responsible for developing proper attitudes toward safety and health within themselves and in those they supervise, and for ensuring that all operations are performed with the utmost regard to the safety and health of all personnel involved, including them.

9. SERVICON SYSTEMS INC. employees are responsible for wholehearted genuine compliance with all rules and regulations, and for continuously practicing safety while performing their duties.

10. SERVICON SYSTEMS INC. is responsible for maintaining all records for our IIPP and other requirements.

I have read, understand and agree to comply with SERVIC ON SYSTEMS INC.’s Safety and Health Policy as outlined above.

Employee Name /Employee Signature Date
Revised by CJ – 03/21/2024

2. SERVICON SYSTEMS INC.

GENERAL STATEMENT OF POLICY

TO OUR EMPLOYEES

We as management have a direct responsibility to provide all reasonable safeguards for our employee’s health and safety. We also have a responsibility to direct and ensure that employees perform their assigned tasks in a safe manner. Most of all, we have a responsibility to develop an awareness of safety in our people.

We have developed our Injury Illness Prevention Program, which with your help will assist in providing safe, healthful and pleasant working conditions.

We all benefit from an effective Injury and Illness Prevention Program. Cooperation from all people in our organization is expected. The results will be worth the effort.

Sincerely,

Michael Mahdesian
Chairman of the Board

Revised by CJ – 03/21/2024

The following persons are responsible for implementing the Injury Illness Prevention Program for SERVICON SYSTEMS INC.:

Responsibilities Name Title

Employee Safety

Purchasing & Distribution of
Personal Protective
Equipment

Updating & Maintaining GHS
Manual

Safety Inspections of Job Sites
Director of SafetyCarlos Janer
Operations ManagersOperations Managers
Recordkeeping &
Maintenance of Training
Documentation

Human Resources DepartmentHuman Resources Department

Investigation of Accidents
Carlos Janer
Operations Managers
Director of Safety
Operations Managers

Chairperson of Executive
Safety Committee

General CounselNick Rabinovitch

Oversight of Operations Safety
Committees & Recognition
Programs

Associate DirectorGabriel Jaimes

3. IDENTIFICATION OF PLAN ADMINISTRATORS
The individual with principal authority and responsibility for implementing and administering the company’s Injury Illness Prevention Program is: Carlos Janer, Director of Safety Carlos Janer Director of Safety
Procurement ManagerRoger Guzman
Director of SafetyCarlos Janer
Operations Managers Operations Managers Revised by CJ – 03/21/2024

4. RECORD KEEPING REQUIREMENTS

PURPOSE
Federal OSHA of 1970 and 29 CFR Part 1904 and SB 198 requires that employers to prepare and maintain records of occupational injuries and illnesses. The act made the Secretary of Labor responsible for the collection, compilation, and analysis of statistics of work-related injuries and illnesses. The Bureau of Labor Statistics (BLS) administers this record keeping and reporting system.

Record of injuries and illnesses are necessary for carrying out the purposes of the act. They provide a basis for a statistical program, which produces injury and illness data that are used by OSHA in measuring and directing the agency's efforts. These records are also helpful to employers and employees in identifying many of the factors, which cause injuries or illnesses in the workplace. In addition, OSHA records are designed to assist safety and health compliance officers in making OSHA inspections. In the state of California, CAL OSHA is responsible for ensuring that Injury and Illness Prevention Program records are properly maintained.

REQUIREMENTS

1. A CAL OSHA Log 300 will be maintained annually. During the month of February, March and April following the year that the injuries were recorded, the log will be posted on the employee bulletin board for one month only.

2. Workers' Compensation Insurance forms 5020 and DWC-1 will be maintained on file.

3. All accident and illness investigation forms will be maintained on file.

4. All government audits such as a CAL OSHA Inspection will be maintained on file.

5. Any and all employee’s safety training records will be maintained on file.

6. Physical Examination reports if any and all employment records will be maintained on file.

7. Any safety monitoring such as air monitoring, or noise dissymmetry monitoring if any will be maintained on file.

8. All employee exposure records to any known toxic substance (if applicable will be maintained on file).

Revised by CJ – 03/21/2024

9. Records of safety meetings will be maintained on file.

10. Records of Self-Inspection for identification of hazards will be kept on file.

11. Records of scheduled and periodic inspections, which identify unsafe work practices, unsafe conditions, and corrective action(s) taken, will be maintained for a minimum of three (3) years.

12. Certain records need to be kept for three years however others must be maintained for indefinite periods of time. We will consult with the agency requiring such documents for further details if necessary.

Revised by CJ – 03/21/2024

5. POSTING MATERIALS
Safety Materials are to be posted on employee bulletin board, and will be in accordance with the posting requirements of the CAL OSHA Manual Entitled "Developing a Workplace Safety and Health Program CS-1".

Postings include but are not limited to:

MANDATORY STATE POSTERS

1. California Industrial Welfare Commission Orders

2. California Occupational Safety and Health Notices - CAL OSHA

3. Workers Compensation Notification

4. Fair Employment Practices Information

5. Payday Notification

6. Unemployment Insurance/Disability Notification

7. CAL OSHA Form 300 (During the months of February, March and April)

8. Code of Safe Practices

9. Forklift Operator Rules (when applicable)

MANDATORY FEDERAL POSTERS

10. Federal Minimum Wage Notice

11. Notice to Employees: Time off to Vote
Revised by CJ – 03/21/2024

12. Equal Employment Opportunity Commission/Age Discrimination (Americans with Disabilities Act effective July 26, 1992)

6. COMMUNICATION

COMMUNICATION FROM SERVICON SYSTEMS, INC.

Employees will be informed of matters relating to occupational safety and health from time to time.

Communication of this nature may be in the form of policy statements, procedural advice, company manuals or specific hazard warning and may be communicated by pay check stuffers, posted notices, memos, or employee newsletters. Important safety issues may also be raised at employee meetings and training programs.

COMMUNICATION FROM EMPLOYEES

Employees are encouraged to direct any questions they have regarding safety issues to their supervisor, or the Injury Illness Prevention Program Administrator. It is also the responsibility of each employee to inform his or her supervisor, or the Injury Illness Prevention Program administrator, immediately of any hazard or unsafe condition at the work site. This shall occur without fear of reprisal in any form. Employees can also notify the Safety & Loss Control Director of any such hazards anonymously, if they prefer to do so.

Signature Date

6.1 EMPLOYER

It shall be the responsibility of the Company to provide all necessary safety equipment for the performance of the work to be performed. It shall be the responsibility of the Operational Safety Committee with oversight of the Executive Safety Council to set the safety policy and recommend action as appropriate in each case.

6.2 MANAGERS

In effectively executing their safety responsibilities, Managers will:

1. Ensure that our workers are provided with a safe work environment.

2. Ensure that all workers have received the appropriate training , including Safety training and fully comprehend the material and shall be able to demonstrate a level of proficiency.

3. Be familiar with the safety program and ensure its effective implementation.

4. Promote and communicate to supervisors and workers on a continuous basis the urgency and priority of the Servicon Safety Culture.

5. Be aware of and address all safety considerations when introducing a new process, procedure, machine or material to the workplace.

6. Give maximum support to all programs and committees as required.

7. Review serious incidents to ensure that all required reports are completed timely and appropriate action is taken to prevent reoccurrence.

Supervisors

Our supervisors are the foundation of the safety program. Their responsibilities are to:

1. Ensure that our worker s are provided with a safe work environment and maintain that safe work environment, by identifying hazards and mitigating those hazards and risks .

2. Regularly Inspect work areas before, during, and after shifts to detect unsafe conditions and work practices. This responsibility includes inspection of all equipment. Utilize company self -inspection checklists as required.

3. Ensure that all workers have received the appropriate training, including Safety training, up to and including annual, biannual, quarterly, and irregularly scheduled safety training. Workers shall be able to fully comprehend the materials and de monstrate a level of proficiency at the time of assignment of duties and thereafter.

4. Be familiar with the safety program and to fairly and consistently enforce all company safety rules and procedures to ensure its effective implementation.

Supervisors (Continued)

5. Promote and communicate to workers on a continuous basis the urgency and priority of Servicon’ Safety Culture. Communicate/Listen – Take the time to listen to what your workers want to say, those few seconds can make a difference.

6. Be aware of and address all safety considerations when introducing a new process, procedure, machine or material to the workplace.

7. Give maximum support to all programs and committees as required.

8. Review and investigate all incidents to ensure that all required reports are completed timely and appropriate action is taken to prevent reoccurrence.

9. Ensure that all injuries, no matter how minor, are treated immediately and referred to the Safety & Loss Control Department within one (1) hour of occurrence via text, call or email.

6.3 EMPLOYEES

All employees are required as a condition of employment to work safely, develop, and exercise safe work habits in the course of their work. We expect every employee to cooperate fully so that all employees will continue to work and benefit from a safe work environment.

Employee responsibilities for safety include the following:

1. Accept and embrace all training provided. Strive for high level of proficiency.

2. Adhere to all safety rules and regulations. Up to and including wearing appropriate Personal Protective Equipment (PPE), maintaining all equipment in good condition, and utilizing all safety guards when in operation.

3. Workers should not handle or tamper with any equipment or machinery that is not within the scope of their duties.

4. Prior to the perfo rmance of any duties, must address all known risks that are associated with those duties. This can be accomplished by completing the Risk Assessment tools available, e.g.: WRA (Work Risk Assessment) form, RAO (Risk Assessment Observation) form. If additional risks are now present, contact supervisor for instructions when appropriate.

5. Communicate urgently when a hazardous or unsafe condition or action is observed. Report unsafe acts and conditions to the supervisor

6. Encourage co-workers to work safely.

7. Wash hands and any affected area thoroughly after handling or coming in contact with any cleaning or hazardous substance

6.3 EMPLOYEES (Continued)

8. Report all defective tools and/or equipment to your supervisor immediately.

9. Keep work areas clean and orderly at all times.

10. Report all incidents and near miss incidents, no matter how minor, immediately to a supervisor.

11. All workers should be familiar with the location of all first aid supplies.

12. All workers should be familiar with the location of emergency equipment, e.g. fire extinguisher(s) etc.

13. All workers must know the location of all emergency exits in their i mmediate work area.

14. All emergency equipment and/or exits must be kept clear of all obstacles.

15. Fully cooperate and assist in the investigation of incidents for the purpose of identifying incident causes, so that recurrence will be prevented.

16. Submit any s uggestions for incident prevention to your immediate supervisor, which may assist in improved working conditions and/or safer work practices.

______________________________________________________________________________ Employee’s Signature Date

7. CODE OF SAFE PRACTICES AND PROCEDURES

GENERAL

1. Fighting, horseplay and practical jokes are strictly prohibited.

2. Good housekeeping in work areas is mandatory. Debris, scrap materials, oil rags, etc., shall not be allowed to accumulate.

3. Alcohol and drug use are strictly prohibited. Employees shall not report for work under the influence of alcohol or drugs.

4. Removing or tampering with any tool or machine guar d, or bypassing any safety devic e is prohibited.

5. Removal of “Danger Do Not Operate” tags or locks on any machinery by unauthorized personnel is strictly prohibited.

6. No employee is permitted to operate any tool , machines, or equipment they are not familiar with, or have not been specifically trained to operate.

7. Electrical lockout procedures must be followed before working on any machinery.

• Refer to specific electrical lockout policies and procedures for your work area.

8. All keys shall be removed from vehicles and equipment prior to repair or maintenance operations. Unless site rules require otherwise.

9. All portable electric tools and power cords must be equipped with effective grounds.

10. Smoking is allowed only in designated smoking areas.

11. Eating is allowed only in designated areas.

12. Interfering with others by threatening, intimidating, or c oercion will not be tolerated.

13. Firearms, ammunition, explosives or incendiary devices on the premises are prohibited.

14. Power actuated tools shall be operated by qualified persons only. The operator must be in possession of a valid operator’s certification card.

15. Forklift trucks shall be operated by trained and certified operators only.

16. Compressed gas cylinders shall be secured in such a way that they cannot topple over.

17. Compressed gas cylinders must have the valve protective cover in place when not in use.

18. Ladders must be inspected prior to use. Defective ladders must not be used. Deficient ladders must be taken out of service immediately.

• Under no circumstances, is any worker allowed to deploy a ladder for the purposes of gaining access to a height greater than 25 feet.
• Anytime access greater than six (6) feet is required, a spotter must be utilized.

• Extender ladders shall extend at least 36 inches above the landing and be properly secured before use.

• Metal ladders must not be used around electric al circuits, or where electrical work is being performed.

19. Access to confined areas or spaces is prohibited without the appropriate training and the consent of your supervisor.

20. Follow the safety rules for your work area. Observe all safety signs.

21. Report all unsafe conditions to your supervisor.

22. When in doubt about any safety procedure(s), do not hesitate to ask your supervisor.

23. Keep equipment, tools, material and work areas clean and orderly.

24. Walk, never run in work areas. Proceed with caution when approaching blind corners and congested areas.

MATERIAL HANDLING

1. Size up the load. Observe the loads position and surrounding hazards. If you need help, get it.

2. Per the Essential Job Function portion of the Job Description, male workers are instructed not to lift more than fifty (50) pounds without assistance and female workers limits are forty (40) pounds.

3. When lifting: Widen base as needed. Take a deep breath. Tighten abdominal muscles and squat or bend knees, getting as close to the object possible. Then lift.

4. Avoid carrying one trash bag in one hand. We encourage you to balance the weight with an equal weight in the other hand.

5. When lowering: lower the body by bending the knees with the object close to the center of the body. Keep back straight, allowing the leg muscles to bear the load.

6. Take a secure grip. Keep fingers away from pinch points.

MATERIAL HANDLING (Continued)

7. Wear appropriate PPE (Personal Protective Equipment) for the task.

8. When a load is heavy, get help or use a mechanical lifting device. e,g. Handtrucks.

9. If the load is being carried by more than one person, allow one worker to be the leader so that you have good timing and coordination.

10. Body mechanics of simultaneous pushing and pulling must be avoided, e.g. pushing janitors cart and pulling trash barrel.

11. You are discouraged from overloading any manual material handling equipment or yourself, in order to avoid additional trips when stocking or disposing of items.

12. Servicon encourages workers to avoid when possible, reaching/stretching for objects that are overhead or above shoulder level. We encourage the use of a step ladder to avoid this circumstance.

13. Only trained individuals are permitted to operate forklifts or other powered equipment.

HOUSEKEEPING

1. It is everyone’s responsibility to perform basic housekeeping duties.

2. It is the responsibility of each worker to keep their work station clean and organized

3. It is the responsibility of each work to keep their cleaning cart clean and organized.

4. Unauthorized food storage may create a health issue for the worker and others.

5. Unauthorized containers and/or products may create a health issue for the worker and others.

6. Mislabeled containers may create a health issue of the workers and others.

7. Used cans, bottles, plastics and other recyclables must not be stored in the janitors closet.

8. Avoid storing excessive supplies and/or equipment in the janitors closet.

9. Mops must not be left in the splash sink/basin or head down on floor. Mops should be rinsed out and excess water removed, then placed on wringer in mop bucket to dry.

10. Any spillage that occurs in the janitor’s closet must be cleaned up immediately.

11. Never place any material in aisles, on ramps, or stairways, or designated paths of travel.

12. Projecting nails or fasteners must be removed from all packing cases, barrels, boxes, and boards.

13. Place all trash or scraps in designated containers.

14. Clean oil, grease, and water spills from the floor immediately.

15. Properly store all materials in designated places.

MACHINERY

It is the employee’s responsibility to inspect any equipment and determine its safe operating condition prior to any use.

1. Never operate a machine unless you are qualified and authorized to do so.

2. It is the employee’s responsibility to use equipment in a safe and workman like manner.

3. Do not operate machinery without proper safety devices.

4. All employees are responsible for replacing vacuum cleaner bags monthly.

5. All employees are responsible for replacing vacuum filters as needed.

6. All employees who operate floor care machinery are responsible for ensuring that all equipment is cleaned and ready for the next use.

7. All employees need to disconnect machinery from power source, if necessary to inspect and to avoid contact with any moving parts.

8. Horseplay on or with any machinery is strictly prohibited.

9. All employees are responsible for wearing the appropriate PPE for all equipment being operated.

10. Make sure guards are in place and are properly adjusted.

11. Do not turn on electricity, compressed air, or steam, or set in motion any machine without making sure all persons are clear.

12. Any defective machinery should immediately be taken out or service and reported immediately to your supervisor.

13. Do not clean, oil, or repair machinery unless you are qualified and auth orized to do so.

14. Do not wear jewelry or loose clothing while operating moving machinery.

15. Long hair must be tied back while operating moving machinery.

HAND TOOLS

1. Employees are responsible for wearing the appropriate PPE for task being performed.

2. Only authorized Company tools are allowed onto the job site and used operationally.

3. Defective hand tools shall not be used.

4. Do not carry sharp tools in pockets or clothing.

5. Employee’s are responsible for proper tool storage.

6. Use hand tools only for their intended purpose.

7. Inspect handles of hand tools for cracks, slivers, or other defects.

8. Always exchange or repair mushroomed or battered tools before they become dangerous.

ELECTRICAL

1. Only trained and authorized employees may work on electrical equipment.

2. All employees must be Lockout/Tagout trained before operating any electrical equipment.

3. Lockout/Tagout all switches before making repairs.

4. All employees must obey and observe all electrical warning signs.

5. Employees must avoid getting any type of moisture onto or in any electrical power source.

6. All employees must wear the appropriate PPE when performing any electrical work, e.g. Arc Flash protection, face shields, etc.

7. Employees must ensure that all maintenance equipment used is safe for electrical use, e.g. Ladders, Footwear, hand tools, etc.

8. Employees must be sure to obtain any required electrical work permits before starting any electrical work.

9. When utilizing extension power cords, they must be inspected for damage.

10. When using power cord extensions, limit the use of these power cord extensions to one (1).

11. Employees must only use authorized or designated power sources for any electrical equipment being used.

FIRST AID

1. Report all injuries, no matter how small or inconsequential you may believe, to your supervisor.

2. Know the location of first aid kits and emergency equipment.

3. Only trained individuals should administer anything beyond basic first aid to injured individuals.

4. If it is an emergency, immediately dial 911.

5. Use first aid supplies only when needed and for the intended purpose.

6. Do not move a seriously injured person unless they are exposed to further injury by fire, falling objects, etc.

7. Know and follow special first aid instructions for your area.

8. If eye wash site is available, know the location and wash out eyes if required.

9. Do not attempt to remove foreign objects from the eye.

OFFICE SAFETY

1. All desk and file drawers are to be closed when not in use.

2. Workers shall observe and obey all posted and placed warning signs in the bui lding.

3. No obstacles are to be left where a person could trip over them.

4. Nothing is to be stacked to the extent that it might fall on someone.

5. Key operator or trained personnel should be called to clear jams in photocopying, laminating, or other machinery.

6. Aisles shall be kept clear at all times.

7. Extension and power cords should be checked for frays.

8. When paper cutter is not in use, the blade must be kept in close position, locked with the guard in place.

9. Workers should avoid reaching for items in overhead locations whenever possible.

10. When attempting to reach items in overhead locations, you must use a step stool, ladder or other approved tool for that purpose.

11. When retrieving, items stored in overhead locations, take all safety precautions to el iminate or reduce the possibility of getting debris into your face, mouth or eyes.

12. There shall be no use of extension cords in areas where they could be, or create a hazard.

13. Any extension or power cord should have a safety protecti ve cover if it creates a tripping hazard.

14. Never pull out the top drawer and the one underneath it at the same time.

15. Do not attempt to move heavy office furniture or files alone. Use handcart to avoid carrying boxes or items any distance.

16. Pick up objects and wipe up spills from the floor immediately.

17. Never carry loads that you cannot see over.

18. Avoid leaning back in chairs.

19. Keep fingers away from ejecting slot when loading or testing stapling tools.

20. Make sure there is adequate lighting before you enter an area .

21. Always close scissors when you are done using them.

22. Office areas should be kept free from unnecessary build up of paper, and other highly flammable materials.

23. Your work station computer should be shut off at the end of the work day .

24. Ripped, torn, worn, or slipping carpets or rugs should be reported immediately.

25. Employees are responsible for reporting any chips, snags, splinters, and sharp corners on the furniture.

26. Employees are responsible each time before sitting down to check the chair to insure that the chair is stable.

27. Copying machines, paper cutters, shredders, sealers, etc., shall not be operated without point of operation guards in place.

28. Running is prohibited in the office.

29. File cabinets shall be secured to prevent them from tilting when the drawers are opened.

30. Smoking is prohibited inside the office building.

31. Smoking is permitted outside and only in designated areas.

32. Stairs and ramps shall be kept free from any obstacles.

33. All handrails shall be secured and free of snags, splin ters, burrs, etc.

DRIVER SAFETY

1. Only authorized individuals are allowed company vehicles.

2. Company vehicles are intended for business use only.

3. Drivers are prohibited from driving a vehicle after ingesting any alcoholic beverage or judgment impairing medication.

4. All employees must possess a valid and appropriate Drivers License for vehicle being utilized.

5. Distracted driving can kill. Drivers always must focus on the task of driving.

6. Drivers are prohibited from texting while driving.

7. Drivers are prohibited from using Handheld phones or devices while driving.

8. Drivers must not eat while driving to the point of distraction.

9. Drivers must avoid reaching for items out of arms length while vehicle is moving.

10. Drivers must practice Defensive Driving always. Must be courteous at all time.

11. Drivers must always wear their seatbelt and ensure that all passengers do the same.

12. Drivers must maintain a three (3) second distance between themselves and the vehicle in front of them.

13. Drivers driving a loaded truck must maintain a ten (10) second distance between themselves and the vehicle in front of them.

14. Driver is responsible for compliance with all vehicle maintenance schedules.

15. In the event of an accident, never admit responsibility and ge t a police report when possible and witness information.

16. Inform your supervisor of all vehicle related incidents immediately.

17. Certain rules violations are so serious that they could result in your immediate termination.

Repeated violations cannot and will not be tolerated.

7.1 CODE OF SAFE PRACTICES AND PROCEDURES ACKNOWLEDGMENT AND UNDERSTANDING

I, _____________________________________________________________________________, have read the Code of Safe Practices for SERVICON SYSTEMS INC. and I attest that they have been explained to me, and that I understand them. I agree to comply with said Code of Safe Practices and Procedures, and I understand that failure to comply could result in disciplinary actions, up to and including dismissal. If there are questions regarding these practices, I understand that it is my responsibility to ask my supervisor for an explanation of said questions. My signature and the date at the bottom of each page indicates that I have read and understand the Code of Safe Practices on those pages, and have no questions regarding their meaning or the necessity of their enforcement.

_______________________________________________________Date_________________ Employee Signature

8. SELF INSPECTION
Self-Inspection is an effective loss control tool, and it is an essential part of hazard control. It is an important management tool. We will view self-inspections as a fact-finding process, not fault finding. We will emphasize locating potential hazards that can adversely affect safety and health of our employees. All personnel will be responsible for continuous, ongoing inspection of their work areas. Do not wait for a scheduled inspection to report an unsafe condition or practice. Periodic planned inspections will be made by members of the Safety Committee (or other designated individuals) utilizing the company self-inspection forms. The safety committee will review the report and action will be taken to eliminate revealed potential hazards. Assignments, target dates for completion and actual completion dates will be documented in the minutes of the Safety Committee.

Imminent hazards will be reported and corrected immediately.

Revised by CJ – 03/21/2024

9 ACCIDENT INVESTIGATION & REPORTING

INCIDENT AND INJURY REPORTING

All incidents need to be reported as soon as reasonable possible after they occur, even if they did not result in injury, to their immediate supervisor or Operations manager or the Safety & Loss Control Department. Or, before they leave the job site or no more than 8 hours after realizing that they have suffered an injury or illness, whichever is earlier. The Safety & Loss Control Director and Safety Committees will review all incident investigation reports for content to determine if appropriate action has been taken. The Executive Safety Council will review each incident.

Form DWC-1 “Employee Injury Report Form" will be given to the employee immediately upon learning of the injury, if medically possible, or within 24 hours of either first notice or first knowledge of an injury. A tracking system will indicate if employee has returned the form, which must be kept on file.

Also, the workers' compensation insurance form will be completed and given to the insurance carrier within 5 working days.

Each accident will be reviewed and investigated. Completed investigation material will be kept on file.

________________
Associate’s Signature Date

Revised by CJ – 03/21/2024

INCIDENT INVESTIGATION

PURPOSE

The purpose of an Incident Investigation is to identify those unsafe conditions and acts which contribute to injuries, and to propose solutions to prevent a similar injury from occurring.

Incident investigations are an invaluable tool in controlling losses. Each accident must be considered a total loss unless its true cause is objectively determined, and all contributing deficiencies are corrected.

It is important to remember that an incident investigation is not a trial to find fault or who to blame. Its purpose is to find incident causes, so that similar incidents may be prevented either by physical or mechanical improvement or employee training and motivation.

An incident is any unplanned happening or event that may or may not result in personal injury, property damage, or both. For an incident investigation program to be successful, all incidents resulting in an injury requiring medical attention or significant property damage should be investigated.

EMPLOYEE INCIDENTS

All incidents, regardless of whether they resulted in injury or not, should be thoroughly investigated.

This should include "near miss" incidents. The investigation should be extensive enough to allow the supervisor to suggest practical corrective action.

A written report should be completed and include:

1. Injured employee's statement concerning the accident.

2. Statements from other witnesses.

3. Complete description of the accident including the type of work in which the employee was involved.

4. Evaluation of unsafe conditions and acts.

5. Recommendations for action to prevent similar accidents.

Revised by CJ – 03/21/2024

INCIDENT/LOSS REPORTING PROCEDURES
Each supervisor shall be furnished with an Incident Investigation Form when required. Timely reporting, within 24 hours of any incident or loss, is mandatory. The supervisor shall thoroughly investigate the cause of each incident/loss occurring within his/her area of operations, and record his/her findings and recommendations on the appropriate form. One copy shall be forwarded to the Main Office. A copy shall be retained in the Supervisor’s file.

A. REPORTING EMPLOYEE INJURIES

1. Regardless of the degree of injury, the employee shall report to his supervisor, or in writing on the State “Employee Injury Form" its occurrence immediately thereafter or as soon as practical.

2. The supervisor shall complete the "Incident Investigation Report" within 24 hours. If the supervisor is told by the employee, or is aware of the work-related injury, IT MUST BE REPORTED TO PERSONNEL WITHIN 24 HOURS EVEN IF THE Supervisor THINKS THE INJURY:
a. is minor or;
b. Might have been caused by unsafe actions such as inattention or negligence, or; c. Aggravated an old injury, or;
d. Is not work-related
If the supervisor thinks any of the four above items are applicable, it should be stated on the report forms. AT NO TIME SHOULD A SUPERVISOR WITHHOLD, OR HINDER THE FILING OF AN EMPLOYEE INJURY REPORT TO PERSONNEL.

3. BECAUSE OF THE COMPLEXITY OF WORKERS' COMPENSATION LAWS, RULES, AND

PROCEDURES, THE SUPERVISOR SHOULD NOT ATTEMPT TO ANSWER ANY QUESTIONS ABOUT WORKERS' COMPENSATION. REFER THE INJURED EMPLOYEE TO THE SAFETY & LOSS CONTROL DEPARTMENT.

4. The manager shall be responsible for closely monitoring employees’ lost time by:
__________________________________________________________. a. Insuring that the employee has been given a Medical Release to work form by the treating physician.
b. Periodically checking on the progress of recovery. c. Insuring that the employee returns to work on the date the physician releases Revised by CJ – 03/21/2024

him/her.

A SUPERVISOR SHALL NOT ALLOW AN EMPLOYEE TO RETURN TO WORK AFTER AN

OCCUPATIONAL INJURY OR OCCUPATIONAL ILLNESS UNLESS HE/SHE RECEIVES A SIGNED AUTHORIZATION TO RETURN TO WORK FROM THE TREATING PHYSICIAN. IF THE INJURED EMPLOYEE HAS BEEN OFF WORK MORE THAN 30 CALENDAR DAYS AND IS IN A NON-SEDENTARY POSITION. HE/SHE MAY BE REQUIRED TO TAKE A SPECIAL PHYSICAL EXAM AT THE COMPANY'S EXPENSE.
d. Making every attempt to put employees to work within the limitation(s) specified by the treating physician.

B. COMPANY PROPERTY/EQUIPMENT DAMAGE
When property or equipment, other than vehicles, is damaged or stolen, it must be reported on the proper report form. A formal investigation should follow within 24 hours. The "Incident Investigation Report" should be used and filled out.

C. VEHICLE INCIDENT REPORTING

1. When an employee is involved in a collision while operating a company or personal vehicle on company business, he/she shall call the police to the scene for investigation.

Supervision shall not interfere with police investigation.

2. The project manager of the employee shall also investigate the collision and complete the appropriate "Incident Investigation Report" within 24 hours.

3. Employees, supervisors and Managers shall follow the company Vehicle Policy.

D. CITIZEN ACCIDENTS (NON-AUTO)
Public incidents shall be reported, and the report forwarded to your supervisor within 24 hours of the time the incident occurred. The "Investigation Report" form should also be completed within 24 hours. However, when there is a serious injury it shall be reported immediately to your supervisor and followed by the reports by list.

E. SUDDEN SEVERE ILLNESS REPORTING
Sudden illness occurring to employees during duty hours requiring EMERGENCY MEDICAL TREATMENT such as possible heart attacks, strokes, seizures, fainting, etc., shall be reported to your supervisor as soon as possible. The supervisor should then notify the company representative, who will contact the family of the injured employee.

Revised by CJ – 03/21/2024

F. INVESTIGATION PROCEDURES

1. Investigation of any incident is an invaluable tool in controlling losses. Each incident must be considered a TOTAL LOSS unless its true cause(s) is\are objectively determined and all contributing deficiencies are corrected.

2. Each vehicular collision large or small shall be fully investigated and reported to the police and the supervisor of the employee involved immediately. The supervisor shall submit the "Investigation Report" form to the supervisor within 24 hours of occurrence.

Although police are called to investigate all vehicle collisions, it is incumbent upon the supervisor to ensure that all facts are obtained.

3. Using the "Supervisors Procedures for Investigating an Incident/Loss", the supervisor shall determine as many facts as possible, evaluate his/her findings, and submit the copies of his/her report to your supervisor.

G. OFF-THE-JOB (OTJ) INCIDENTS

1. Off-the-job incidents, which are costly to the employee and employer, and continually present absenteeism problems to the company, shall also be reported. Ask the employee to specify the injury and its causes and document for record keeping only.

2. It is important that the compilation of OTJ statistics be made available for the education of employees regarding off-time safety.

Public and Customer Accidents
The following steps should be taken in the event of a public injury:

1. Notify your supervisor immediately.

2. Be courteous and business like.

3. Offer the injured first aid and make him or her comfortable, but do not move or administer medical treatment.

4. Obtain the names and addresses of witnesses, other than employees, who saw the accident.

5. The area supervisor should complete and file an "Accident Investigation" report, while all details are fresh, paying particular attention to unsafe conditions or acts, and action that could be Revised by CJ – 03/21/2024

taken to prevent similar accidents. The Safety Coordinator will review all reports for completeness and accuracy and sign the form following his review.

6. Take pictures.

10. Care should be taken to eliminate:

i. Arguments that could be viewed following the accident. Showing genuine concern for the injured party is good for maintaining a positive public image, but do so without the admission of Liability.

ii. Admission of responsibility.

iii. Discussion of insurance or medical arrangements.

iv. Opinions or statements by company employees to anyone other than a company representative.

v. Unauthorized picture taking.

8. Transportation of injured person in personal or company vehicles should be discouraged. Call an ambulance or taxi whenever possible. The payment of transportation will be determined by the company.

9. Costs for medical treatment of public injuries should not be on a volunteered. Bills should then be forwarded to the human resources department for consideration.

SUPERVISOR'S PROCEDURES FOR INVESTIGATING AN INCIDENT/LOSS

1. Check the Scene
a. Begin where the incident occurred. The first step is to carefully examine where the injury occurred.
b. Reconstruct as much as possible the chain of events leading up to the injury, and attempt to determine the single event that caused the injury. Have the employee tell you what happened? If necessary, have him/her show you up to the point where the injury occurred. DO NOT let them do the part of the incident that resulted in the injury. c. Draw a diagram of the location if it will be helpful in arriving at a conclusion.

Revised by CJ – 03/21/2024

d. Sketch in machinery, equipment, and any other nearby physical objects, together with the places where witnesses were standing.

2. Write it Down
a. Make notes on all facts that may relate to the cause of the injury. As an example:
employee had complained of dizziness or employee had not used proper equipment, etc.
b. Write down any procedure used; that is an unsafe act, etc. c. Write down any unsafe conditions in work area, defective tools, or faulty equipment noted.
d. Write down such other items as: the time of your investigation, the lighting conditions, weather conditions if pertinent, a description of supplementary evidence and conversations having a bearing on the case.

3. Collect the Evidence
If an injury or near miss occurs when machine parts or structures fail, it is essential to determine what failed and why. This can frequently be done without laboratory analysis and corrective action can be initiated without great expense. If, however, a detailed study is determined to be essential, then all components shall be collected and submitted for study immediately if cost of analysis is economically feasible.

4. Interview Witness
It is important to interview witnesses at the scene or as soon thereafter as possible. Make brief notes and identify who gave the information.

5. Interview the Victim
a. Timing is important. When the injury is minor, the interview should be made as soon as the investigation of the scene and a review of the medical report is complete. b. If the injury is serious, selecting the right time is a judgment factor. Too soon afterward and the victim may be confused and inaccurate; waiting too long may cause him/her to be cautious and evasive. Let the employee tell the story as he/she wishes without actual interrogation, but a complete picture should be encouraged. The interview must be complete, and it may be necessary to question the employee or witnesses several times.

Revised by CJ – 03/21/2024

6. Weigh the Evidence

a. It is essential to eliminate any inconsistencies in the testimony of the injured or witnesses even if further questioning is required.

b. Once assembled, all facts should be reviewed for completeness before submission on the "Incident Investigation Report" form to the Personnel Department.

DEFINITIONS

Industrial Injury - An injury arising out of and in the course of employment wi th the company.

Occupational Illness - An illness caused by exposures to a specific hazardous condition or material in the workplace.

Revised by CJ – 03/21/2024

10. HAZARD INDENTIFICATION AND MITIGATION

It is important to make sure that all hazards in the work areas in which Servicon System employees are assigned, be addressed and mitigated whenever possible. These hazards should be addressed using the WRA (Work Risk Assessment) form and JHA (Job Hazard Assessment) form. They should be used in the following sequence:

A. When the program is first established, the WRA should be completed to address any immediate hazards that are noted, when walking the new job site for the first time.

B. Once the employee begins working, periodic inspections should be made to ensure that any hazards initially identified have been addressed and mitigation measures remain in place.

C. Prior to the employee performing any task within the assigned work area, a JHA should be conducted by a team composed of the supervisor, employee and the Safety & Loss Control department if required, to identify the hazards associated with the specific tasks that the employee may encounter while performing those tasks. The JHA is comprised of the following categories:
• Identification of the specific task and steps being performed • Potential hazards identified within the individual steps being done • Mitigation methods to address those hazards
• Follow-up after JHA implemented to determin e if mitigation methods are effective
D. Whenever new substances, processes, procedures, or equipment are introduced to the workplace that represent a new work safety and health hazard; and E. Whenever Servicon is made aware of a new or previously unrecognized h azard

Revised by CJ – 03/21/2024

10.1 CORRECTION OF UNSAFE CONDITIONS

When it is determined that a previously unknown safety or health condition, work practice, or work procedure exists, Servicon will take all appropriate measures under the circumstances to correct the condition, practice or procedure in a timely manner. The severity of a hazard will be considered along with other relevant factors when evaluating the most appropriate method of correcting any hazardous situation and the time and the time frame within whi ch the correction will be made.

If an imminent hazard exists that cannot be abated immediately without endangering one or more employees or property, the company may find it appropriate to remove all exposed personnel from the area in which the hazard exists, unless they are necessary to correct existing condition. If employees cannot perform their jobs without exposure to hazards that cannot be reasonably corrected, they will be provided necessary warnings and safeguards.

_________________________________________________________________________ Associate Signature Date
Revised by CJ – 03/21/2024

10.2 EMPLOYEE SAFETY SUGGESTION / HAZARD FORM

Please use this form to report any hazards you see or to make any suggestions about improving safety and health in our facility. You have the option of giving your name, or remaining anonymous.

I have noted the following safety / health hazards(s):
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________________________________________________________________________________ Location: _______________________________ Date: _____________________________

I have the following suggestion(s) for correcting the hazard(s) mentioned above, or for improving safety and health in this facility:
____________________________________________________________________________________ _ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Location: _____________________________________ Date: _______________________ Name (OPTIONAL)___________________________________
Revised by CJ – 03/21/2024

10.3 SAFETY COMMITTEE RESPONSIBILITIES
Safety committees in themselves should not be considered a safety program, but they do have two basic functions.

1. Creating and maintaining an active interest in safety.

2. Serve as a means of safety communication.

A safety committee will consist of four persons (this may depend on the size of the facility). The persons selected will be in positions of authority, (such as operating supervisor or supervisor), and will from various working levels. The persons selected should be familiar with all job duties in their area, and the general operation of the facility.

A safety committee will be set up to carry out these basic functions:

1. Discuss safety policies and recommend their adoption by management.

2. Address unsafe conditions and practices and determine their remedies.

3. Work to obtain results by having its management-approved recommendations put into practice.

4. Teach safety to the committee members, who in turn, will teach safety to the entire personnel of the facility.

5. Keep all employees informed on safety matters.

6. Maintain the interest of all employees, and convey to them that their cooperation is needed to prevent accidents.

7. Make safety activities an integral part of operating policies and a function of operations.

8. Provide for free discussion of accident problems and preventive measures.

9. Help the operating supervisor evaluate safety suggestions.

10. It shall also be the responsibility of management and safety committee members to maintain copies and/or records of all unsafe conditions and unsafe work practices.

Revised by CJ – 03/21/2024

Closely allied to the sincere and productive efforts of a safety committee are benefits such as:

1. Improvement of operational efficiency.

2. Lowering of production costs.

3. Improving methods and conditions.

4. Improving employee health and wellness.

Safety Committee Member Signature Date

Revised by CJ – 03/21/2024

10.4 SAFETY COMMITTEE MEETINGS

The Safety Committee will meet on a quarterly basis. The minutes should give a synopsis of any important discussions, and should clearly indicate whatever action has been taken on the recommendations, which have been discussed at the meeting. The Safety Committee shall review and act on the following:

1. Minutes of the previous meeting

2. Unfinished business of the previous meeting

3. Self-Inspection Reports

4. Discussion of accidents and corrective action taken

5. Accident trends

6. New and outstanding recommendations submitted by outside agencies (insurance carrier, fire department, CAL OSHA, etc.)

7. New Business

All meetings will be documented.

Group safety meetings - Supervisors will be responsible for holding department safety meetings on a regular basis. Employee attendance and discussion topics will be documented.

Revised by CJ – 03/21/2024

AGENDA

SAFETY COMMITTEE MEETING

Date of Meeting: Time of Meeting: a.m. p.m.

Location of Meeting: _____________________________________________________________ Attendees Names: _______________________________________________________________ ________________________________________________________________________________

I. Call to order by Chairman

II. Reading of minutes of prior meeting for approval by Committee

III. Review of all past accidents and claims with identification of trends and accident-prone areas or department.

IV. Progress reports on what has been done about previous Committee recommendations.

V. Review of findings of the most recent hazard survey and new recommendations.

VI. Other business:

A.

B.

C.

VII. Adjournment
Revised by CJ – 03/21/2024

11. SAFETY TRAINING

SERVICON SYSTEMS INC. will provide training and instruction to employees under the Injury Illness Prevention Program on a regular basis. Such training and instruction will be provided:

(a) when the program is first established

(b) as part of the orientation provided to new employees

(c) to employees beginning new job assignments for which training has not been previously received

(d) when new substances, processes, procedures, or equipment are introduced to the work place and represent a new hazard

(e) when the company becomes aware of a new hazard (one that was previously not recognized)

(f) to supervisors who must be familiar with the safety and health hazards to which employees under their immediate direction and control may be exposed.

Upon initial employment, employees shall be given instructions regarding the hazards and safety precautions applicable to the type of work in question and directed to read the Code of Safe Practices.

The Servicon Systems Inc. will permit only qualified persons to operate equipment and machinery.

Where employees are subject to known job site hazards, such as flammable liquids and gases, poisons, caustics, harmful plants and animals, toxic materials, confined spaces, etc., they shall be instructed in the recognition of the hazard, in the procedures for protecting themselves from injury, and in the appropriate first aid procedure in the event of an inju ry.

Revised by CJ – 03/21/2024

Employee safety training courses will include but not limited to the following:

1. Back Safety Training - Includes an illustration of how the back functions as well as how to lift, bend, and stoop correctly.

2. Hazard Communication - In accordance with Section 5194 of the California Administrative Code

3. Personal Protective Equipment Training - How to properly use equipment.

4. Hearing Conservation Training - In accordance with Noise Control Booklet published by the Department of Industrial Relations.

5. Lockout/Blockout procedures in accordance with G.I.S.O. Standards and tool safety training

6. Forklift Safety

7. Hand tool safety training

8. Machine operator safety training

9. First Aid / CPR

10. Office safety training

11. Code of Safe Practices

12. Supervisor Safety training.

13. Defensive Driver training

14. Emergency Evacuation Plan

____________________________________________________________________________ Associate Signature Date

Revised by CJ – 03/21/2024

11.1 NEW EMPLOYEE SAFETY ORIENTATION

Each employee shall be given and required to read the Code of Safe Practices. New employees will be given information regarding:

a. Review of Workers' Compensation Benefits

b. Accident Reporting Procedures

c. Review of State Disability Benefits

d. The Code of Safe Practices - Employees shall sign and return the acknowledgment page, indicating that they have read and understand it.

e. Review of Hazardous Communication Program

1) Global Harmonized System (GHS)

2) Hazard Labeling

3) Review Personnel Protective Equipment

4) Review Technical Terms

f. Employee's Responsibility

1) Participation in Safety Program

2) Reporting unsafe acts and conditions

Any specific safety training such as forklift operation, personal protective equipment, first aid, CPR, etc. shall be scheduled separately.

Revised by CJ – 03/21/2024

NEW ASSOCIATE SAFETY CHECKLIST

ASSOCIATE: ____________________________________ DATE HIRED:_____________

Supervisor - CHECK OFF EACH ITEM AS IT IS COMPLETED

1. _____ Associate provided safety policy statement and safety rules.

2. _____ Reviewed injury reporting procedures.

3. _____ Issued safety equipment - glasses, earplugs, etc., and explained use and care.

4. _____ Reviewed lock-out and tag-out procedures.

5. _____ Review safe lifting procedures.

6. _____ Reviewed housekeeping and clean-up procedures.

7. _____ Located first aid kits and/or given information regarding Industrial medical group.

8. _____ Reviewed hazard communication program, location of Safety Data sheets, and how to read S.D.S.

9. _____Reviewed evacuation procedures and any specific duties.

10. _____ Reviewed Forklift Operator rules? (where applicable

11. _____ Does the employee understand the above?

I acknowledge that information on the above was furnished to me during my orientation. ________________________________________________________________ ____________ Associate Signature Date

I have instructed the above-named employee regarding the fundamentals of safe practices. ____________________________________________________________________________ Supervisor’s Signature Date

Sign and return the original copy immediately to the Human Resources Department following the employee’s date of hire or transfer into your department.

Retain a copy in the employee's departmental file.

Revised by CJ – 03/21/2024

11.2 INDIVIDUAL ASSOCIATE TRAINING

DOCUMENTATION

INITIAL TRAINING

NAME OF ASSOCIATE: _____________________________________________________________ NAME OF TRAINER: _______________________________________________________________ TRAINING SUBJECT: _______________________________________________________________ TRAINING MATERIALS USED: _______________________________________________________ DATE OF HIRE / ASSIGNMENT: _____________________________________________________

{ } The potential occupational hazards in general in the work area and associated with my job assignment.

{ } The Codes of Safe Practices whi ch indicate the safe work conditions, safe work practices and personal protective equipment required for my work.

{ } The hazards of any chemicals to which I may be exposed and my right to information contained on materials safety data sheets for those chemicals, and how to understand this information,

{ } My right to ask any questions, or provide any information to the employer on safety either directly or anonymously without any fear of reprisal.

{ } Disciplinary procedures the employer will use to enforce compliance with Codes of Safe practices.

I certify that I have received training and that I understand the training presented to me, and that I agree to comply with the Code of Safe Practices for my work area.

___________________________________________________________________________ Associate Signature Date

Revised by CJ – 03/21/2024

11.3 SAFETY TRAINING SHEET
(ASSOCIATE TRANSFER)

DATE ______________________ NAME OF EMPLOYEE________________________________ NAME OF NEW Supervisor_________________________________________________________ New Work Area Previous Work Area___________________ Previous supervisor_______________________________________________________________ Date of training for transferred employee___ _____________________________________

Type of training provided to employee
Emergency procedures
Work Area safety rules
Work area hazards
Safety hazards
Health hazards
Material Safety Data Sheet (M.S.D.S.)
Labels
Work area monitoring
Work practices
Personal Protective Equipment
Additional safety and health information provided:
_____________________________________________________________________________________

Instructor Signature Date

Date
Personnel Department

Associate Signature
Route copy to: Area Supervisor
Revised by CJ – 03/21/2024

ASSOCIATE TRAINING

SIGN IN SHEET

DATE____________________________________________________________________________

TRAINER: ________________________________________________________________________

TOPIC OF TRAINING: _____________________________________________________________

ATTENDEES
(Please print and sign your name)

Print Name Signature

Revised by CJ – 03/21/2024

12. EMERGENCY PROCEDURES

12.1 EMERGENCY EVACUATION PLAN
AND

12.2 FIRE / EMERGENCY DRILL AND PROCEDURES

To implement an effective Emergency Evacuation and Fire Prevention Plan, it is necessary to have a comprehensive training program that all employees understand. An efficient written program will allow for all employees to undertake the responsibility necessary to ensure that he/she, and his/her co - workers have a clear understanding of their role in the program.

SERVICON SYSTEMS INC. is required to have an operational emergency action plan for employee safety during and after catastrophic events and emergencies, including toxic chemical release. This plan must include the following:

• Names of person(s) in charge in the event of an emergency

• Emergency escape procedures and emergency escape route assignments for all employees, designated on a posted evacuation plan

• Procedures to be followed by employees who remain to mai ntain critical operations

• Procedures to account for all employees after emergencies

• Rescue and medical duties for those employees who are to perform them

• The preferred means of reporting fires and other emergencies to employees and to the appropriate authorities

• Names and or job titles of persons who can be contacted for further information or explanation of duties under the plan

Practice fire drills should be held periodically to include all shifts in order to ensure that all employees become acquainted with the proper procedure should an actual fire emergency occur. We will ensure that the following is communicated to each employee:

At jobsites employers, should follow evacuation plan developed by building plant management and proceed to nearest safe exit and designated meeting place.

Revised by CJ – 03/21/2024

Practice Fire Drill
A. The purpose of a practice fire drill is to ensure that all employees are familiar with the proper evacuation procedure as well as to assist in determining which areas need further clarification and/or to uncover weaknesses in the system.

B. To communicate any changes in employee responsibilities C. To communicate any changes in the present procedure to all employees.

Practice sessions will not be announced and will only be enactments of a real fire emergency. The purpose of practice fire drills is to instill in the mind of each individual the proper procedure to be followed and to ensure the safety of all individuals in the event of a real fire emergency.

Before implementing a fire emergency plan of action, SERVICON SYSTEMS INC. will assign individuals who will be responsible for the implementation and proper training of the Response Team. The Response Team will ensure that all rules and regulations and procedures are strictly adhered in accordance to Title 3320 of the General Industry Safety Orders.

Fires occur when least expected. For this reason fire drills, should be taken seriously. Practice fire drills are essential in order to familiarize everyone within the company the proper evacuation procedure to be taken in the event of a real fire. Should an actual fire occur, each employee will know exactly what his/her responsibility is, and what to do when a fire alarm goes off.

The following procedures shall be the responsibility of the Fire Marshall (or Response Team Leader). It is also the responsibility of the employer to offer full support, cooperation and to monitor the program, to ensure that all lines of communication are in place at all times. The Response Team members shall be held accountable to ensure that all personnel are familiar with the plan of action should a real fire emergency occur.

The following elements, at a minimum, shall be included in the plan.

SERVICON SYSTEMS INC. will ensure the following:

1. Emergency escape procedures and emergency escape routes, assignment of the Response Team is clearly identified, posted, and communicated to all personnel.

2. Potential fire hazards and their proper handling and storage procedures, potential ignition sources (such as welding, smoking and others) and their control procedures, and the fire protection equipment or systems which can control a fire involving them.

3. The emergency response team shall observe the actions of personnel to ensure that all employees adhere to the proper procedure in a positive manner should a real fire Revised by CJ – 03/21/2024

emergency occur.

4. Assignment of Response Team members. They are as follows:

(Names will be posted on employee bulletin board)

5. Project Managers shall be responsible for housekeeping and ensure that accumulations of flammable and combustible waste materials and residues do not contribute to a fire emergency.

FIRE DISCOVERY

SERVICON SYSTEMS INC. will be responsible to ensure that all its employees are aware of the preferred means of reporting a real fire emergency.

6. During the practice drill, it shall be the responsibility of the Project Manager______ to act out the following procedure:

________________________: CALL 9-1-1

__Project Manager shall: ADVISE all SERVICON SYSTEMS INC. personnel of the situation

(In the event of a real fire it shall be the responsibility of the _________________ to call 9 -1-1 and the fire department.)

will assist or act as a substitute for the receptionist in the event he/she is

absent or unavailable.

It shall be the responsibility of the Emergency Response Team to appoint someone. All personnel shall know the proper procedure to take when the alarm has been activated.

EXAMPLE:

RED LIGHT FLASHING - EVACUATE
ALARM SOUNDING – EVACUATE

7. It shall be the responsibility of the following personnel to ensure that their department/area personnel have been safely escorted out of the building. These individuals' names will be posted on the company bulletin board. They are:
___________________________________________________________________ ___________________________________________________________________ Revised by CJ – 03/21/2024

AND

8. The following personnel shall be trained in CPR and first aid in order to assist those employees injured. The names of the individuals will be posted on the company bulletin board: They are:
_______________________________________________________

9. SERVICON SYSTEMS INC. will ensure that all personnel and visitors are evacuated from the premises.

A company sign-in sheet will be available for all visitors that enter the company

10. SERVICON SYSTEMS INC. will assure that the following individuals are responsible for making sure that fire extinguishers are available at the site of the fire and surrounding areas. They are:
______________________________________________________________________ ______________________________________________________________________

11. SERVICON SYSTEMS INC. will ensure that the following individuals are responsible for shutting, locking-out, or tagging-out moving machinery. They are:
_______________________________________________________________________ _______________________________________________________________________

12. SERVICON SYSTEMS INC. will ensure that the following individuals are responsible for shutting off all gas systems. They are:
______________________________________________________________________

13. After each practice fire drill and after a real fire emergency all personnel shall meet at:
_________________________________________________________________________ At that time, all personnel shall be accounted for and all personnel shall remain at the location until dismissed to their work areas.

It is the responsibility of SERVICON SYSTEMS INC. to ensure that their personnel clearly understand the evacuation procedure, and that the procedure clearly identifies escape routes and location of fire extinguishers throughout the facility. SERVICON SYSTEMS INC. shall communicate to its personnel that the safety of its employees is their first priority.

PRACTICE FIRE DRILLS
The following events shall take place to ensure that full participation and support of all personnel during the practice fire drill and in the event of a real fire emergency are in place.

All employees shall be made aware of the designated meeting location in the building. During the Revised by CJ – 03/21/2024

practices fire drill all employees will observe the proper procedure to follow when the practice begins.

A "fire discovery" by a designated employee will result in the notification of the receptionist.

FIRE DISCOVERY
The Fire Marshall or the designated Response Team member will instruct all employees on the proper method of reporting a fire discovery. By instructing each employee to:

Immediately inform the nearest supervisor. The Fire Marshall or Response Team member will observe that the supervisor follows the procedure to:
a. Ensure that all personnel been escorted to safety;
b. Doors are closed to prevent a real fire emergency from spreading; c. Executes the company's method of announcing a fire emergency by using any of the following methods:
• Proper telephone procedure
• Public announcement system
The Fire Marshal or Fire Response Team will then critique and make suggestions, or revise the plan if necessary, to enhance the fire emergency plan. The Fire Marshall or Fire Response Team will ensure group discussions within each department to ensure further discussion and /or to discover any shortcomings in the plan.

In order for a practice fire drill or real fire emergency to be effective, practice fire drills shall be held at each shift. At which time an emergency evacuation practice drill can be held and simultaneously ensure that all personnel are familiar with and are comfortable with the plan that has been established for their protection in the event of a real fire emergency.

FIRE EXTINGUISHER TRAINING AND EDUCATION
General Industry Safety Order (G.I.S.O.) Article 157 (Portable Fire Extinguishers) 6151:
(g) Training and Education:
(1) Where the employer has provided portable fire extinguishers for employee use in the workplace, the employer shall also provide an educational program to familiarize employees with the general principles of fire extinguisher use and the hazards involved with incipient stage fire fighting. (2) The employer shall provide the education required in subsection (g)(1) of this Section upon initial employment and at least annually thereafter.
(3) The employer shall provide employees who have been designated to use fire-fighting equipment as part of an emergency action plan with training in the use of the appropriate equipment.

Revised by CJ – 03/21/2024

(4) The employer shall provide the training required in subsection (g)(3) of this Section upon initial assignment to the designated group of employees and at least annually thereafter.

Revised by CJ – 03/21/2024

EMERGENCY PROCEDURES

MEDICAL EMERGENCIES
Call “9-1-1” IMMEDIATELY.

Identify yourself, describe the medical emergency, and give the exact location where help is needed.

DO NOT HANG UP. Emergency personnel may ask you for further information about the victim’s medical problem or condition. Remember, do not hang up, the dispatcher may need additional information.

Remain with the victim, have someone else meet the responding unit at the building entrance in order to direct medical personnel to the injured person.

FIRE
In case of fire, do the following in this order; Call the local Fire Department and the local Police immediately by dialing "9-1-1". Give your name, phone number, location, type and extent of the fire.

Do not hang - up until the dispatcher acknowledges all pertinent information. Have someone meet arriving fire units and have him/her direct unit/s to the scene.

Pass the word to others that there is a fire in the building. Be sure to notify anyone in danger of entrapment. Evacuate. Assemble nearby and assist anyone who has been injured. Help account for others missing from your office or area.

DO NOT ATTEMPT TO EXTINGUISH THE FIRE.

Report every fire. The fire might appear to be out but may have extended into spaces that are not visible and will rekindle later.

EARTHQUAKE

ABOVE ALL, STAY CALM
BEFORE
Offices should maintain a well-stocked first aid kit, as well as a supply of bottled water.

Staff should also take common sense precautions to make the workplace a safe environment in the event of an earthquake. For further details, contact your assigned Emergency Team Coordinator. The Emergency Team Coordinator is _______________________________.

Revised by CJ – 03/21/2024

DURING
If indoors, stay indoors.

Move away from windows, bookcases, file cabinets, computer equipment, or anything else that can become a flying object. Stand in an inside doorway, an inside corner of a room, or stoop under a desk and hold tightly to a desk leg. (The desk may bounce away leaving you unprotected). If there is no time for anything else, squat where you are and protect your head with your arms.

If in a crowded public place, do not rush for the doors. Move away from display shelves, tables, and booths containing objects that could fall.

If outdoors, stay outdoors.

Move into an open area away from overhead power lines, towers, walls, buildings, trees, and other hazards.

If in a parked car, stay inside the car.

AFTER
If there are any injuries, follow the instructions given under "Medical Emergencies". Help account for others missing in your office or work area.

Do not use phones. Replace receivers on hooks if they have been jarred off in order to reduce system overload.

Check for gas leaks. Do not light matches, smoke, turn on light switches, do not use any electrical appliances. If you must evacuate, take available medical supplies, battery powered radios, flashlights, canned foods and blankets with you. Lock offices to discourage vandalism.

Move into the open, avoid downed wires and structural hazards. Do not attempt to leave by car.

Do not stay in low-lying coastal areas after a quake. An earthquake can lead to tsunamis, or tidal waves.

Stay away from piers and waterfronts.

GAS LEAKS
If you smell gas, call the local gas company. Individuals who are speech or hearing impaired, may call the (800) number given by the gas company. Give your name, phone number, building location, and exact location where you smelled the gas. Call the local Police. Alert others in the area of the potential danger. Evacuate the building to a distance of at least 1,000 feet, until the gas company declares the Revised by CJ – 03/21/2024

area safety. Stay upwind if possible.

FLOODS

The onset of most floods is a relatively slow process and usually takes several days. Flash flood warnings are the most urgent type and are transmitted to the public o ver radio and or television.

Assigned personnel will need to be in tune to this information in the event conditions warrant the immediate evacuation of employees.

CRIMINAL ACTIVITY

(Break-In, theft, prowler, security alarm on, etc.)

In cases of criminal activity, call the Police immediately.

To make a criminal case incident report, call the Police.

Inform administrator of any criminal incidents that have occurred at any location. Doors, locks, or keys may be changed or other measures taken to enhance facility security if a report has been submitted.

If an alarm goes off, call the police. Do not attempt to enter the property to turn off the alarm. In doing so, you intrude on private property without prior authorization and therefore jeopardize your personal safety.

Keep all personal, and office valuables (purses, petty cash, etc.) in a secure out -of-the-way place. Do not tempt a thief by leaving valuables visible or within easy reach.

Revised by CJ – 03/21/2024

INTERNAL EMERGENCY PHONE AND NOTIFICATION PROCEDURES

COMPANY NAME: ____________________________________________________________ ADDRESS: _____________________________________________________________________

NEAREST CROSS STREETS: _______________________________________________________

To report an emergency during normal business hours:

1. Dial 9-1-1

2. Report emergencies with the following information:

a. Type of emergency

b. Location

c. Your full name

To report an emergency after hours or during other shifts

Please notify:

__________________________________________________________________________

Revised by CJ – 03/21/2024

EMERGENCY TELEPHONE LIST

THE FOLLOWING LIST OF SERVICES, PERSONNEL, AND ORGANIZATIONS WILL ASSIST YOU DURING AN EMERGENCY.

EMERGENCY RESPONSE TEAM MEMBERS

NAME TITLE DEPARTMENT EXTENSION

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

FIRE DEPARTMENT: _______________________________________________ POLICE DEPARTMENT: ____________________________________________ AMBULANCE/PARAMEDIC: _______________________________________ LOCAL HEALTH DEPARTMENT: ___________________________________

UTILITIES
GAS COMPANY: ___________________________________________________ WATER COMPANY: ________________________________________________ LOCAL HOSPITAL/CLINIC: _________________________________________

DISASTER RELIEF ORGANIZATIONS
RED CROSS: _________________________________________________________ SALVATION ARMY: _________________________________________________

LOCATION OF EMERGENCY EQUIPMENT
FIRST AID KITS: ________________________________________________________ BLANKETS: ____________________________________________________________ Revised by CJ – 03/21/2024

ASSOCIATE SAFETY ORIENTATION

NAME ____________________________________________ DATE EMPLOYED ____________ DEPARTMENT ASSIGNED: ____________________________ TYPE OF WORK____________ PAST WORK EXPERIENCE: ______________________________________________________ THE FOLLOWING ITEMS HAVE BEEN DISCUSSED AND UNDERSTOOD:

Please answer Yes or No

1. Company safety policies and programs
__________________________________________________________________________________

2. Safety rules, both general and specific to job assignment __________________________________________________________________________________

4. When, where, and how to report injuries
__________________________________________________________________________________

5. When, where, and how to report unsafe conditions
__________________________________________________________________________________

6. Review of fire and emergency evacuation plan
__________________________________________________________________________________

7. Location and use of fire extinguishers
__________________________________________________________________________________

8. Safe work clothing
__________________________________________________________________________________

9. Importance of good housekeeping (clean up spills, etc.) ________________________________________________________________________________

10. Material safety data sheets (M.S.D.S.)
__________________________________________________________________________________

11. Special hazards of job
__________________________________________________________________________________

12. Assignment, use and care of personal protective equipment __________________________________________________________________________________ Revised by CJ – 03/21/2024

13. Proper lifting procedures (include demonstration)
__________________________________________________________________________________

14. Employee certified in the following:
__________________________________________________________________________________ __________________________________________________________________________________

15. Additional training required:
__________________________________________________________________________________ __________________________________________________

IMPORTANT: If this employee is transferred to another job, a new form should be filled out.

SIGNATURES

Employee________________________________ Date_______________________________________

Supervisor/Supervisor______________________Date______________________________________ Revised by CJ – 03/21/2024

FIRST AID SUPPLY LIST
Supplies for First Aid
Type of supply required by number of employees

Dressings in adequate quantities consisting of:

1-5

6-15

16-200

over 200

1. Adhesive dressings

x

x

x

x

2. Adhesive tape rolls, 1" wide

x

x

x

x

3. Eye dressing packet

x

x

x

x

4. 1" gauze bandage roll or compress

x

x

x

5. 2" gauze bandage roll or compress

x

x

x

x

6. 4" gauze bandage roll or compress

x

x

x

7. Sterile gauze pads, 2" sq.

x

x

x

x

8. Sterile gauze pads 4" square

x

x

x

x

9. Sterile surgical pads suitable for pressure
dressings

x

x

10.Triangular bandages

x

x

x

x

11. Safety Pins

x

x

x

x

12.Tweezers and scissors

x

x

x

x

Additional equipment in adequate quantities
consisting of:

13. Cotton tipped applicators

x

x

14. Forceps

x

x

15. Emesis basis

x

x

16. Flashlights

x

x

17. Magnifying glass

x

x

18. Portable oxygen and its breathing equipment

x

19. Tongue depressors

x

Appropriate record forms -

x

x

x

x
Revised by CJ – 03/21/2024

standard first aid textbook

Other supplies and equipment, when provided, shall be in accordance with the documented recommendations of an employer authorized, licensed physician upon consideration of the extent and type of emergency care to be given based upon the anticipated incidence and nature of injuries and illnesses and availability of transportation to medical care. Drugs antiseptics, eye irrigation solutions, inhalants, medicines, or proprietary preparations shall not be included in first aid kits unless specifically approved, in writing by an employer authorized licensed physician.

Informing Employees of Emergency Procedures
Each employer shall inform all of his employees of the procedure to follow in case of injury or illness.

Provision for Obtaining Emergency Medical Services
Proper equipment for the prompt transportation of the injured or ill person to a physician or hospital where emergency care is provided, or an effective communication system for contacting hospitals or other emergency medical facilities, physicians, ambulance and fire services, shall be provided. The telephone numbers of the following emergency services in the area shall be posted near the job telephone, telephone switchboard, or otherwise made available to the employees where no job site telephone exists:

1. A physician and at least one alternate if available

2. Hospitals

3. Ambulance services

4. Fire-protection services
Emergency Washing Facilities
Where the eyes or body of any person may be exposed to injurious or corrosive materials, suitable facilities for drenching the body or flushing the eyes with clean water shall be conspicuously and readily accessible.

Emergency Call Systems
A two-way voice emergency communication system shall be installed for buildings and structures five or more floors or 48 feet or move above or below ground level, to notify persons designated in the emergency medical services plan. The location and condition of the employee shall be able to be communicated over the system. The use of construction passenger elevators for medical emergencies shall take precedence over all other use. EXCEPTION: Where Job site conditions prevent, or impair the communication of the required information over the system, an alternative system acceptable to the Division shall be used.

Revised by CJ – 03/21/2024

GENERAL REQUIREMENTS

Safe and unobstructed access to all available fire fighting equipment shall be maintained at all times.

All fire fighting equipment provided by the employer shall be conspicuously located, or the location conspicuously marked.

All fire fighting equipment shall be maintained in operating condition. Defective equipment shall be immediately replaced.

Revised by CJ – 03/21/2024

13. HAZARDOUS MATERIALS COMMUNICATION TRAINING
Hazard Communication requirements
(HAZCOM)
We must comply with CAL OSHA Standard 5194 Hazard Communication Standard. Federal law known as the “Employee Right to Know Law”.

The purpose of a Hazard Communication Program is to ensure that employees understand the hazards of the materials with which they work and know how to protect themselves by wearing suitable personal protective equipment or taking other protective precautions.

CAL OSHA audits would include a review of:

The written Hazard Communication Program
• Hazardous Materials Inventory
• Accessibility of Material Safety Data Sheets (M.S.D.S.) used at the work site and a system for communicating information about the M.S.D.S. to employees • Hazard Communication Employee Training Record documenting that employees were trained (1) in reading and interpreting the M.S.D.S. that would apply to them, and (2) in reading or interpreting necessary product labels, and (3) correct handling of those substances to which they are likely to be exposed.
• Use of correct/accurate labels on containers
• Adequacy of information on labels and S.D.S.
• A representative number of employee interviews to determine the general nature and effectiveness of hazard communication training

HAZARDOUS MATERIALS INVENTORY
An up to date indexed list (inventory) of hazardous substances likely to be encountered by employees in the normal course of their work should be kept on the Job site. Standardized approved Safety Data Sheets (S.D.S.) is necessary in order to inventory any potential hazardous material used or stored on the Job site. The S.D.S. is available from the manufacturer or distributor. Old materials or materials no longer used in current operations should be identified, safely disposed of, and removed from the inventory.

Revised by CJ – 03/21/2024

SAFETY DATA SHEETS (S.D.S.)
Safety Data Sheets are written materials about chemicals that inform users about what happens when they are exposed, how to recognize the exposure symptoms, how to treat, etc.

The master inventory of Safety Data Sheets will be kept at all times in an accessible place for review by all employees. Employees will be trained in the hazards of the materials they use. If any new and significant health information is added to the S.D.S., the Supervisor will:
• Distribute new labels and new copies of the S.D.S. to replace the superseded one • Retrain employees on the new information as soon as possible • Document training on the Hazard Communication Employee Training attendance record

HAZARDOUS MATERIALS STORAGE
Clearly identified hazardous materials storage areas are necessary. Hazard warning signs should be used where a known hazard exists. Employees shall be aware and cautioned of known hazardous materials and of materials whose properties may be unknown which may accumulate on the Job site.

The labels on such materials frequently are the only indicator of contents. Extreme caution must be used when coming in contact with such materials.

The hazardous nature of many substances is frequently intensified and more widely dispersed during combustion. Good storage and good housekeeping practices ensure that unnecessary ignition sources and/or combustible fuel are physically separated from hazardous materials.

Fire Hazard Categories
• Fire hazard categories are noted below:
• Combustible liquids - a liquid with a flash point (FP) between 1000F and 2000 F • Flammable liquids - a liquid with a FP under 100oF
• Aerosols and flammable gases (e.g., propane) - extremely dangerous • Pyrophoric materials - substances that spontaneously ignite (e.g., ammunition) • Explosives - (e.g., gasoline) also deadly under certain conditions. The presence of explosives must be noted and precautions taken. Gasoline in storage is an extreme hazard. It is Revised by CJ – 03/21/2024

particularly dangerous when vapors are released by pouring, etc. (Sawdust in the air can also explode if sparked).

LABELING
Labels are designed to provide information to employees concerning the hazards of various chemicals.

It is important that hazardous chemicals are not placed in improperly labeled containers.

All chemicals should be stored with manufacturer’s label in the original container, if possible.

Secondary containers should be labeled with an extra copy of the original manufacturer’s label, or with a generic one that carries appropriate hazard warnings. At minimum, each label should contain:
• Identification of material in the container
• Appropriate hazard warnings, such as health, fire and reactivity • Description of contents
• Name of address of the manufacturer

HAZARDOUS SUBSTANCES TRAINING
Employees will be trained to work safely with hazardous materials. Our Hazard Communication Program will include the following training techniques:
• General training in how to read and interpret an S.D.S. • Presentation about different types of hazardous materials potentially in the work area • Review of each S.D.S. describing chemicals used in specific work area • Employee question and answer opportunities
Training activities may include:
• Methods used to detect release of hazardous material
• Physical and health hazards associated with material
• Safe work practices and protective measurers necessary when handling material Appropriate HAZCOM training will be given (1) at time of hire, (2) at time of re-assignment, (3) when new hazardous substances are introduced into the workplace, (4) when existing substances used are Revised by CJ – 03/21/2024

discovered to be hazardous, (5) during regular staff meetings, and (6) annually thereafter.

Each employee is required to sign a Training Record verifying that they attended the training, received the written materials, and understood our policies on hazard communication.

Elements of the Hazard Communication Training Program

The following elements will be included in our training program:

• Location and availability of the written Hazard Communication Program, the list of hazardous chemicals and the S.D.S.

• Physical and health hazards of the chemicals and other hazardous substances used by workers.

• Measures employees can take to protect themselves from these hazards (appropriate wo rk practices, emergency procedures and personal protective equipment).

• Explanation of the labeling system we employ and how the employee can obtain and use the appropriate hazard information.

NON-ROUTINE TASKS INVOLVING HAZARDOUS SUBSTANCES
Prior to starting work on such jobs, each employee will be given information about the hazardous chemicals to which they may be exposed and the protective measures necessary. (This work could be seemingly harmless, such as painting or general clean up).

ON-SITE CONTRACTORS
The person placing the work order will be responsible for providing outside contractors with the following information:
• Hazardous chemicals to which they may be exposed while at our facility • Precautions the contractor’s employees may take to lessen the possibility of exposure.

Contractors are not permitted to use hazardous materials on company premises unless they comply with the procedures detailed in this program, including appropriate training. Contractors will be asked to furnish management with details of any hazardous materials which will be brought onto or used on company premises.

Revised by CJ – 03/21/2024

S.D.S. MEDICAL USE

Employees who have been exposed to a hazardous material causing an injury or illness that requires medical treatment should be in possession of the appropriate S.D.S. at the time of the first (emergency) medical treatment. The S.D.S. provides useful treatment information and emergency phone numbers to treating physicians. It should also be noted that on occupational illness resulting from a toxic, or chemical exposure must be recorded on the OSHA 300 Log.

Revised by CJ – 03/21/2024

HAZARD COMMUNICATION TRAINING

Facility/ Job Site:____________________________
Topic: ________________________ Date:__________ Time:_________ Content:______________________________________________________ Training Material:________________________ Page: ____ of ____

EMPLOYEE PRINTED NAME EMPLOYEE SIGNATURE
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
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ATTENDANCE SHEET
Revised by CJ – 03/21/2024

Name:____________________________ X_____________________ Date:___________ Name:___________________________ X_________________ Date:________________ Name of Trainer

Facility________________________________ Page: _______of________

1. List below the names of all employees in your department and their hire date.

2. After completion of a training session, enter the date that each employee participated.

Topic: _____________________________ Training Material:__________________

EMPLOYEE NAME HIRE DATE EMP # DATES OF TRAINING

TRAINING RECORD
Revised by CJ – 03/21/2024

14. LOCKOUT / TAGOUT PROCEDURES
Purpose:

To provide a safe Lockout/Tagout and verification procedures for equipment machines, processes, or systems to prevent injuries to employees or damage to equipment.

Scope

1. Our procedure utilizes the concept of Zero Energy State (ZES), which requires the source energy, whether active or stored, be locked off, de-energized, or shut down when a machine, process, or system requires maintenance or servicing, or as described further.

2. Our procedure applies to all moveable, electrically energized or pressurized equipment, and systems during installations, repair, maintenance, or servicing.

3. Exceptions:
a. Our procedure does not apply to routine operational adjustments or set up procedures as long as the operator retains personal control over such devices, as jogging switch, etc.
b. When maintenance people are required to “troubleshoot” equipment or a system while under, locked out and tagged, the maintenance supervisor and operating supervisor responsible for the equipment and work, and will indicate “Troubleshooting” on the tag.

The lock may then be removed, and test instruments used. c. In the event that it is not practical to lockout a piece of equipment, process of a system, or remove power cord or fuses, disconnection of pressurized cylinders, use of a block or jack, to prevent movement may be used. Such alternative methods must be approved by maintenance supervisor before adoption.

Responsibility

1. will have the responsibility for the initial shut down, locking out or tagging out, and assuring of their equipment that is to be worked on or Revised by CJ – 03/21/2024

serviced. They are responsible for the implementation, administration, direction, and maintenance of Servicon Systems Inc. Lockout/Tagout policies and procedures.

a. Assure that locks, tags, and blocking devices are appropriate for the type of equipment to be worked on, are readily available and identifiable as belonging to an individual.
______________________shall:

a. Identify jobs that require locking out, tagging out, or blocks put in place.

b. Assure that procedures are used correctly and that no short cuts are taken.

c. Periodically observe employees to assure that procedures are being followed.

d. Issue locks, keys, tags, and blocks to affected employees and keep a record of what belongs to whom.

e. ____________________ shall identify all switches, motor control center, valves and devices that need to be, locked and tagged.

f. ____________________ will inspect the equipment, checking its interlocks after it has been locked out.

Procedure

1. The Danger “Do not operate” Tag shall be used to comply with this procedure. a. The tag shall be used on the control points of machinery, processes, valves, or equipment that is under repair, defective, being serviced, cleaned, or newly installed.
b. The tag shall be completed and placed at the control points, only after the operating and maintenance supervisor has assured this. c. The tag shall be used on obsolete equipment or machinery that has not been fully isolated from an operating system.
d. The tag shall contain the exact description of the equipment or system to be worked on, the purpose of the tagging, and the name of the person placing the tag, time, date, and name of the person authorizing the use of the tag. No other information is to be added to the tag.

Revised by CJ – 03/21/2024

e. The tag is to remain on the equipment’s switch system while work is being performed, and while the hazard is removed and or corrected. However, this shall not exceed 15 days. If the work or hazard must extend beyond 15 days, the maintenance supervisor shall review the equipment’s status and issue a new tag.

2. When work is being performed on machinery, equipment, or process, individual safety locks and multiple lock devices will be used to secure equipment, to assure ZES and prevent accidental start -up. Note: Applying safety locks at the start stop button or switch is not considered safe and is prohibited.

3. Safety Locks

a. Safety locks shall be one key series or pattern and be used to each maintenance employee along with a multiple lock.

b. Each lock’s tag should be clearly stamped with the employee’s name and lock number.

c. Only one key should exist for each lock in the system.

4. Maintenance employees assigned to perform work on the machinery, equipment, or process shall have placed their locks on the operating supervisor’s multiple lock devise after assuring the equipment is in ZES by trying to start it. If it does not start, work may begin.

5. Safety locks, devices, and tags shall remain in place as long as work is being performed by maintenance employees or outside contractor employees.

6. If work on the equipment, process, or system, has not been completed by the end of the first shift, the individual assigned to work shall not remove their locks until those replacing them have attached their locks and are briefed about the scope of the work by the maintenance employee or maintenance supervisor.

7. Upon completion of the work, the maintenance employee, or the maintenance supervisor may then remove the lock.

8. In the event of an emergency or absence of a lock’s owner, the safety lock may be removed in the presence of both the operating department supervisor and the maintenance supervisor, if its removal does not expose employees to potential injury or damage to the equipment. Cutters may be used if necessary. A special notation to the effect must be made on the tag.

Revised by CJ – 03/21/2024

TRAINING
Training is to be held annually and will include but not limited to:

1. The viewing of a safety videotape on the “Control of Hazardous Energy Sources” (Lockout/Tagout)

2. A discussion on Servicon Systems Inc. Lockout/ Tagout policies and procedures.

3. Handout materials including information of Lockout/Tagout procedures, etc.

4. A discussion on Servicon Systems Inc. disciplinary policies in regard to lockout/tagout.

5. A quiz on the Servicon Systems Inc. Lockout/Tagout Policy and Procedures

6. All authorized and affected employees will be trained to recognize locks used for lockout and tagout.

7. All authorized and affected employees will be trained to recognize and utilize tags used in the lockout/tagout program.

8. All operators, mechanics, maintenance, adjustment, and cleaning personnel shall be trained in the full text of this program and be shown where all necessary equipment is located, who is assigned to what locks, tags and blocks, and how to de-energize each type of machinery within the facility.

9. At the completion of all training sessions, the maintenance employee will put his/her signature to the fact that he/she has read/listened, understood, and will use the information presented.

10. A written record will be kept on who was trained for what, who belongs to what locks and blocks, who worked on what machinery, and what training the person went through before servicing the machinery for each job performed.
______________________ shall be responsible for informing the maintenance employees, at large of what the locks and tags mean. He/she will make note of which employees were notified. ______________________ shall be responsible for the training of the maintenance personnel. He will also keep records of who was trained and what they were trained for. ______________________ shall be responsible for keeping records of what job was done on what day, at what time, by whom, and with what training.

Revised by CJ – 03/21/2024

LOCKOUT CONTROL METHODS

There are many ways to lockout a piece of equipment. Commonly, the main disconnect switch is one opening where a lock can be placed. If more than one employee works on the equipment, a lockout adapter suitable for the installation of several locks must be used, enabling all workers to lockout the machine with their individual locks.

If the switches are in a metal box, the box itself must be locked out. If a fuse was removed in order to de-energize the equipment, the fuse box must be locked.

If the controls are in a covered metal box, a common hasp can be welded or riveted to the door, along with a lock staple. Then the switch can be “opened” and the door closed and padlocked. Fuse boxes can be locked in this way also.

Machines activated by compressed air or steam will have valves that control movement. These valves will not only need to be locked out, but also bled to release any backed pressure.

LOCKS

Each worker must have his or her own lock and the only key to that lock. The lock will be substantial and durable and will have the name of the worker on it. When more than one worke r is servicing a piece of equipment that must be locked out, a Lockout adapter can be used which allows all the workers to place their locks to the disconnecting means. After the work is completed, each worker will remove his or her lock and the machine can be returned to service.

TAGS

Tags should not be used alone. Use tags or signs in addition to locks. The tags must state:

1. The reason for the lockout.

2. The name of the employee who is working on the equipment and how that person may be reached.

3. The date and time the tag was put in place.

BLOCKS
Suitable blocks are another important safety device used to assure equipment safety prior to repair or service. Blocks must be placed under raised dies, lifts, or any equipment that might inadvertently move by sliding, falling, or rolling.

Revised by CJ – 03/21/2024

Blocks, special brackets, or special stands, such as those, which are commonly, used under raised vehicles must be available and always used. Another form of blocking is the use of a blind. A blind is a disk of metal placed in a pipe to ensure that air, steam, or another substance will not pass through that point if the system is accidentally activated.

Before blinds or blocks are installed, bleed down steam, air, or hydraulic lines to get rid of any pressure.

In addition, coiled springs spring loaded devices, or suspended loads must be released so that their stored energy will not result inadvertent movement.

TESTING EQUIPMENT DURING LOCKOUT
In many maintenance and repair operations, machinery may need to be tested, and therefore energized, before additional maintenance work can be performed. Establish the following procedure:

1. Move all personnel to a safe distance from the equipment.

2. Clear away tools and materials from equipment.

3. Remove lockout devices and de-energize systems following the established safety procedure.

4. Again, neutralize all energy sources, purge all systems, and lockout prior to continuing work.

Equipment design and performance limitations may dictate that alternative, effective worker protection is provided when the use of the established lockout procedure is not feasible. If machinery must be capable of movement in order to perform a maintenance task, such as a cleaning operation, workers can use extension tools (i.e., extended swabs, brushes, or scrapers) to protect themselves from injury.

RESTORING EQUIPMENT TO SERVICE
After the work is completed and the equipment is ready to be returned to normal operation, the procedure below must be followed:

1. Remove all non-essential items.

2. See to it that all equipment components are operationally intact, including guards and safety devices.

3. Repair or replace defective guards before removing locks.

4. Remove all lockout devices using the correct removal sequence.

5. Make a visual check before restoring energy to ensure that everyone is physically clear of the equipment.

Revised by CJ – 03/21/2024

LOCKOUT/TAGOUT QUIZ

Indicate whether each of these statements is TRUE or FALSE.

1. Lockout is when energy isolation devices such as locks or blocks utilized to control hazardous energy sources.

2. Tagout is when an energy isolating device is utilized (locks or blocks), and a written warning is attached to it.

3. A worker may use any sturdy lock to apply a lockout.

4. Lockout/tagout should be used whenever you are performing service or maintenance o n any machine where you could be injured by unexpected start -up or release of stored energy.

5. An employee may determine whether and when to use lockout, tagout, or both.

6. Applying locks or tags in the right places de-energizes the equipment.

7. Turning off the power switch removes all energy from powered equipment.

8. Engineering safety features are foolproof ways of protecting workers from hazardous energy.

9. For fair enforcement of safety rules, workers should know the rules and penalties for failing to follow the safety rules.

10. Before lockout/tagout is applied, all workers in the affected are must be notified.

11. Before you turn off equipment in order to lock or tag it out, you must know the type of energy it uses, the hazards of that energy, and how to control the energy.

12. Once you have isolated a system from its main power source, you can be sure no energy will reach the equipment.

13. In a lockout, one person is allowed to attach a single lock for an entire work crew.

14. After equipment, has been isolated from its power sources, it is still necessary to control any energy stored in the system.

15. When you are finished testing equipment to verify that it has been isolated from its energy sources, you must be sure to shut off all machine controls.

Revised by CJ – 03/21/2024

16. Once energy isolation and lockout/tagout have been applied, you can be sure that equipment will be re-energized while you are working on it.

17. Before removing lockout/tagout devices, you must make sure the danger area is clear of tools and workers.

18. When contractors perform maintenance work in you workplace, they must know Servicon Systems Inc. lockout/tagout procedures.

19. If you have temporarily re-energized equipment while you are working on it, you must reapply energy isolation and lockout/tagout as soon as energy is no lo nger needed in the system.

20. If a worker is not present to remove his or her own lock, any co -worker can remove it as long as he first makes sure it is safe.

Revised by CJ – 03/21/2024

LOCKOUT/TAGOUT ANSWER SHEET

1. TRUE 11. TRUE

2. TRUE 12. FALSE

3. FALSE 13. FALSE

4. TRUE 14. TRUE

5. FALSE 15. TRUE

6. FALSE 16. FALSE

7. FALSE 17. TRUE

8. FALSE 18. TRUE

9. TRUE 19. TRUE

10. TRUE 20. FALSE
Revised by CJ – 03/21/2024

15. BLOODBORNE PATHOGEN PROGRAM
In accordance with the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030 and Section 5193 of the General Industry Safety Orders. the following exposure control plan has been developed:

PURPOSE
The purpose of this exposure plan is to:

1. Eliminate or minimize employee occupational exposure to blood or certain other body fluids.

EXPOSURE DETERMINATION
OSHA requires employers to perform an exposure determination concerning employees that may be exposed to blood or other potentially infectious materials. The exposure determination is made without regard to the use of personal protective equipment. This determination is required to list all job classifications in which all employees may be expected to incur such occupational exposure regardless of frequency.

At this facility, the following job classifications are listed below:

JOB CLASSIFICATIONS
_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ In addition, OSHA requires a listing of job classifications in which some employees may have occupation exposure. Since not all employees in these categories would be expected to incur such exposures to blood or other potentially infectious materials, task or procedures that would cause these employees to have occupational exposure are also required to be listed in order to clearly understand which employees in these categories are considered to have such exposure.

The job classifications and associated tasks for these categories are as follows:

JOB CLASSIFICATIONS TASK/PROCEDURE __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Revised by CJ – 03/21/2024

__________________________________________________________________________________ __________________________________________________________________________________

IMPLEMENTATION SCHEDULE AND METHODOLOGY

COMPLIANCE METHODS

Precautions will be observed at this facility in order to prevent contact with blood or other potentially infectious materials. All bl ood or other potentially infectious material will be considered infectious regardless of the perceived status of the source individual.

Work practice controls will be utilized to eliminate or minimize exposure to employees at this facility.

Where oc cupational exposure remains after institution of these controls, personal protective equipment shall also be utilized.

At this facility the following controls will be utilized:

CONTROL METHODS

1. ______________________________________________ ______________________

2. ____________________________________________________________________

3. ____________________________________________________________________

4. _________________________________________________________________ ___

5. ____________________________________________________________________

The above controls will be examined and maintained on a regular schedule. The schedule for reviewing the effectiveness of the controls is as follows:

Weekly / Monthly Supervisor __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Hand washing facilities shall be made available to the employees who incur exposure to blood or other potentially infectious materials. These facilities shall be readily accessible after incurring exposure.

Revised by CJ – 03/21/2024

__________________________ shall ensure that after the removal of personal protective gloves, employees shall wash hands and any other potentially contaminated skin area immediately or as soon as feasible with soap and water.

__________________________ shall ensure that if employees incur exposure to their skin or Mucous membranes then those areas shall be washed or flus hed with water as soon as feasible following contact.

WORK AREA RESTRICTIONS

In work areas when there has been a cut type injury employees that assist the injured victim, is not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses, until they have thoroughly washed the victim’s blood. Coats or clothing that has been contaminated by blood should be cleaned and properly laundered. Mouth pipetting / suctioning of blood or other potentially infectious materials is prohibited.

PERSONAL PROTECTIVE EQUIPMENT

_________________________ is responsible for ensuring that the following provisions are met. All personal protective equipment used at this facility will be provided without cost to employees. Personal protective equipment will be chosen based on the anticipated exposure to blood or other potentially infectious materials. The protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach the employees’ clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time, which the protective equipment will be used.

__________________________ shall ensure that the employee uses appropriate personal protective equipment unless the supervisor shows that the employee temporarily and briefly declined to use personal protective equipment when under rare and extraordinary circumstances, it was the employee’s professional judgment that in the specific insta nce its use would have prevented the delivery of healthcare or pose an increased hazard to the safety of the worker or co-worker. When the employee makes this judgment, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future.

Revised by CJ – 03/21/2024

PERSONAL PROTECTIVE EQUIPMENT ACCESSIBILITY

All personal protective equipment shall be in the appropriate sizes, is readily accessible at the work site or is issued without cost to the employee. Hypoallergenic gloves, glove liners, powder less gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

PERSONAL PROTECTIVE EQUIPMENT CLEANING, LAUNDERING AND DISPOSAL

All personal protective equipment will be cleaned, laundered, and disposed of by the employer at no cost to the employee. All repairs and replacements will be made by the employer at no cost to the employee. All garments which are penetrated by blood shall be removed immediately or as soon as feasible. All personal protective equipment will be removed prior to leaving the work area.

When removed, it shall be placed in an appropriately designated area or container for storage, washing, decontaminations or disposal.

GLOVES

Gloves shall be worn where it is reasonably anticipated that employees will have hand contact with blood, other potentially infectious materials, non -intact skin, and mucous membranes; when performing vascular access procedures and when handling or touching contaminated items or surfaces.

Disposable gloves used at this facility are not to be washed or decontaminated for re-use and are to be replaced as soon as practical when they become contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. Utility gloves may be decontaminated for re-use provided that the integrity of the glove is not compromised. Utility gloves will be discarded if they are cracked, peeling, torn, punctured, or exhibits other signs of deterioration or when their ability to function as a barrier is compromised.

EYE AND FACE PROTECTION

Masks in combination with eye protection devices, such as goggles or glasses with solid side shield, or chin length face shields, are required to be worn whenever splashes, spray splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can reasonably be anticipated. Situation(s) at this fa cility which would require such protection are as follows:

__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Revised by CJ – 03/21/2024

ADDITIONAL PROTECTION

Additional protective clothing such as lab coats, gowns, aprons, clinic jackets, or similar garments shall be worn in instances when gross contamination can reasonably be anticipated. The following situations at this facility require such protective clothing be utilized:

_________________________________________________________________________________ _ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________

HOUSEKEEPING AFTER AN ACCIDENT

This facility will be cleaned and decontaminated according to the following schedule:

AREA SCHEDULE CLEANER

__________________________________________________________________ ________________ __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________________ _______ __________________________________________________________________________________ __________________________________________________________________________________

Decontamination will be accomplished by utilizing the following materials:
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ All contaminated work surfaces will be decontaminated after completion of procedures and immediately or as soon as feasible after any spill of blood or other potentially infectious materials.

All bins, pails, cans, and similar receptacles shall be inspected and decontaminated on a regularly scheduled basis.

Any broken glassware, which may be contaminated, will not be picked up directly with the hands.

Regulated waste shall be placed in containers which are closeable, constructed to contain all contents Revised by CJ – 03/21/2024

and prevent leakage of fluids during handling, storage, transportation or shipping.

The waste must be labeled or color-coded and closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping.

NOTE: Disposal of all regulated waste shall be in accordance with state and local regulations.

LAUNDRY PROCEDURES
Laundry contaminated with blood or other potentially infectious materials will be handed as little as possible. Such laundry will be placed in appropriately marked (biohazard labeled, or color coded red bag) bags at the location where it was used. Such laundry will not be sorted or rinsed in the area of use.

HEPATITIS B VACCINATION
________________________________ , is in charge of the Hepatitis B vaccination program.

Hepatitis B vaccination shall be made available after the employee has received the training in occupations exposure and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete Hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicate for medical reasons. Participation in a pre-screening program shall not be a prerequisite for receiving Hepatitis B vaccination. If the employee initially declines Hepatitis B vaccination but at a later date while still covered
under the standard, decides to accept the vaccination, the vaccination shall then be readily available.

All employees who decline the Hepatitis B vaccination offered shall sign the OSHA required waiver indicating their refusal.

If a routine booster does of Hepatitis B vaccination is recommended by the U.S. Public Health Service at a future date, such booster doses shall be made available.

POST EXPOSURE EVALUATION AND FOLLOW UP
All exposure incidents shall be reported, investigated, and documented. When the employee incurs an exposure incident, it shall be reported to ______________________________________ Following a report of an exposure incident, the exposed employee shall immediately receive a confidential medical evaluation and follow up including at least the following elements:
a. Documentation of the route of exposure and the circumstances under which the exposure incident occurred;
Revised by CJ – 03/21/2024

b. Identification and documentation of the source individual unless it can be established that identification is infeasible or prohibited by state or local law;

c. The source individual’s blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent cannot be obtained. When the source individual’s consent is not required by law, the source individual’s blood, if available, shall be tested and the results documented.

d. When the source individual is already known to be infected with HBV or HIV, testing for the source individuals known HBV or HIV status need not be repeated.

e. Results of the source individual’s testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identify and infectious status of the source individual.

Collection and testing of blood for HBV and HIV serological status will comply with the following:

a. The exposed employee’s blood shall be collected as soon as feasible and tested after consent is obtained.

b. The employee will be offered the option of having their blood collected for testing of the employees HIV/HBV serological status. The blood sample will be preserved for up to 90 days to allow the employee to decide if the blood should be tested for HIV serological status.

All employees who incur an exposure incident will be offered post exposure evaluation and follow up in accordance with the OSHA standard.

_________________________________________ shall ensure that the Healthcare professional who is responsible for the employee’s Hepatitis B vaccination is provided with:

a. A copy of Section 5193 of the General Industry Safety Orders

b. A written description of the exposed employee’s duties as they relate to the exposure incident;

c. Written documentation of the route of exposure and circumstances under which exposure occurred;

d. Results of the source individuals blood testing, if available and e. All medical records relevant to the appropriate treatment of the employee including vaccination status.

Revised by CJ – 03/21/2024

Healthcare Professional’s Written Opinion
___________________________________ shall obtain and provide the employee with a copy of the evaluating healthcare professional’s written opinion within 15 days of the completion of the evaluation.

The healthcare professional’s written opinion for HBV vaccination shall be limited to whether HBV vaccination is indicated for an employee and if the employee has received such vaccination.

The healthcare professional’s written opinion for post exposure follow-up shall be limited to the following information:
a. A statement that the employee has been informed of the results of the evaluation and b. A statement that the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.

NOTE: All other findings or diagnosis shall remain confidential and shall not be included in the written report.

LABELS AND SIGNS
______________________________ , shall ensure that biohazard labels shall be affixed to containers of regulated waste. The universal biohazard symbol shall be used. The label shall be fluorescent orange or orange-red. Regulated wastes must be handled in accordance with the rules and regulations of the organization having jurisdiction.

INFORMATION AND TRAINING
_____________________________, shall ensure that training is provided at the time of initial assignment to tasks where occupational exposure may occur, and that it shall be repeated within twelve months of the previous training. Training shall be tailored to the education and language level of the employee and offered during the normal work shift. The training will be interactive and cover the following:
a. A copy of the standard and an explanation of its contents; b. A discussion of the epidemiology and symptoms of Bloodborne diseases; c. An explanation of the modes of transmission of Bloodborne pathogens; d. An explanation of the Servicon Systems Inc., Bloodborne Pathogen Exposure Control Plan, and a method for obtaining a copy.
e. The recognition of tasks that may involve exposure.
f. An explanation of the use and limitations of methods to reduce exposure. g. Information on the types, use, location removal, handling decontamination, and disposal of personal protective equipment.
h. An explanation of the basis of selection of personal protective equipment. i. Information on the Hepatitis B vaccination, including efficacy, safety, method of administration, benefits, and that it will be offered free of charge.

Revised by CJ – 03/21/2024

j. Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials. k. An explanation of the procedures to follow up required after an e mployee exposure incident.
l. Information on the evaluation and follow up required after an employee exposure incident.
m. An explanation of the signs, labels, and color-coding systems.

The person conducting the training shall be knowledgeable in the subject ma tter.

Employees who have received training on Bloodborne pathogens in the twelve months preceding the effective date of this policy shall only receive training in provisions of the policy that were not covered.

Additional training shall be provided to employees when there are any changes of tasks or procedures affecting the employee’s occupational exposure.

RECORD KEEPING

Medical Records
_____________________________, is responsible for maintaining medical records as indicated below.

These records will be kept ________________________________ _. Medical records shall be maintained in accordance with Cal OSHA Section 5193. These records shall be kept confidential and must be maintained for at least the duration of employment plus 30 years. The records sh all include the following:

a. The name and social security number of the employee.

b. A copy of the employee’s HBV vaccination status, including the dates of vaccination.

c. A copy of all results of examinations, medical testing and follow up procedures.

d. A copy of the information provided to the healthcare professional, including a description of the employee’s duties as they related to the exposure incident and documentation of the routes of exposure and circumstances of the exposure.

Revised by CJ – 03/21/2024

TRAINING RECORDS

_____________________________, is responsible for maintaining the following training records. These records will be kept at _____________________________.

Training records shall be maintained for three years from the date of training. The following information shall be documented:

a. The dates of the training sessions;

b. An outline describing the material presented;

c. The names and qualifications of persons conducting the training;

d. The names and job titles of all persons attending the training sessions.

AVAILABILITY

All employee records shall be made available to the employee in accordance with Section 5193 of the General Industry Safety Orders.

All employee records shall be made available to the Assistant Secretary of Labor for the Occupational Safety and Health Administration and the Director of the National Institute for Occupational Safety and Health upon request.

Revised by CJ – 03/21/2024

TRANSFER OF RECORDS

If this facility is closed or there is no successor employer to receive and retain the records for the prescribed period, the Director of the NIOSH shall be contacted for final disposition.

EVALUATION AND REVIEW

_________________________________, shall be responsible for annually reviewing this program, and its effectiveness and for updating this program as needed.

DATES

All provisions required by this standard will be implemented by: _ ___________________

UNIVERSAL PRECAUTIONS

Universal precaution is OSHA’s accepted method of infectious control to protect employees from occupational exposure to Bloodborne pathogens a nd other potentially infectious materials. Body Substance Isolation (BSI), which defines all body fluids as infectious, is also acceptable to OSHA.

These precautions are works practices that help prevent contact with patient’s blood and certain other body fluids. These precautions are your best protection against Aids, Hepatitis B and other infectious diseases. The precautions protect everyone on the health -care team. Patients and their families depend on us to prevent the spread of infectious disease.

AIDS (HIV), Hepatitis (HBV) and other infectious diseases are spread through blood (or any fluid containing visible blood), semen, vaginal secretions and certain fluids such as amniotic pericardial, peritoneal, pleural, synovial, and cerebrospinal.

Transmission of HIV or HBV has NOT been documented through any of the following: tears, saliva, feces, nasal secretions, sputum, sweat, urine or vomit that is blood-free.

Revised by CJ – 03/21/2024

FOLLOW THESE PRECAUTIONS!

WASH HANDS - Before and after patient contact.

WEAR GLOVES - While performing any procedure which involves contact with blood/body fluids/mucous membranes/non-intact skin.

WEAR GOWNS/APRONS - During procedures that are likely to generate splashes of blood and/or body fluids.

WEAR MASKS - If patient is actively coughing or has a suspected or diagnosed communicable disease of the respiratory tract.

WEAR GOGGLES/MASKS - To protect skin and mucous membranes of the eyes/nose/mouth.

INFECTIOUS WASTE - Place in red biohazard bag.

OTHER PRECAUTIONS

Employees with exudative (oozing) lesions or weeping dermatitis must refrain from all direct patient care until the condition resolves.

Pregnant workers should be especially familiar with all of these precautions and comply with them consistently.

All employees whose jobs involve exposure to blood or body fluids covered by universal precautions should be vaccinated for Hepatitis B.

TAKE TIME TO PROTECT YOURSELF – YOUR HEALTH DEPENDS ON IT! Revised by CJ – 03/21/2024

IN THE EVENT OF AN INCIDENT OR ACCIDENT

EMPLOYEES WILL BE REFERRED TO

SEWAGE, LIQUID AND BIOHAZARD WASTE REMOVAL

Sewage:

(Name)

(Location)

Liquid:

(Name)

(Location)

Biohazard:

(Name)

(Location)
Revised by CJ – 03/21/2024

16. FORKLIFT SAFETY PROGRAM

FORKLIFT OPERATOR SAFETY TRAINING POLICY

SERVICON SYSTEMS INC. will train all their forklift operators on at least an annual basis.

Training will be conducted by an outside service. Drivers will be certified that they have been trained in compliance with amended section 3668 (d) of the Title 8 General Industry Safety Orders effective July 15, 2000.

Performance evaluations shall be conducted at least once every three years.

Refresher training will be conducted when:
(A) The operator has been observed to operate the vehicle in an unsafe manner;

(B) The operator has been involved in an accident or near – miss incident;

(C) The operator has received an evaluation that reveals th at the operator is not operating the truck safely;

(D) The operator is assigned to drive a different type of truck; or

(E) A condition in the workplace changes in a manner that could affect safe operation of the truck.

Revised by CJ – 03/21/2024

GENERAL INDUSTRY SAFETY ORDER 3664

FORKLIFT OPERATING RULES

Every employer using industrial trucks or industrial tow tractors, shall post and enforce a set of operating rules including the appropriate rules listed below:

1. Only drivers authorized by the employer and trained in th e safe operation of industrial trucks or industrial tow tractors shall be permitted to operate such vehicles. Methods shall be devised to train operators in the safe operation of powered industrial trucks.

2. Stunt driving and horseplay are prohibited.

3. No riders shall be permitted on vehicles unless provided with adequate riding facilities.

4. Employees shall not ride on the forks of lift trucks.

5. Employees shall not place any part of their bodies outside the running lines of an industrial truck, loaded or empty, unless it is effectively blocked to prevent it from falling.

6. Employees shall not be allowed to stand, pass, or work under the elevated portion of any industrial truck, loaded or empty, unless it is effectively blocked to prevent it from falling.

7. Drivers shall check the vehicle at least once per shift, and it is found to be unsafe, the matter shall be reported immediately to a supervisor or mechanic, and the vehicle shall not be put in service again until it has been made safe.

Attention shall be given to the proper functioning of tires, horn, lights, battery, controller, brakes, steering mechanism, and the lift system of forklifts (forks, chains, cable, and limit switches).

8. No truck shall be operated with a leak in the fuel system.

9. Vehicles shall not exceed the authorized or safe speed, always maintaining a safe distance from other vehicle, keeping the truck under positive control at all times and all established traffic regulations shall be observed. For trucks traveling in the same direction, a safe distance may be considered to be approximately 3 truck lengths or preferably a time lapse of 3 seconds passing the same point.

10. Other trucks traveling in the same direction shall not be passed at intersections, blind spots, or dangerous locations.

Revised by CJ – 03/21/2024

11. The driver shall slow down and sound the horn at cross aisles and other locations where vision is obstructed. If the load carried obstructs forward view, the driver shall be required to travel with the load trailing.

12. Operators shall look in the direction of travel and shall not move a vehicle until certain that all persons are in the clear.

13. Trucks shall not be driver up to anyone standing in front of a bench or other fixed object of such size that the person could be caught between the truck and object.

14. Grades shall be ascended or descended slowly.

a. When ascending or descending grades in excess of 10 per cent, loaded trucks shall be driven with the load upgrade.

b. On all grades the load engaging means shall be tilted back if applicable, and raised only as far as necessary to clear the road surface.

c. Motorized hand and hand/rider trucks shall be operated on all grades with the load - engaging means downgrade.

15. The forks shall always be carried as low as possible, consistent with safe operations.

16. When leaving a vehicle unattended, either;

a. the power shall be shut off, brakes set, the mast brought to the vertical position, and the forks are left in the down positions. When left on an incline, the wheels shall be blocked; or

b. the power may remain on provided the brakes are set, the mast is brought to the vertical position, forks are left in the down positions, and the wheels shall be blocked front and rear.

17. When the operator of on industrial truck is dismounted and within 25 feet of the truck still in his view, the load engaging means shall be fully lowered, controls neutralized, and the brakes set to prevent movement.

18. Vehicle shall not be run onto any elevator unless the driver is specifically authorized to do so. Before entering an elevator, the driver shall make sure that the capacity of the elevator will not be exceeded. Once on an elevator, the power shall be shut off and the brakes set.

Revised by CJ – 03/21/2024

19. Motorized hand trucks shall enter elevators or other confined areas with the load end forward.

20. Vehicles shall not be operated on floors, sidewalk doors, or platforms that will not safely support the loaded vehicle.

21. Prior to driving onto trucks, trailers and railroad cars, their flooring shall be checked for breaks and other structural weaknesses.

22. Vehicles shall not be driven in and out highway trucks and trailers at unloading docks until such trucks are securely blocked and brakes set.

23. To prevent railroad cars from moving during loading or unloading operations, the car brakes shall be set, wheel chocks or other recognized positive stops used, and blue flags or lights displayed in accordance with applicable regulations promulgated by the public Utilities Commission.

24. The width of the tire on the powered industrial truck shall be the minimum distance maintained from the edge by the truck while it is on any elevated dock, platform freight car or truck.

25. Railroad tracks shall be crossed diagonally, wherever possible. Parking closer than 8 ½ feet from the centerline of railroad tracks is prohibited.

26. Trucks shall not be loaded in excess of their rated capacity.

27. A loaded vehicle shall not be moved until the load is safe and secure.

28. Extreme care shall be taken when tilting loads. Tilting forward with the load engaging means elevated shall be prohibited except when picking up a load. Elevated loads shall not be tilted forward except when the load is being deposited onto a storage rack or equivalent. When stacking or tiering, backward tilt shall be limited to that necessary to stabilize the load.

29. The load-engaging device shall be placed in such a manner that the load will be securely held or supported.

30. Special precautions shall be taken in the securing and handling of loads by trucks equipped with attachments, and during the operation of these trucks after the loads have been removed.

31. When powered industrial trucks are used to open and close doors the following provisions shall be complied with;
Revised by CJ – 03/21/2024

A. A device specifically designed for opening or closing doors shall be attached to the truck.

B. The force applied by the device to the door shall be applied parallel to the direction to travel of the door.

C. The entire door opening operation shall be in full view of the operator.

D. The truck operator and other employees shall be clear of the area where the door might fall while being opened.

32. If loads are lifted by two or more trucks working in unison, the total weight of the load shall not exceed the combined rated lifting capacity of all truck s.

TEST SCORE RESULTS:

NAME________________________________________
Revised by CJ – 03/21/2024

COMPANY___________________________________ Written___________% DATE_________________________________________ Practical__________%

POWERED FORKLIFT OPERATOR QUIZ
Select The Answer Which Is Most Correct

1. Powered industrial trucks should be operated by:
a. all employees
b. persons you know
c. only authorized and trained drivers

2. As an industrial truck operator, it is:
a. your responsibility to watch for pedestrians
b. management’s responsibility to keep them out of your work area c. pedestrians’ responsibility to watch for you

3. Operators should check their vehicles at least:
a. once a week
b. at the beginning of each shift
c. monthly

4. In checking your vehicle, you find the power steering system squeals as you turn it:
a. tell another employee
b. notify your Supervisor
c. ignore it until the end of the shift

5. When parking your vehicle, be sure to leave the forks:
a. at least five feet above the floor area
b. three feet above the floor level
c. as low as possible to the floor level

6. You must use your horn when:
a. trying to catch your Supervisor’s attention
b. racing another vehicle
c. at blind intersections

7. When driving on a slippery or wet surface you must:

Revised by CJ – 03/21/2024

a. drive slowly
b. place foot on brake pedal
c. drive at a high speed

8. In operating your vehicle it is most important to:
a. listen for unusual noises
b. keep it clean
c. keep it waxed

9. When charging from forward to reverse:
a. always stop
b. slow down
c. don’t worry about speed; industrial vehicles are built to take shock

10. Never exceed the rated load capacity of your vehicle:
a. unless you add additional counter weighing
b. unless your lift is under 84 inches high
c. no, never

11. The GREATEST cause of accidents among new vehicle operators is:
a. driving on the wrong side of the aisle
b. driving backwards
c. forgetting to watch overhead obstructions when lifting

12. If you have to park on an incline:
a. leave the machine in gear
b. set brakes and block the wheels
c. turn off motor only

13. When taking a load down a ramp:
a. reduce speed by zigzagging
a. drive forward
b. drive backwards
c.

14. When operating an industrial vehicle the driver should face:

Revised by CJ – 03/21/2024

a. the front of the vehicle
b. any direction
c. the direction of travel

15. When entering or leaving a building, you should:
a. stop and drive out
b. slow down
c. stop, sound horn, and go out slowly

16. Railroad tracks should be crossed:
a. straight ahead
b. on a slant
c. turn and back up across

17. Another person may ride the forks of a forklift truck:
a. if absolutely necessary
b. absolutely in no case
c. if the operator approves

18. If you are traveling a road or aisle you should:
a. keep to right as usual
b. travel in center of road or aisle

19. Vehicles should not exceed the authorized or safe speed, always maintaining a safe distance from vehicles, and keeping the truck under positive control at all times:
a. True
b. False

20. Stunt driving and horseplay are allowed during lunch and after hours a. True
b. False

21. Vehicle should not be used on passenger or freight elevators unless specifically authorized to do so:
a. True
Revised by CJ – 03/21/2024

b. False

22.You must make sure that the capacity of the elevator will not be exceeded before you drive your vehicle on:

a. True
b. False

23. Vehicles shall not be driven in and out of highway trucks and trailers at loading and unloading docks until such trucks are securely blocked and brakes set.

a. True
b. False

24. Loaded vehicles shall not be moved until the load is safe and secure.

a. True
b. False

25. If you take special care, it’s okay to let bystanders stand beneat h the loads when high-stacking

a. True
b. False
Revised by CJ – 03/21/2024

DAILY INSPECTION FOR FORKLIFTS

DRIVER _______________________________________ DATE ________________ VEHICLE ______________________________________ TIME ________________

MARK OFF COLUMNS AS NEEDED

Needs Attention O.K.

TIRE CONDITION

EMERGENCY LIGHTS

TRANSMISSION OIL

OTHER INSTRUMENT

INDICATOR

DAMAGES OR LEAKS

HYDRAULIC OIL LEVEL

BATTERY WATER LEVEL

HORN

STEERING WHEEL

BRAKES

HYDRAULIC CONTROLS

SEAT BELTS

BATTERY CHARGER

INDICATOR

NOTES: EXPLANATION OF WHAT NEEDS ATTENTION

Revised by CJ – 03/21/2024

SECONDARY CATEGORY – POWERED INDUSTRIAL TRUCKS

MOTORIZED HAND TRUCKS

The motorized hand truck is controlled by a walking operator. They also have a platform or lifting forks to engage the load and may be either high – lift for tiering or low – lift to raise the load only enough for horizontal movement.

A powered hand truck should be equipped so that its brakes will be applied when the handle is in either the fully raised or the fully lowered position. The principal hazards in the operation of a motorized hand truck include the operator getting pinned between the truck and a fixed object and the truck running up on the operator’s heels. Operators should walk ahead of the truck, leading it from either side of the handle and facing the direction close t o a wall or other obstruction, down an incline, or onto an elevator, the operator should put the truck in reverse and walk behind it facing the direction of travel.

Steering handles should be provided with guard to prevent the operator’s hands or the controls from coming into contact with obstacles when the truck must be maneuvered in close quarters. The wheels of many powered hand trucks can be considered guarded by their position under the frame or lift platform. However, where the wheels might injure the operator or others, guards should be installed.

High – lift platform rollers and chain sprockets should be guarded to protect the operator in his normal operating position. Many trucks, however, are being manufactured with a platform for the operator to ride in a standing position. The platform must extend beyond the operator’s position and be strong enough to meet the requirements of ANSI B56.1 Standard. Also, it is recommended there be no operator enclosure. Prism – shaped covers can be installed ov er the battery box to discourage operators from sitting on the truck during operation. Information is taken from the Accident Prevention Manual for Industrial Operations, 8th Edition, Engineering and Technology, National Safety Council.

Revised by CJ – 03/21/2024

POWERED FORKLIFT TRUCK AND MOTORIZED HAND TRUCK

SAFETY COURSE QUIZ

SELECT AND CIRCLE THE ANSWER WHICH IS MOST CORRECT:

1. Powered industrial trucks should be operated by:
a. all employees.
b. persons you know.
c. only authorized and trained drivers.

2. As an industrial truck operator, it is:
a. your responsibility to watch for pedestrians.
b. management’s responsibility to keep them out of your work area. c. Pedestrian’s responsibility to watch for you.

3. When parking your vehicle, be sure to leave the forks:
a. at least five feet above the floor level.
b. three feet above the floor level.
c. as low as possible to the floor level.

4. You must use your horn when:
a. trying to catch your Supervisor’s attention.
b. racing another vehicle.
c. at blind intersections.

5. When driving on a slippery or wet surface you must:
a. drive slowly.
b. place foot on brake pedal.
c. drive at a high speed.

6. Never exceed the rated load capacity of your vehicle:
a. unless you and three of your friends jump on the back to add additional counterweight.

Revised by CJ – 03/21/2024

b. unless your forklift is under 84 inches high.
c. no, never.

7. If you have to park on an incline:
a. leave your forklift in gear.
b. set the brakes and block the wheels.
c. only shut the motor off.

8. When taking a load down a ramp:
a. reduce speed by zig – zagging.
b. drive forward.
c. drive backwards.

9. When operating an industrial vehicle, the operator should face:
a. the front of the vehicle.
b. any direction.
c. the direction of travel.

10. Another person may ride the forks of a forklift:
a. if absolutely necessary.
b. absolutely in no case.
c. only if the operator gives his o.k.

11. A powered hand truck should be equipped:
a. so brakes will be applied when the handle is in either the fully raised or fully lowered position.
b. with a cage to carry two or more of your friends.
c. with a fire extinguisher.

12. The principal hazards in operation of motorized hand trucks include:
a. excessive speed.
b. wet and slippery floors.
c. getting pinned between the truck and a fixed object and the hand truck running up on the heels of the operator.

Revised by CJ – 03/21/2024

13. Operators of powered hand trucks should:

a. walk behind the truck when taking a load down an incline. b. walk in front of the truck guiding its direction.
c. ride on the hand truck with the load.

14. Stunt driving and horseplay are allowed during lunch and after hours:

a. True
b. False

15. A motorized hand truck is controlled by a walking operator:

a. True
b. False

16. Motorized hand trucks are equipp ed with only high – lift for tiering loads.

a. True
b. False

Revised by CJ – 03/21/2024

18. FALL PROTECTION

FALL PROTECTION MAINTENANCE LOG
Equipment or
type of
protection
Inspected
Items
Signature Date Condition

OKAY
Needs Repair
Repaired or
Replaced by
Dated
Corrected
Scaffolds

Ladders

Man lifts

Nets

Ropes

Platforms

Railings

Toe boards

Rigging (s)

Rope grab (s)

Harness (es)

Lanyard (s)

Lifelines

Note: *Lifelines should be protected against cuts and abrasions *Fall arrest equipment involved in a fall must be replaced *All labels need to be replaced if not removed or not visible

Revised by CJ – 03/21/2024

19. ELECTRICAL SAFETY AND ASSURED GROUNDING PROCEDURES

Regulations from these subchapters will be treated as minimum standards. Whenever feasible additional safeguards will be developed and implemented.

Servicon Systems Inc. will comply with Cal Osha Regulations regarding Assured Equipment Grounding Conductor Program.

____________________________ will be responsible for the implementation of the program.

Two tests will be required. They are:

1. A continuity test to ensure the grounding conductor is electrically continuous.

2. A test to ensure that the grounding conductor is connected to its proper terminal.

These tests are required before first use, after any repairs, after damage is suspected to have occurred, and at 3-month intervals. Any equipment failing the required tests cannot be made available or used by employees.

Approved ground fault circuit interrupter testing equipment will be used to spot check electrical cords and outlets during each quarter. Documentation of testing will be maintained on file.

Electrical equipment to be inspected before first use, after any repairs, after damage is suspected to have occurred and at three month intervals will includ e:

Any equipment failing required tests will be removed from service immediately.

Revised by CJ – 03/21/2024

20. HOT WORK / WELDING COMRPESSED GAS

Definition - Hot Work

Hot work is any activity that could provide a source of ignition should combustible materials or flammable vapor –air mixtures present. Hot work includes but is not limited to the operation of gas torches, non-explosion proof electric tools with arcing contacts, non-explosion proof electrical lighting, grinders and sandblasting equipment. Pneumatical ly operated equipment is excluded unless the specific activity can produce a source of ignition (e.g. Grinding wheel on pneumatic grinder, etc.)

Policy
Prior to start up of any hot work activity the supervisor will assess the job and determine what safeguards must be taken.

Contract Work
At job sites where no work permits are required the supervisor will obtain a hot work permit prior to any work being done.

Welding Safety Policy
Welding will be in compliance with Sections 4846 -4853 of Title 8 General Industry Safety Orders and Article 32 Oxygen Acetylene and fuel gas of the Cal Osha Construction Safety Orders.

Contract Work
At job sites where welding or cutting is required Servicon Systems Inc. supervisor will adhere to all customer requirements such a s lot and permits and use of a fire watch. The most stringent requirements shall apply.

Compressed Gas Policy
Servicon Systems, Inc. supervisor and employees shall comply with Section 3300 -3312 of Title 8 of the General Industry Safety Orders.

Contract Work
Servicon Systems, Inc. supervisor and employees shall comply with the customer requirements. The most stringent requirements shall apply.

Revised by CJ – 03/21/2024

21. FIRST AID TREATMENT AND REPORTING FORMS

Definition - Hot Work

Hot work is any activity that could p rovide a source of ignition should combustible materials or flammable vapor –air mixtures present. Hot work includes but is not limited to the operation of gas torches, non-explosion proof electric tools with arcing contacts, non-explosion proof electrical lighting, grinders and sandblasting equipment. Pneumatically operated equipment is excluded unless the specific activity can produce a source of ignition (e.g. Grinding wheel on pneumatic grinder, etc.)

Policy
Prior to start up of any hot work activity the supervisor will assess the job and determine what safeguards must be taken.

Contract Work
At job sites where no work permits are required the supervisor will obtain a hot work permit prior to any work being done.

Welding Safety Policy
Welding will be in compliance with Sections 4846 -4853 of Title 8 General Industry Safety Orders and Article 32 Oxygen Acetylene and fuel gas of the Cal Osha Construction Safety Orders.

Contract Work
At job sites where welding or cutting is required Servicon Systems In c. supervisor will adhere to all customer requirements such as lot and permits and use of a fire watch. The most stringent requirements shall apply.

Compressed Gas Policy
Servicon Systems Inc. supervisor and employees shall comply with Section 3300-3312 of Title 8 of the General Industry Safety Orders.

Contract Work
Servicon Systems Inc. supervisor and employees shall comply with the customer requirements. The most stringent requirements shall apply.

Revised by CJ – 03/21/2024

22. CONFINED SPACE ENTRY
Definition

A. Limited openings

B. Unfavorable natural ventilation

C. Not intended for continuous worker occupancy

D. Contains or has potential to contain hazardous atmosphere

E. Has internal configuration that could entrap, engulf or asphyxiate

I. History & Statistics

Statistics

1. 90%+ of fatalities due to asphyxiation

2. 60%+ of fatalities (would be) rescuers

3. ? % chance it could be YOU!

II. Confined Space Hazards

A. Atmospheric

1. Oxygen – Normally 20.9%

a. Deficiency – Less than 19.5% according to NIOSH, OSHA b. Excess – More than 23.0% according to NIOSH (OSHA – 22%)

2. Combustibles

a. Fire triangle
b. LEL & UEL
c. Examples – Methane 5% LEL, 15% UEL
Propane 2.2% LEL, 9.5% UEL
Pentane 1.5% LEL, 7.8% UEL

Revised by CJ – 03/21/2024

3. Toxic Gases – Measured in PPM where 10,000 PPM = 1.0% Gas Personal Exposure Limit in PPM
a. H2S 10
b. CO2 25
c. SO2 2
d. NO2 2
e. CI2 1

4. Airborne dust
- Any concentration that obscures visibility at 5 feet or less B. Physical Hazards

1. Slipping, tripping

2. Falling

3. Falling objects

4. Entrapment

5. Engulfment

6. Drowning
C. Environmental Hazards

1. Chemical

2. Radioactive

3. Temperature

4. Humidity

5. Noise
Revised by CJ – 03/21/2024

6. Biological

a. Bacterial/Viral

b. Animal

D. Electrical Shock Hazard

E. Mechanical – Moving Mechanisms

F. Hydraulic

1. Liquid inflow/outflow

2. Hydraulic controls

G. Pneumatic

1. Pressurized air or gases

2. Pneumatic controls
III. Confined Space Program
A. Procedures

1. Identification/Labeling

2. Permits
a. Regular
b. Hot Work

3. Atmospheric monitoring
a. Prior to entry
Top, middle, bottom of space
b. Continuously during entry
c. Prior to re-entry after exit

4. Ventilation
Revised by CJ – 03/21/2024

a. Continuous or as required
b. Clean air supply to blower
c. Exhausting fan must be XP
d. Must not block exit
e. Avoid recirculation

5. Isolation
a. Lockout/tagout energy sources
b. Blank or block/bleed hydraulic & pneumatic lines
c. Disconnect linkages, belts, chain drives, power shafts d. Secure moving parts

6. Qualified person
a. Authorizes entry
b. More highly trained
c. Responsible for
(1) Identifying Hazards
(2) Insuring equipment availability
(3) Pre-entry briefing

7. Briefing/Preparation
a. Prior training
b. Medical histories available
c. Pre entry briefing
d. Rescue readiness

8. Rescue plan
a. Pre-planned methods
b. On-site team
c. Equipment at entry
d. Role of local emergency responders
e. Communicators

9. Management emphasis
“Top –Down” Priority

10. Disciplinary measures for infractions
B. Training

1. Initial training

2. Periodic retraining
Revised by CJ – 03/21/2024

3. Regular practice with equipment

4. Simulated rescue drills

5. Different training levels for:
a. Entrants
b. Observers/Attendants
c. Rescuers
d. Qualified persons (Authorizes Entry)

C. Manpower

1. Qualified/Competent person

2. Entrants required for job

3. Outside attendants

4. Rescue team/Emergency responders

5. All personnel physically and mentally fit for job

6. Never send best qualified in CPR and first aid into confined space

D. Equipment

1. Gas Detectors

A. Single reading (Grab Sample)

(1) Electronic sampling instruments
(2) Detector (stain) tubes

B. Continuous Monitor

(1) Combustible – Catalytic
(2) Oxygen – Electrochemical
(3) Toxic – Electrochemical
Semiconductor (MOS)

C. Fixed point for certain applications
Revised by CJ – 03/21/2024

D. Other considerations
1) Sample draw capability
2) Size
3) Durability
4) Cost
5) Ease of use, training
6) Ease of calibration, maintenance
7) Intrinsic safety approval (Ul, FM, MSHA)
8) RFI Protection
E. Regular Calibrations Required

2. Ventilators

3. Lockout/Block/Breed devices

4. Fall protection /Retrieval
a. Fall Protection
b. Retrieval
c. Lowering

5. Emergency Breathing Equipment
a. SCBA
b. Supplied air with escape pack
(1) Cascade System
(2) Filtration panel
(a) Compressor
(b) Plant air
(3) Portable manifolded SCBA bottles
c. 5/10 minute escape packs

NOT FOR RESCUE

6. All electrical equipment XP or IS

7. Personal protective clothing
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8. Fire Extinguishers

IV. Conclusion

A. Reiterate hazard awareness – especially “unseen” atmospheric hazards

B. Encourages immediate identification of all confined spaces for purposes of:

1. Labeling

2. Hazard identification

3. Applicability of available equipment

i.e. - Will an SCBA fit through the opening?
- Can a tripod be used?
- Are detection tubes necessary for unusual toxics?

4. Potential rescue planning

C. Implement procedures

D. Train personnel

E. Acquire necessary equipment

Revised by CJ – 03/21/2024

RECOMMENDATIONS FOR SAFE ENTRY

A CHECKLIST

Use the following checklist to evaluate the confined space.

DO NOT ENTER A CONFINED SPACE UNTIL YOU HAVE CONSIDERED EVERY QUESTION AND HAVE DETERMINED THE SPACE TO BE SAFE.

YES NO

□ □ Is entry necessary?

TESTING

□ □ Are the instruments used in atmospheric testing properly calibrated?

□ □ Was the atmosphere in the confined space tested?

□ □ Was Oxygen at least 19.5% (not more than 21%?

□ □ Were toxic, flammable, or oxygen-displacing gases / vapors present?

- Hydrogen Sulfide
- Carbon Monoxide
- Methane
- Carbon Dioxide
- Other (list)

___________________________________________________________________________

ONITORING

□ □ Will the atmosphere in the space be monitored while wor k is going on?

□ □ Continuously?

□ □ Periodically? (if yes, give interval:_______________________________

(REMEMBER – ATMOSPHERIC CHANGES OCCUR DUE TO THE WORK PROCEDURE OR THE PRODUCT STORED. THE ATMOSPHERE MAY BE SAFE WHEN )

Revised by CJ – 03/21/2024

CLEANING

□ □ Has the space been cleaned before entry is made?

□ □ Was the space steamed?

□ □ If so, was it allowed to cool?

VENTILATION

□ □ Has the space been ventilated before entry?

□ □ Will ventilation be continued during entry?

□ □ Is the air intake for the ventilation system located in an area that is free of combustible dusts and vapors and toxic substances?

□ □ If atmosphere was found unacceptable and then ventilated, was it re - tested before entry?

ISOLATION

□ □ Has the space been isolated from other systems?

□ □ Has electrical equipment been locked out?

□ □ Has disconnects been used where possible?

□ □ Has mechanical equipment been blocked, chocked,
and disengaged where necessary?

□ □ Have Lines under pressure been blanked and bled?

CLOTHING/EQUIPMENT

□ □ Is special clothing required (boots, chemical suits, glasses, etc.)? (If so, specify)______________________________________________________)

□ □ Is special equipment required (e.g., rescue equipment, communications equipment, etc.)? If so, specify
(__________________________________________________________________) □ □ Are special tools required (e.g., spark proof)? If so, Revised by CJ – 03/21/2024

specify(___________________________________________________________)

RESPIRATORY PROTECTION
□ □ Are MSHA/NIOSH approved respirators of the type required available at the work site?
□ □ Is respiratory protection required (e.g., air-purifying, supplied air, self- contained breathing apparatus, etc.)? If so, specify
__________________________________________________________________ □ □ Can you get through the opening with a respirator on? If you don’t know, find out before you try to enter.)

TRAINING
□ □ Have you been trained in proper use of a respirator? □ □ Have you received first aid/CPR training?
□ □ Have you been trained in confined space entry and do you know you know what to look for?

STANDBY RESCUE
□ □ Will there be a standby person on the outside in constant visual or auditory communication with the person on the inside?
□ □ Will the standby person be able to see and/or hear the person inside at at all times?
□ □ Has the standby person(s) been trained in rescue procedures? □ □ Will safety lines and harness be required to remove a person? □ □ Are company rescue procedures available to be followed in the event of an emergency?
□ □ Are you familiar with emergency rescue procedures? □ □ Do you know who to notify and how in the event of an emergency? Revised by CJ – 03/21/2024

PERMIT

The permit is an authorization in writing that states that the space has been tested by a qualified person that the space is safe for entry, what precautions, equipment, etc., are required, and what work is to be done.

YES NO

□ □ Has a confined space entry permit been issued?

□ □ Does the permit include a list of emergency telephone numbers?

For further information on confined spaces, occupational hazards, safe work practices and other topics that could affect your well being write
to:_______________________________________________________________________________

Revised by CJ – 03/21/2024

23. SCAFFOLD AND LADDER SAFETY

1. Scaffolding

All scaffolds built by Servicon Systems Inc., rented or brought it to a job site must meet Cal Osha standards. This means they must have appropriate railings, mid rails, toe boards, etc. Scaffolds may not be erected in areas that will block egress routes o r access to emergency equipment. Scaffolding shall be inspected by a competent person in scaffold erection. Scaffolds should meet all of the requirements of Cal Osha and Our Customers.

Please review Cal Osha Construction Standards Article 21.

Scaffold - General Requirements and Article 23 Suspended Scaffolds.

Also - See Scaffold Inspection Report

2. Ladders

All ladders that are purchased or job made and are used at our premises or at a job site must meet the Cal Osha Standard before they are used.

Please review Cal Osha Construction Standard Article 23 – Ladders and Title 8 G.I.S.O. Section 3276- 3279.

Revised by CJ – 03/21/2024

24. RESPIRATORY PROTECTION PROGRAM

INTRODUCTION

In the control of those occupational diseases caused by breathing air contaminated with gases of aerosols, the primary objective is to prevent harmful exposures. This is accomplished as far as feasible by accepted engineering control measures (for example, general and local ventilation, enclosure or isolation, and substitution of less hazardous processes or materials) when effective engineering controls are not feasible, or while they are being instituted, appropriate respirators shall be required.

PURPOSE AND SCOPE

The practices and procedures described here constitute the program under which r espirators are effectively utilized at

RESPONSIBILITY

A. __________________________________ is the respiratory program coordinator. __________________________________will be responsible for:

1. Provision of appropriate respirators

2. Implementing training and instruction programs

3. Administering the overall program

4. Insuring that the appropriate standards include the requirement for respirator use when necessary.

B. is responsible for

1. Insuring that respirators are available as needed

2. Insuring that employees wear respirators as required

3. Inspection of respirators on an established basis or schedule

C. The employee is responsible for:

Revised by CJ – 03/21/2024

1. Using the respirator supplied to him/her in accordance with instructions and training.

2. Cleaning, disinfecting, inspecting and storing his/her respirator after each use.

3. Reporting a respirator malfunction to supervisor.

D. The respirator

1. Technical assistance in determining the need for respirators and in the selection of appropriate types.

2. Surveillance of work area conditions

3. Periodic evaluation of the respirator program

4. Educational materials and programs to be used in employee training

5. Medical surveillance for employees required to utilize respirators

6. Material Safety Data Sheets to individuals utilizing respirators

RESPIRATOR SELECTION
The respirator program coordinator selects respirators. This choice is based on the physical, chemical and physiological properties of the air contaminant and on the concentration likely to be encountered.

The quality of fit and the nature of the work being done also affect the choice of respirators. The capability of the respirators chosen is determined from appropriate governmental approvals, manufacturers’ tests and plant experience with the respirators.

DISTRIBUTION
Respirators are issued to individuals whenever possible. Each respirator that is individually assigned is identified in a way that does not interfere with its performance. The date of issuance should be recorded.

INSPECTION AND MAINTENANCE
Respirators are properly maintained to retain their original effectiveness by periodic inspection, repair, cleaning and proper storage.

A. Inspection
Revised by CJ – 03/21/2024

1. The user inspects all respirators routinely before and after each use and after cleaning to check condition of face piece, headbands, valves and ho ses, and canister, filter or cartridge fit.

2. Inspects all respirators at least once per month.

3. Respirators maintained for emergency use are tagged noting the date of inspection, the initials of the person doing the inspection, and a respirator identification number. A log indicating these inspections is maintained in the plant office.

B. Maintenance

Respirators that do not pass inspections are replaced or repaired immediately. Repair of the respirator by the user is limited to changing canisters, cartridges, filters and head straps. All other replacements or repairs are performed by the or an experienced person with parts designed for the respirator. No attempt is made to replace components, or make adjustments, modifications or repairs beyond the manufacturers’ recommendations.

CLEANING
Individually assigned respirators are cleaned and disinfected as frequently as necessary to insure that proper protection is provided for the wearer. Respirators not individually assigned and those for emergency use are cleaned and disinfected after each use.

The following procedure is used for cleaning and disinfecting respirators:

A. Filters, cartridges, or canisters and disinfecting respirators:

B. Respirators are washed in a detergency solution, rinsed in clean water and allowed to dry in a clean area. A soft bristly brush is used to scrub the respirator to remove adhering dirt.

STORAGE
After inspection, cleaning and necessary repairs, respirators are stored to protect against dust, sunlight, extreme heat, extreme cold, excessive moisture, or damaging chemicals.

TRAINING
Every employee who may have to wear a respirator is trained in the proper use of the respirator. Both Revised by CJ – 03/21/2024

the employee and his supervisor receive this training. The training includ es:

A. Description of the respirators

B. Intended use and limitation of the respirator

C. Proper wearing, adjustment, and testing for fit

D. Cleaning and storage methods

E. Inspection and maintenance procedures

This training is repeated as necessary, at least annua lly, to ensure that employees remain familiar with the proper use of respiratory protection. The program coordinator to determine its continued effectiveness evaluates the training program at least annually.

RECORDS

The following records are maintained by the

A. The number and types of respirators in use

B. A record of employee training programs including fit testing

C. Inspection and maintenance reports

D. Medical certification that the employee is capable of wearing a respirator under his given work conditions.

E. M.S.D.S. of all hazardous substances
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POLICY REGARDING

APPENDIX D to SECTION 5144

Particle dust masks or filter type masks for fumes, vapors, gases, or mist, will be made available to those employees requesting these type masks when exposed to nuisance dust or fumes, vapors, gases, or mists when exposure are below the exposure limits set by Cal Osha Standards.

Approved respirators will be utilized when recommended by M.S.D.S. sheets or when exposures exceed exposure limits set by Cal Osha Standards.

24.1 Medical Surveillance
Medical Surveillance will be in compliance with Title 8 Industrial Relations Subchapter 7 General Industry Safety Orders of the Barclays Official California Code of Regulations.

Medical testing and examinations will be completed
by:_______________________________________________________________________________ ______________________________________________________________ Medical Surveillance will be conducted for but not be limited to:
• Audiograms, if employees are working in loud areas which include operating units at a refinery.
• Hazardous Waste Worker Exam if employees are working with hazardous waste or conducting post emergency response clean-up.
• DOT physical if subject to DOT regulations.
• Benzene, asbestos, lead, etc., if exposed to these substances in concentrations and at frequencies specified by OSHA.
• Respiratory protection physical if expected to wear respirator.

Revised by CJ – 03/21/2024

25. HEARING CONSERVATION

SECTION ONE - INTRODUCTION
Evidence is well established that worker exposure to noise of sufficient intensity and duration can result in hearing damage. Noise-induced hearing loss rarely results from just one exposure; it can progress unnoticed over a period of years. Initial noise-induced hearing loss occurs at the higher frequencies where the consonant portion of speech is found, making communications difficult.

1.1 Policy
It is the policy of Servicon Systems Inc. to provide employees with a safe and healthful working environment. This is accomplished by utilizing facilities and equipment that have all feasible safeguards incorporated into their design. When effective engineering controls are not feasible, or when they are being initiated, administrative controls will be used when and where possible, followed by the use of personal protective equipment.

The primary goal of the Servicon Systems Inc. Hearing Conservation Program is to reduce, and eventually eliminate hearing loss due to workplace noise exposures. The program includes the following elements:
a. Work environments will be surveyed to identify potentially hazardous noise levels and personnel at risk.
b. Environments that contain or equipment that produces potentially hazardous noise should, wherever it is technologically and economically feasible, be modified to reduce the noise level to acceptable levels. c. Where engineering controls are not feasible, administrative controls and/or the use of hearing protective devices will be employed.
d. Periodic hearing testing will be conducted to monitor the effectiveness of the hearing conservation program. Early detection of temporary threshold shifts will allow further protective action to be taken before permanent hearing loss occurs.
e. Education is vital to the overall success of a hearing conservation program. An understanding by employees of the permanent nature of noise-induced hearing loss, Servicon Systems Inc. Hearing Conservation program, and the employee's responsibilities under the program, are all essential for program effectiveness.

Servicon Systems Inc. management is aware that excessive noise exposure is a potential cause of hearing loss, is establishing a hearing conservation program that is in Revised by CJ – 03/21/2024

accordance with OSHA standards. Servicon Systems Inc. has adopted the following standards for noise exposure limits:

Duration per day, hours Sound level (dBA)
8 85
6 92
4 95
3 97
2 100
1/2 110
1/4 115

When the sound levels listed above are exceeded, feasible administrative or engineering controls will be instituted. If the controls fail to reduce the sound levels to within those listed above, hearing protection will be provided and used to reduce the sound levels to an acceptable level. In addition, OSHA requirements dictate that whenever employee noise exposures equal or exceed an 8 -hour time-weighted average ( TWA) of 85 dBA, slow response, a continuing effective hearing conservation program shall be instituted.

1.2 Program Organization
The Servicon Systems Inc. Hearing Conservation Program is organized and administered through management procedures and standa rd operating procedures. The Management Procedure outlines and defines program responsibilities and describes a minimum acceptable Hearing Conservation Program.

SECTION TWO - RESPONSIBILITIES

2.1 Servicon Systems Inc. Management Section
Servicon Systems Inc. Management are responsible for developing, implementing, and administering the Hearing Conservation Program. Additional responsibilities include:

1. Identification of work areas and equipment within Servicon Systems Inc. facilities where noise levels equal or exceed 85 dBA.

2. Identification, through personnel monitoring, of Servicon Systems Inc. employees whose noise exposure level equals or exceeds an 8 -hour TWA of 85 dBA.

Notification of employee exposure measurements is to be included in employees' medical files.

3. Annual remonitoring of identified at-risk employees.

Revised by CJ – 03/21/2024

4. Resurvey of work areas and equipment where noise levels exceed 85 dBA every 2 years.

5. Training of employees in the need for, proper use and care of hearing protection devices.

6. Identification of noise control measures (including engineering and administrative controls) and recommendations.

Servicon Systems Inc. is responsible for providing baseline and annual audiograms for new employees who may be assigned to tasks with potential exposure to elevated levels of noise. Servicon Systems Inc. also schedules and conducts audiograms on an annual basis for employees exposed to sound levels greater than or equal to 85 dBA. Servicon Systems Inc. is also responsible for tracking all employees who have experienced significant changes in hearing (standard threshold shifts) in order that follow -up investigations may be conducted.

Revised by CJ – 03/21/2024

2.2 Training Activity
Servicon Systems Inc. and Servicon Systems Inc.’s management is responsible for coordinating and scheduling health and safety training courses and seminars sponsored by Servicon Systems Inc., for their personnel. Servicon Systems Inc. and their management personnel will also maintain documentation of the training courses presented in accordance with Servicon Systems Inc.’s program requirements.

2.3 Supervisors
It is the responsibility of supervisors to ensure that all of their employees exposed to noise levels equal to or greater than 85 dBA have access to appropriate hearing protective devices in the work area. Supervisors are also responsible for enforcing the use of hearing protective devices and engineering and administrative controls in designated noise hazardous areas.

2.4 Employees
Employees are responsible for wearing and main taining hearing protective devices as instructed. Employees exposed to excessive levels of noise must also participate in annual training programs and the medical surveillance program, which includes audiometric testing.

SECTION THREE - NOISE EVALUATION AND SURVEILLANCE PROCEDURES

3.1 Identification of Hazardous Noise Areas
Servicon Systems Inc. management will identify work areas within their facilities where noise levels equal or exceed 85 dBA. Records shall be maintained by Servicon Systems Inc. and updated at least every two years to determine if any alteration in noise levels has occurred. Those areas where the noise levels are below 85 dBA will not be routinely monitored. Identification of hazardous noise areas and equipment and any subsequent noise monitoring will be conducted by Servicon Systems Inc. or agents thereof.

Signs will be posted at the entrance to any work area where noise levels exceed 85 dBA, requiring anyone entering the area to wear proper hearing protection.

Personnel who work in these areas shall have hearing protection supplied to them, shall be instructed in its proper use, and be required to wear this equipment when in these identified areas. It is the responsibility of the area supervisor to ensure that these precautions are maintained.

Equipment that produces noise levels greater than 85 dBA shall be appropriately labeled.

Revised by CJ – 03/21/2024

3.2 Noise Measurements and Exposure Assessments
In order to effectively control noise it is necessary that the noise be accurately measured according to standard procedures and that the measurements be properly evaluated against accepted criteria. All noise monitoring will be conducted in accordance with established standard operating procedures.

The monitoring of employees for noise exposure is made up of two parts, area, and personal monitoring. Area measurements are generally obtained first. If noise levels are at or above 85 dBA, personal monitoring using dosimeters is then performed. Sample data sheets will be used to record monitoring data for both area and personal noise monitoring results. If it is determined initially that employees are exposed to over 85 DBA on a time weighted basis then the Hearing Conservation Program will automatically take effect with those employees without further noise testing.

3.2.1 Area Measurements
In an area survey, measurements of environmental noise levels are recorded using a sound level meter to identify work areas where employees' exposures may be above hazardous levels, and where more thorough exposure monitoring may be needed. Area monitoring is conducted using a calibrated sound level meter set to the A scale, slow response. Within the area of interest, several different locations will be measured.

Typical measurement locations would include:
• In the hearing zone at the employee's normal work location. • Next to the noise source(s).
• At the entrance(s) to the work area.
• At other locations within the area where the employee might spend time working.

A rough sketch of the area will be included with the results showing the locations where the noise readings were obtained.

If the noise levels are below 85 dBA on a time-weighted average basis in the area, no further routine monitoring will be required for that area. Should any of the noise measurements equal or exceed 85 dBA, records shall be maintained as to the noise levels recorded, where they were taken, and the source(s) of the noise. These records shall be updated at least once every 2 years to determine if any changes have occurred that would warrant remonitoring of exposed personnel. If any of the measurements equal or exceed a noise level of 85 dBA, employees who work in or near the high noise area or equipment shall have their noise exposure determined through personnel monitoring using dosimeters.

3.2.2 Personnel Monitoring
Revised by CJ – 03/21/2024

Further determination if needed of the noise exposure level will be accomplished using calibrated noise dosimeters. Each employee to be monitored will have a dosimeter placed on him/her at the beginning of his/her normal work shift with the microphone placed in the "hearing zone". The dosimeter will be worn for the full duration of the work shift while the employee performs his/her normal work routine. At the end of the work shift, the dosimeter will be removed and information printed out as soon as possible. Background information will be collected from each employee detailing job description, unusual job activities, etc., for the time period sampled. Those employees whose noise exposure equals or exceeds 85 dBA on an 8-hour TWA, will be referred to the Occupational Health Clinic for inclusion in the Hearing Conservation Medical Surveillance Program.

3.3 Remonitoring of Hazardous Noise Areas
All areas where noise levels equal or exceed 85 dBA shall be remonitored at least every 2 years. Employees who work for extended periods of time (>2 hours) in the high noise areas and where their 8-hour TWA equals or exceeds 85 dBA will be monitored every year to determine their personal noise exposure.

Whenever an employee exhibits a standard threshold shift, as determined by the Occupational Health Clinic, the employee's work place shall be remonitored to identify and ameliorate the cause.

3.4 Remonitoring Due to Changes
Any area with noise levels that equal or exceed 85 dBA shall also be remonitored whenever a change in production process, equipment, or controls increase the noise exposure such that additional employees are exposed to noise levels at or above 85 dBA on a time-weighted average basis. Areas where the noise levels have dropped below 85 dBA due to alterations in equipment, controls, or process changes shall be eliminated from the monitoring program.

SECTION FOUR - NOISE CONTROL METHODS

4.1 Engineering and Administrative Controls
The primary means of reducing or eliminating personnel exposure to hazardous noise is through the application of engineering controls. Engineering controls are defined as any modification or replacement of equipment, or related physical change at the noise source or along the transmission path that reduces the noise level at the employee's ear.

Engineering controls such as mufflers on heavy equipment exhausts or on air release valves are required where possible.

Administrative controls are defined as changes in the work schedule or operations, which reduce noise exposure. If engineering solutions cannot reduce the noise, administrative controls such as increasing the distance between the noise source and Revised by CJ – 03/21/2024

the worker or rotation of jobs between workers in the high noise area should be used if possible.

The use of engineering and administrative controls should reduce noise exposure to the point where the hazard to hearing is eliminated or at least more manageable.

4.2 Personal Protective Equipment
Hearing protective devices (ear plugs, muffs, etc.) shall be the permanent solution only when engineering or administrative controls are considered to be infeasible or cost prohibitive. Hearing protective devices are defined as any device that can be worn to reduce the level of sound entering the ear. Hearing protective devices shall be worn by all personnel when they must enter or work in an area where the operations generate noise levels of:
• Greater than 85 dBA sound levels, or

4.2.1 Types of Hearing Protective Devices Hearing protective devices include the following:
a. Insert Type Earplugs
A device designed to provide an airtight seal with the ear canal. There are three types of insert earplugs – pre-molded, formable, and custom earplugs.

1. Pre-molded Earplugs
Pre-molded earplugs are pliable devices of fixed proportions. Two standard styles, single flange and triple flange, come in various sizes, and will fit most people. Personnel responsible for fitting and dispensing earplugs will train users on proper insertion, wear, andcare.

While pre-molded earplugs are reusable, they may deteriorateand should be replaced periodically.

2. Formable
Formable earplugs come in just one size. Some are made of material which, after being compressed and inserted, expands to form a seal in the ear canal. When properly inserted, they provide noise attenuation values that are similar to those from correctly fitted pre-molded earplugs. Individual units may procure approved formable earplugs.

Supervisors must instruct users in the proper use of these earplugs as part of the annual education program. Each earplug must be held in place while it expands enough to remain firmly seated. A set of earplugs with a cord attached is available. These earplugs may be washed and therefore are reusable, but will have to be replaced after two or three weeks or when they no longer form an airtight seal when properly inserted.

Revised by CJ – 03/21/2024

The type(s) of earplug(s) and location(s) for their use at Servicon Systems Inc., is (are):
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ b. Earmuffs
Earmuffs are devices worn around the ear to reduce the level of noise that reaches the ear. Their effectiveness depends on an airtight seal between the cushion and the head.

The type(s) of earmuffs and location(s) for their use at Servicon Systems Inc., is (are):
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

4.2.2 Selection of Hearing Protective Devices (HPD’s)
Employees will be given the opportunity to select hearing protective devices from a variety of suitable ones provided by Servicon Systems Inc.. In all cases, the chosen hearing protectors shall have a Noise Reduction Ratio (NRR) high enough to reduce the noise at the eardrum to 85 dBA or lower.

4.2.3 Issuance of Hearing Protective Devices
The hearing protective devices will issued by Servicon Systems Inc. (initial hearing protective devices may include foam inserts, disposables). Instruction on the proper use and care of earplugs and earmuffs will be provided whenever HPDs are dispensed.

Personnel requiring earmuffs in addition to earplugs will be informed of this requirement and educated on the importance of using proper hearing protection.

Servicon Systems Inc. will dispense earmuffs when necessary and will maintain a supply of disposable earplugs.

4.2.4 Use of Hearing Protective Devices
a. Always use and maintain HPDs as originally intended and in accordance with instructions provided.
b. Earmuff performance may be degraded by anything that compromises the cushion-to-circumoral flesh seal. This includes other pieces of personal protective equipment such as eyewear, masks, face shields, and helmets.

4.2.5 Maintenance of Hearing Protective Devices
Revised by CJ – 03/21/2024

a. Reusable earplugs, such as the triple flange or formable devices should be washed in lukewarm water using hand soap, rinsed in clean water, and dried thoroughly before use. Wet or damp earplugs should not be placed in their containers. Cleaning should be done as needed.
b. Earmuff cushions should be kept clean. The plastic or foam cushions may be cleaned in the same way as earplugs, but the inside of the muff should not get wet. When not n use, earmuffs should be placed in open air to allow moisture that may have been absorbed into the cups to evaporate.

4.2.6 Hearing Protection Performance Information
The maximum of sound attenuation one gets when wearing hearing protection devices is limited by human body and bone conduction mechanisms. Even though a particular device may provide outstanding values of noise attenuation, the actual noise reductions may be less because of the noise surrounding the head and body bypasses the hearing protector and is transmitted through tissue and bone pathways to the inner ear.

The term "double hearing protection" is misleading. The attenuation provided from any combination earplug and earmuff is not equal to the sum of their individual attenuation values.

SECTION FIVE - MEDICAL SURVEILLANCE

5.1 Notification
Upon identification of employees whose 8-hour TWA equals or exceeds 85 dBA, OHS will recommend to the Occupational Health Clinic and the employee's Supervisor, in writing, of the need to enroll certain employee(s) in the Hearing Conservation Medical Surveillance Program. Information supplied to the OHC will include the employee(s) name, supervisor's name, telephone number, CIO, and the noise levels recorded in the employee's work area, including dosimetry data. It will be the responsibility of the Supervisor to enroll his/her employee in the Hearing Conservation Medical Surveillance Program.

In work locations where either through administrative or engineering controls, noise levels are found to have fallen such that the employee's 8-hour TWA is below 85 dBA, Servicon Systems Inc. will notify the Clinic and the employee's Supervisor, by memo, that the employees working in that area are no longer required to be enrolled in the Hearing Conservation Program. The final decision as to an employee's enrollment status will be left with the Occupational Health Clinic Physician.

The results of area and personal remonitoring shall be forwarded to the Clinic upon completion of the noise surveys.

Any personnel experiencing difficulty in wearing assigned hearing protection (i.e., irritation of the canals, pain) will be advised to immediately report this to their Revised by CJ – 03/21/2024

supervisor and make arrangements to go to the Occupational Health Clinic for evaluation as soon as possible.

5.2 Audiometric Testing
Servicon Systems Inc., or agents thereof, are responsible for administering the Audiometric Testing Program portion of the Hearing Conservation Program. The object of the audiometric testing program is to identify workers who are beginning to lose their hearing and to intervene before the hearing loss becomes worse. Audiometric testing will be provided by ____________________________________ to all employees with exposure to noise levels of 85 dBA or greater. Annual retesting will be performed for all personnel enrolled in the Hearing Conservation Medical Surveillance Program.

SECTION SIX - TRAINING
The training and education program will provide information about the adverse effects of noise and how to prevent noise-induced hearing loss. At a minimum, all training will cover the following topics:
a. Noise-induced hearing loss;
b. Recognizing hazardous noise;
c. Symptoms of overexposure to hazardous noise;
d. Hearing protection devices - advantages and limitations. e. Selection, fitting, use, and maintenance of HPDs.
f. Explanation of noise measurement procedures.
g. Hearing conservation program requirements.

Employees will also be provided with copies of the OSHA noise standard (29 CFR 1910.95) and other handouts regarding the Servicon Systems Inc. Hearing Conservation Program (General Industry Safety Orders Article 105, Sections 5095-5100, appendix A-F are attached herein).

Servicon Systems Inc. employees shall be encouraged to use hearing protective devices when they are exposed to hazardous noise during activities at home; e.g., from lawn mowers, chain saws, etc.

All personnel identified for inclusion in the hearing conservation program should receive a minimum of one hour of initial instruction in the requirements of the program. Ideally, this will be done when hearing protection is dispensed.

Appropriate refresher training annually thereafter and will be provided by the immediate supervisor. Supervisors will be provided annual training by Servicon Systems Inc..

Revised by CJ – 03/21/2024

Supervisors must schedule trai ning for new personnel assigned to work in noisy environments and for retraining of current personnel.

SECTION SEVEN - PROGRAM EVALUATION
Periodic program evaluations will be conducted to assess compliance with federal and state regulations and Servicon Systems Inc. Program requirements. Both the monitoring and audiometric testing portions of the Hearing Conservation Program will be reviewed annually to assure its quality and effectiveness.

An evaluation of the Program, including wearer acceptance, appr aisal of protection afforded, and field audits of hearing protection use and record keeping will be conducted at least annually. Items to be considered include:
a. Standard operating procedures
b. Training records and course content for supervisors and employ ees. c. Maintenance of HPDs
d. Field audits of HPD use
e. Review of recorded threshold shifts on OSHA log.

The findings of the Servicon Systems Inc. Hearing Conservation Program evaluation will be documented, and this documentation will list plans to correct faults in the program and set target dates for the implementation of the plans.

SECTION EIGHT - STANDARD OPERATING PROCEDURES
An important element of the Hearing Conservation Program is the development of detailed standard operating procedures (SOPs). The SOPs outline the steps necessary to meet the goals of the Hearing Conservation Program and Procedures (Appendix A), and document Hearing Conservation Program activities. The SOPs are periodically reviewed and revised by the Safety Committee and Safety Ma nager/Coordinator.

The following SOPs will be developed and maintained by Servicon Systems Inc.:
a. Basic Sound Survey Using a Sound Level Meter, SOP-1. b. Detailed Sound Survey Using a Noise Dosimeter, if necessary SOP -2. c. Hearing Conservation Program Training, SOP-3
d. Audit of the Hearing Conservation Program, SOP-4.

Revised by CJ – 03/21/2024

SECTION NINE - RECORDKEEPING
Servicon Systems Inc. Program records will include the following:

All non-medical records (ex., work area and equipment surveys) will be maintained for a period of five years. Results of hearing tests and medical evaluations performed for hearing conservation purposes as well as noise exposure documentation shall be recorded and shall be a permanent part of an employee's health record.

All personnel who routinely work in designated hazardous noise areas shall be identified and a current roster of such personnel shall be maintained by Servicon Systems Inc. and updated periodically.

Appendix A
Noise - Training Information
NOISE
Supervisors and exposed workers must become aware of and understand about the adverse effects of noise and how to prevent noise-induced hearing loss. People exposed to hazardous noise must take positive action, if progressive permanent hearing loss is to be prevented. Each exposed worker and supervisor should know the following.

A. Noise exposure may result in permanent damage to the auditory system and there is no medical or surgical treatment for this type of hearing loss.

Though the use of a hearing aid may provide some benefit, normal hearing will not be restored. Many people don't realize that loud sounds can cause hearing loss.

Furthermore, in its initial stages, the person may not notice a problem since noise- induced hearing loss is invisible, painless, and occurs in the high frequencies. It is dangerous to ignore the temporary characteristics of noise-induced hearing loss (such as ringing or buzzing in the ears, excessive fatigue, etc.).

B. Each person should know how to recognize hazardous noise even if a noise survey has not been conducted an/or warning signs posted. Recognizing and understanding the adverse effects of off-duty noise exposures is also important. The best rule to follow is: "If you have to shout at arms length (approximately three feet) to talk face-to-face, you are probably being exposed to hazardous levels of noise."
C. Preventing noise-induced hearing loss is accomplished by reducing both the time and intensity of exposure. Reducing exposure time is accomplished by avoiding any unnecessary exposure to loud sound. Reducing intensity is usually accomplished by wearing personal hearing protection. Each person must be able to properly wear and care for the particular type of hearing protection selected. Speech communication is difficult in high intensity noise.

Revised by CJ – 03/21/2024

However, most people don't realize that it's easier to understand speech if hearing protection is worn in a hazardous noise environment. Hearing protection reduces the noise and the level of speech, resulting in a more favorable listening level. Hearing protection reduces the intensity of frequencies above the speech range; thus, reducing the noise and accentuating speech. People who claim wearing hearing protection makes it difficult to hear speech are probably in noise levels less than 85 dBA or have already developed a hearing loss.

D. Each person must know how to tell if they have been overexposed to loud sound. Overexposure may occur even while wearing hearing protection.

Earplugs and/or earmuffs alone may not be enough protection. Each time a temporary threshold shift (TSS) occurs, a certain degree of permanent loss results. The recognizable symptoms of overexposure are described as "dullness in hearing or ringing in the ears."
Revised by CJ – 03/21/2024

26. FLEET VEHICLE SAFETY PROGRAM

It is important to provide continuous drivers and management safety training and to review areas of concern and weakness in the fleet safety program. One of the best ways to convey information and to get feedback is through safety meetings.

1. Safety meetings shall be held monthly. Appropriate mi nutes shall be maintained.

2. Subjects to be considered during a safety meeting.

A. Any accidents that occurred since the previous meeting B. Change in laws or regulations
C. Employee complaints and observations
D. Defensive driving techniques
E. Preventive maintenance programs
F. Vehicle inspection

DEFENSIVE DRIVING TECHNIQUES

All company drivers should be trained in safe driving habits and be familiar with the National Safety Council’s Defensive Driving Program or equivalent. Principle topics are:

A. Defensive driving
B. Split – second decision making
C. Backing up rules
D. Safety Distances
E. Intersection driving
F. Poor condition driving in dust storms, rain, etc.

Revised by CJ – 03/21/2024

FLEET SAFETY PROGRAM

MANAGEMENT

Assumes the primary responsibility for the corporate fleet safety program. ____________________________________Will be accountable for implementing safety policy and providing the management guidelines to see that fleet safety is effective.

DRIVERS

Are responsible for developing safe driving habits as outlined in the National Safety Counc il’s Defensive Driving Program, they also must comply with the corporate safety policy.

DRIVER SELECTION

Each driver candidate is subject to the following procedure prior to being hired.

1. Each candidate must complete in full an employment application

2. Provide a current driver’s record (M.V.R.) no more than two weeks old. This can be obtained by the applicant at the California Department of Vehicles.

3. Subject to a pre-employment drug screen

4. Provide a valid driver’s license of the appropriate class.

5. Submit to a pre-employment physical examination.

6. Pass a road test. The road test will be given by a designated employee. A written evaluation will be submitted to the branch manager.

7. The manager will check references whenever possible.

8. The fleet safety program shall be reviewed with each driver of a company vehicle.

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ACCIDENT REPORTING AND DISCIPLINARY POLICY

An accident report shall be completed and submitted to the Manager by the beginning of the day following the day of the accident. In the event of a serious accident, the Manager will be called immediately.

All accident reports will be reviewed by the Manager, the driver’ s immediate supervisor, and one other person. The committee will determine if the accident is chargeable or non chargeable, using the criteria of the National Safety Council’s Defensive Driving Program.

If a driver wishes to attend his review meeting, he may. If he does not attend, but wishes to appeal the committee findings, he may request another meeting appeal.

For chargeable accidents, the following disciplinary action will be taken based on the driver’s record for the previous 18 months.
• First chargeable accident, written warning in personnel file. • Second chargeable accident, automatic three (3) days off without pay. • Third chargeable accident – TERMINATION
NOTE: A driver may be transferred to a non-driving position and not permitted to operate the company vehicle in lieu of termination.

The following infractions will be grounds for written warning:
• Backing a vehicle without being directed by another employee or person whenever possible. • Poor housekeeping in or on the vehicle.
• Continued failure to properly inspect the vehicle.
• Telephone complaints from clients or the general public.

The following infractions will be grounds for three (3) days off without pay:
• Unsafe load or unloading
• Knowingly driving an unsafe vehicle or driving with physical defects that have not been reported to his/her immediate supervisor or the maintenance department.

Revised by CJ – 03/21/2024

• Driving with an expired driver’s license.
• Driving with an improper license for the vehicle or load being driven. • One (1) written warning on file for previous violation of company safety policy. • Late reporting of an accident involving a vehicle
The following infractions will be grounds for immediate termination:
• Any alcoholic beverages transported or consumed in a company vehicle • Driving under the influence of alcohol
• Driving with a revoked driver’s license
• Horseplay involving a vehicle
• A written warning and three (3) days off for previous violation of company safety policies • Failure to report an accident
The Department of Motor Vehicles Records will be reviewed annually. Those drivers with poor driving records will be interviewed by his Manager and his immediate supervisor. Depending on the type and frequency of violations on his record, one of the following determinations will be made:
• The driver may continue to drive for a probationary period • The driver will not be allowed to drive a company vehicle before a probationary period • The driver may be terminated

VEHICLE INSPECTION GUIDE
• All drivers will complete a vehicle inspection on whatever vehicle they have been assigned at the beginning of his shift.
• A written vehicle inspection report shall be turned in to the driver’s immediate supervisor by the end of the shift. Unless the vehicle is unsafe to drive. If this is the case, the vehicle shall be removed from service, immediately until the equipment violation is corrected and the vehicle is safe to drive. • After a review by the supervisor, the inspection reports will be sent to the Maintenance Revised by CJ – 03/21/2024

Department where a permanent record will be maintained.

• Any defects that affect the safety of a vehicle or would constitute an equipment violation shall be reported to the driver’s supervisor immediately.

Revised by CJ – 03/21/2024

27. HAND AND POWER TOOL SAFETY

SMALL GASOLINE POWERED EQUIPMENT
All hand and power tools whether provided by Servicon Systems Inc., or the General Contractor must be in good, safe working condition before they are allowed on the job site.

1. Inspections of hand and power tools will be made at the time of purchase, each day prior to being used and during the supervisors’ inspection of the job site.

2. When power operated tools are designed to have safety guards they will be equipped with guards when in use.

3. Proper Personal Protective Equipment will be provided when employees are exposed to:
• Falling, flying, abrasive or splashing objects
• Harmful dusts, fumes, mists, vapors, or gases
The following Servicon Systems Inc. pertain to fuel powered tools:

1. All fuel powered tools must be stopped while being refueled, serviced, or maintained.

2. Internal combustion engine powered equipment must be located so that the exhausts are well away from combustible materials.

3. Fuel must be transported, handled, and stored in accordance with Subpart F (Fire Protection and Prevention) of the OSHA construction rules.

4. When fuel powered tools are used in enclosed spaces the applicable OSHA rules for concentrations of toxic gases and proper personal protective equipment must be followed.

Carbon monoxide – Enclosed spaces and small gasoline powered equipment can create a deadly combination. It is recommended not to use gasoline powered engines indoors. Adequate ventilation must be provided and testing of air quality conducted regularly if they are used indoors.

Fuel handling and use – If any flammable or combustible liquids are used at job site:

1. A fire extinguisher, rated not less than 10B, must be provided within 50 feet of wherever more than five galls of flammable or combustible liquids are being used.

2. Only approved containers and portable tanks will be used for storage and handling of flammable and combustible liquids.

Revised by CJ – 03/21/2024

3. Approved red metal safety cans will be used when handling or using flamm able liquids in quantities greater than one gallon.

4. If the flammable liquid has a flash point at or below 80 degrees Fahrenheit, the can will have a yellow band or the name of the dangerous liquid stenciled in yellow.

Personal protective equipment – Protective equipment for your eyes, face, head, and extremities, protective clothing, respiratory devices, and protective shields and barriers, will be provided, and used when hazardous conditions are present.

Hand Tool and Power Tool Safety Policies

All hand tools shall be inventoried. Tools shall be inspected visually prior to use and repaired or replaced if found defective.

Contract Work – All tools shall be inventoried prior to starting the job. The list should include a description of the tools, brand names, size, and quantities.

Servicon Systems Inc., shall follow the policies of its customers or Cal Osha (whichever is more stringent) when they are working at their job sites. Only those tools inspected and approved shall be allowed on the job.

Hand Tools

1. Defective hand tools shall not be used

2. Do not carry sharp tools in pockets on clothing

3. Use hand tools only for their intended purpose

4. Inspect handles of hand tools for cracks, slivers, or other defects

5. Always exchange or repair mushroomed or battered tool before they become dangerous.

Power Tools

1. Removing or tampering with any tool or machine guard, or bypassing any safety devise is prohibited.

2. No employee is permitted to operate any tools, machines, or equipment they are not familiar Revised by CJ – 03/21/2024

with, or have not been specifically trained to operate.

3. Electrical lockout procedures must be followed before working on any machinery. Power tools are no exception.

4. Refer to specific electrical lockout policies and procedures for your work area.

5. All portable electric tools and power cords must be equipped with effective grounds

6. Power actuated tools shall be operated by qualified persons only. The operator must be in possession of a valid operator’s certification card.

7. Keep equipment, tools, material and work areas clean and orderly.

8. Walk, never run while carrying a power tool. Proceed with caution when approaching blind corners and congested areas. Turn off tool before moving from one location to another.

Never operate a machine unless you are qualified and authorized to do so.

Revised by CJ – 03/21/2024

28. SUBSTANCE ABUSE POLICY

PURPOSE

It is the intent and purpose of this policy to provide a safe, productive work environment and to protect the well-being of all company employees and the general public as well as company p roperty.

It is also the intent of the policy guidelines for consistent handling throughout the company regarding drug and alcohol related problems.

POLICY

It is the policy of Servicon Systems Inc. that the use or possession of alcohol or the unlawful possession, use, sale or transfer of drugs, or controlled substances and drug related paraphernalia (except the physician-prescribed use of prescription drugs, verifiable by a current prescription) when on the job, on company property, in company vehicles, o r in personal vehicles on company business is strictly prohibited and shall constitute a violation of company policy and practice subject to disciplinary action up to and including immediate suspension of employment and/or discharge.

Further, any employee under the influence of alcohol, drugs or controlled substances while on the job, on company property, in company vehicles, or in personal vehicles on company business is in violation of company policy and practice and subject to disciplinary action up to and including immediate suspension of employment and/or discharge. "Under the Influence" is defined as: Being unable to perform work in a safe and/or productive manner; being in a physical or mental condition which creates a risk to the safety and well -being of the affected individual, other individuals, the general public or property. Having any detectable level of alcohol, drugs or controlled substances in the body, following a job-related accident may constitute grounds for disciplinary action up to a nd including immediate suspension of employment and/or discharge.

NOTE:

Prescription drugs will be included in the above if it is determined that the employee is unable to perform normal work duties because he/she is under the influence as defined as abo ve.

Revised by CJ – 03/21/2024

DRUG TESTING
As requested by Customer at specific job sites.

1. Pre-employment
Applicants for employment will be given an alcohol, drug and controlled substance screening test as a condition of initial employment. A positive test result for alcohol, drugs or controlled substances (excepting physician-prescribed drugs verifiable by a current prescription) will disqualify an applicant for employment.

2. Active Employees
A. A screening test for the presence of drugs, alcohol and/or controlled substances may be required when the physical condition of an employee is in doubt as evidenced by physical impairment including, but not limited to, lack of coordination, slurred speech, disorientation, etc. which may inhibit an employee from performing his/her job in a correct and safe manner.

B. Any employee involved in a work-related accident or major injury will be tested for alcohol, drugs, and/or controlled substances. Definition of major injury: Death of an employee, loss of consciousness, hospitalization for more than 2 hours other than for observation, fracture, suturing, lost work days.

A positive test result for alcohol, drugs and/or controlled substances (exception for physician- prescribed drugs verifiable by a current prescription) may result in disciplinary action up to and including immediate suspension of employment and/or discharge.

Refusal by any employee to submit to testing, including an appropriate consent for testing, will result in disciplinary action up to and including immediate suspension of employment and/or discharge. Confidentiality will be safeguarded as much as is reasonably possible with regard to discussions and/or testing regarding an employee's use of drugs, alcohol or restricted substances.

VOLUNTARY ACTION
Any employee who volunteers (prior to discovery) the information that he/she has a drug or alcohol abuse problem and thereafter cooperates with the company with regard to treatment and rehabilitation will not be subject to discipline for doing so. It should be fully understood, however, that continued or renewed drug or alcohol abuse after commencement of treatment may result in appropriate disciplinary action, up to and including discharge. Confidentiality will be safeguarded regarding all conversation with management personnel in connection with a voluntary program.

Release of information will be limited to those who need to know to carry out their duties as Supervisors of medical professionals.

Revised by CJ – 03/21/2024

Assistance in locating outside rehabilitation agencies and servi ces is available through Personnel.

Personnel will maintain a current list of Alcohol and Drug Abuse rehabilitation programs. Any employee may consult this list. The Company makes no comment on the qualification of the programs included on this list, and the employee shall be responsible for choosing his or her rehabilitation program. The employee should also consult with their respective group insurance representative as to the availability of insurance coverage for the program, if any.

IMPLEMENTATION

Supervisors are individually responsible for doing their part in maintaining a safe and productive work place. As part of this responsibility all supervisors are expected to report any incidents involving suspected or actual violations of the Drug and Alcohol Abuse policy to Personnel.

If any accident or injury is suspected to be the result of drug or alcohol abuse, the Personnel Office should be notified for purposes of further investigation. A full and complete report on the incident will then be presented to the employee's supervisor for proper disposition.

NOTE:

The Personnel Office must be consulted prior to taking any disciplinary or discharge actions in connection with this policy.

The Personnel Office will notify the Safety Director.

APPROVED: ____________________

APPROVED: ____________________

Revised by CJ – 03/21/2024

EMPLOYEE ASSISTANCE PROGRAM

FOR CHEMICAL/ALCOHOL DEPENDENCE

SERVICON SYSTEMS INC. is committed to providing a safe and productive work environment for all of its employees. All employees are expected to conduct themselves in a manner that assures the protection of rights and the safety of their fellow workers. Occasionally an employee may become involved with a dependence on drugs or alcohol that could have a potentially detrimental effect on themselves and others in the work place. For the employee who recognizes their problem and sincerely wishes to attain treatment for their dependency, the company has established an assistance program. The Company is willing to assist you in obtaining an EAP.

CRITERION

1. Voluntarily request the assistance.

2. Request the assistance prior to any termination action as a result of a violation of work rules or performance requirements.

3. Display a sincere commitment to seeking help to end the depe ndency.

PLAN
When an employee voluntarily requests assistance, the company agrees to:

1. Grant a Leave of Absence without pay equal to the time necessary for the employee to complete an in-patient treatment program at a medical facility.

2. Place the employee in the same or similar job upon their return from Leave of Absence.

3. Continue insurance coverage during the Leave of Absence provided that the employee continues to pay their dependent coverage (if they carry dependent coverage). If no dependent coverage then company will pay employee coverage whenever applicable.

4. Provide consultation and assistance in locating and arranging admission into an appropriate medical facility for treatment.

5. Consider continuing after-care appointments during the employee's work hours.

6. Maintain to the fullest extent possible for the confidentiality of the employee's situation.

Revised by CJ – 03/21/2024

PROCEDURES

1. The employee will make the request for inclusion in the program through their supervisor.

2. A consultation will be held with their Supervisor and Personnel Office.

3. A medical facility and plan will be offered and admission procedures will be effected.

4. The employee will report back to work following discharge with medical clearance and proof of completion.

5. The Supervisor and Personnel will monitor the employee's after -care program.

6. Random testing will be arranged and scheduled through the Safety Director.

Breathalyzer/Breath Test

A Breathalyzer may be used if the company notices any change in work procedures, methods, etc.; results will be used as probable cause to send employee for Drug and Alcohol Screen.

Revised by CJ – 03/21/2024

EMPLOYEE ASSISTANCE PROGRAM

I, ______________________________________________________________________________, do hereby agree to the following:

1. To voluntarily enter an approved in-patient rehabilitation and after-care program for chemical dependency.

2. To sign all forms and releases required to provide the company with verification of completion of the program.

3. To return to work immediately after clearance from the medical facility is obtained.

4. To participate and provide verification of participation in the after -care program.

5. To submit to laboratory testing for the presence of controlled substances for a period of one year at the discretion of the management.

I understand that my failure to comply with any of these stated requirements will nullify my eligibility to participate in the Employee Assistance Program and will jeopardize the rights and protection therein offered to me under the program. I further understand that my failure to comply with any of the above stated requirements may result in disciplinary action up to and including immediate suspension of employment and/or discharge.

__________________________________________________________________________________ Signature of Employee Date

__________________________________________________________________________________ Signature of Employee Date

Revised by CJ – 03/21/2024

PLEASE SIGN AND FORWARD TO PERSONNEL DEPARTMENT

I have read the company drug and alcohol policy and Employee Assistance Program for Chemical/Alcohol Dependence. I understand its meaning and agree to comply with the terms of the policy.

__________________________________________________________________________________ Employee Signature Date

__________________________________________________________________________________ Supervisor Signature Date

SUPERVISOR:

Refusal to sign must be witnessed below.

________________________________ was given a copy of the Drug and Alcohol Policy.

__________________________________________________________________________________ Supervisor Date

__________________________________________________________________________________ Witness Date Revised by CJ – 03/21/2024

29. PERSONAL PROTECTIVE EQUIPMENT

__________________________________________________________________________________ is responsible for the purchase and distribution of personal protective equipment.

Personal protective equipment requirements will be determined based on the hazards and exposures and work environment of each particular worksite.

The purchase of Personal Protective equipment other than work shoes and equipment provided by the union for the employees shall be the responsibility of Servicon Systems Inc. Inc.

Please refer to Sections 25 Hearing Conservation program and Section 24 Respi ratory Protection Program regarding protection from high noise levels and dusts, fumes, vapors, or mists.

Personal Protective equipment could include but not be limited to:

1. Hot gloves

2. Safety Glasses, goggles or shields

3. Ear plugs

4. Respirators

5. Hard hats

6. Vests

7. Latex gloves and CPR masks
Revised by CJ – 03/21/2024

30. DISCIPLINARY PROGRAM

ELEMENTS FOR AN EFFECTIVE PROGRAM

Companies must have a system in place to recognize and reward positive behavior, as well as a disciplinary action plan for negative behavior. The art of balanc ing praise and recognition, with consistent discipline is paramount for a successful disciplinary program. Unfortunately and all too often, Managers tend toward one of two extremes; either reprimanding or disciplining employees, or ignoring obvious violations of rules and regulations.

Managers should ask themselves the following questions when assessing the effectiveness of an organization's disciplinary program:

Is the disciplinary program fair, firm, and consistent?

Do all employees know and understand the rules and regulations?

Are the rules and regulations documented in a written format? Are employees required to sign a document which certifies that they have received a copy of these policies?

Is there evidence that all Managers assist employees in correcting behavior. In other words, do Managers support employees and develop plans and actions for positive change?

Is disciplinary action administered with the same severity to all employees? Are some employees "Written Up" and others not?

A written policy is essential. Written policies and procedures demonstrate that the organization extends the same opportunity to every employee, not just a chosen few.

The goal of an effective disciplinary program should be to provide a system that addresses and corrects dysfunctional behavior, and provides assistance and support to the employee, which will help him/her become a productive member of the organization. Disciplinary actions should be used as a tool, not as a weapon. The supervisor sho uld consider alternatives such as informal counseling, and additional training or coaching. Remember, use the same approach with every employee, consistency is the name of the game.

Revised by CJ – 03/21/2024

DISCIPLINARY POLICIES

The following disciplinary points are offered as a suggestion and should not be implemented without consulting your immediate supervisor, Superintendent or Human Resources.

INFORMAL COACHING AND COUNSELING

PROGRESSIVE DISCIPLINE

VERBAL WARNING

WRITTEN REPRIMAND/WARNING

DISCIPLINARY SUSPENSION

GUIDELINES TO FOLLOW

Managers should apply basic principles and consider a number of variables before, during, and after the administration of any disciplinary action. Some of these guidelines are as follows:

Conduct an Investigation

The supervisor should cond uct a thorough investigation. All facts should be gathered and the appropriate action should be determined which will address and correct the situation.

Documentation

Documentation is the single most important element in the disciplinary process. Documentation should be made of every disciplinary action and placed in the employee's personnel file. Failure to document, in writing will place you and your organization in a very unfavorable position.

Be Firm, Fair and Consistent

Disciplinary action shoul d be applied with the same strength and severity to every employee.

Disciplinary action should be administered to all employees who break the rules. This does not mean disciplining an employee each and every time they make a mistake. Managers must take precautions from being perceived as having favorites. Each employee should be treated with respect.

SUPPORT

Behavioral modification is to assist individuals in changing, altering, and adjusting specific behaviors.

When this goal is achieved, the employee will not feel as if the supervisor has attacked his/her character or personality, but has addressed an issue.

Revised by CJ – 03/21/2024

CONDUCT A DISCIPLINARY CONFERENCE

Review the employee file - this will assist you in assessing any previous disciplinary action taken previously. Prepare the written documentation - Greet the employee in a warm, receptive environment. Begin the discussion - the supervisor should open the discussion and explain what he/she hopes to accomplish during the session. Review your concerns - explain in detail what the problem is and explain how the behavior is affecting the operation and/or organization. Employee Input - ask the employee for their input and give them the opportunity to express the concern from their own perspective. The supervisor should be attentive to the employee’s feelings. Develop an Action Plan - The employee should be asked for a plan of action to correct the behavior. In this process, the supervisor should help the employee develop a specific plan. Conclude the meeting - Express your confidence in the employee, end the meeting with a handshake.

Revised by CJ – 03/21/2024

31. SAFETY TOOLKITS / TAILGATE MEETINGS

INTRODUCTION
This section presents information and an overview to help you prepare and conduct toolkit talks atyour worksites. With the help of the information and reproducible handout sheets provided in thismanual, almost anyone can conduct a toolkit talk.

PREPARING FOR THE SAFETY TOOLKITS
Preparation is the key to a successful toolkit talk. In this case, “success” is marked by a session thatgoes off well, with employees motivated and interested. Preparing for a toolkit talkpresentation canbe as elaborate or as brief as you choose, as can the talk itself. In general, a toolkittalk is defined as ashort safety-training meeting with employees, usually at the start of theshift, andusually including aone – page handout summarizing the safety information covered inthe
talk.

Preparation for the toolkittalk consists of determining the following:

1. Scheduling

2. Who to include

3. What information to cover

4. How to cover the information

5. The handout for the toolkit talk

6. Other materials for the toolkit talk.

SCHEDULING YOUR SAFETY TOOLKITS
You can conduct toolkit talks as frequently as you feel you have time to do so, and you talks can last aslong or as short as your schedule allows. It is recommended to create a regular schedule of some sort,with frequency (once a week, month, year) and duration (usually between five and thirty minutes long).

WHO TO INCLUDE
The next decision you need to make regarding your toolkit talk is who to include. This decision may becase-by-case, depending on the topic you are covering that session, or it may be that each Supervisorprepares his own session for his group of employees, and everyone in the group attends.

However youchoose to conduct your talks, it is best to include only those employees who need the information.

Revised by CJ – 03/21/2024

WHAT INFORMATION TO COVER
toolkit talks are meant to be short and informative so you cannot cover all the relevant information onall topics. So, you must prioritize the information to be covered. Information should be selected basedon applicability to your company’s worksite / environment and regulatory requirements.

HOW TO COVER THE INFORMATION

1. Plan the meeting a week in advance so you are familiar with the topic. Gather hand out literature or other material you intend to use at the meeting. Wherever possible, use actual equipment to illustrate your points. For example; bring broken tools to show how they can cause accidents, or bring protective clothing or other equipment to show their proper use. Be able to lead a discussion and present the talk without reading it.

2. Hold the meeting in your work area or department. Seating space is not absolutely necessary.

A good time to hold the meeting is first thing in the morning or immediately after lunch when the work will not be interrupted and the work area is comparatively quiet.

3. Every week have a meeting, but show your support for job safety everyday.

TIPS FOR SUCCESSFUL MEETINGS

1. Limit each talk to five minutes. Don’t let the meeting turn into a gripe session about unrelated topics.

2. Give recognition. Start the meeting by complimenting your people for some recent good work or by saying something in a positive sense.

3. Give the talk in your own words. Each of these safety topics gives you general information and should be used as references for your discussion. Be sure to customize your talk to specific operations.

4. Get your people to participate. The purpose is to get workers to think about safety problems.

Make the talk a discussion. Have your people name hazards and what to do about them.

Encourage them to offer suggestions for improving safety.

5. Reinforce the positive points brought out during the discussions at the end of the meeting.

OTHER DISCUSSION TOPICS

1. Review injuries that have occurred recently.

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DISCUSSION
What happened?
Why did it happen?
What should have been done?

OTHER DISCUSSION TOPICS

2. Review safety violations that were noted recently.

DISCUSSION
What was the violation?
What hazard did it create?
What injury could have occurred?

OTHER DISCUSSION TOPICS

3. Review the work planned for the week ahead.

DISCUSSION
What hazards are we concerned about?
What safety equipment should be used?
What procedures should be followed?

THE HANDOUT FOR THE SAFETY TOOLKITS
The handout for the session can take some time to prepare if you are starting from scratch. But in this manual there is prepared handout material ready for a Supervisor to copy and distribute to all employees participating in the toolkit talk.

You may not want to use the handout provided as is, it may not be specific enough to you operation, or you may want to include more details about company – specific information than is included for that Revised by CJ – 03/21/2024

particular topic in this manual’s handout. You can always create your own handout, or you may want to add your own company – specific information to the handout provided here. You can take parts of the handouts in this manual and combine them with your own information to create a hybrid handout and still make your job easier.

OTHER MATERIALS FOR THE SAFETY TOOLKITS
In addition to the handouts, you may need to gather other materials for the toolkit talk. Other trainingmaterials may include materials to be used in any demonstrations or exercises, or items you may wantto give employees to keep that are related to the topic, such as a set of earplugs, safety glasses (duringa PPE toolkit talk) or locks and tags (for a lockout/tagout talk). Gather these and anyother materials atleast the day ahead of time, to ensure preparation.

HOW WILL YOU DOCUMENT THE SAFETY TOOLKITS?
You should document the toolkit talk, as you would want to document any training session.

Suchdocumentation provides evidence to Osha of good faith effort in your safety program in case of aninspection. It also provides a record of training in case of injury or lawsuit. To help such documentationthis manual provides a sign- off sheet for each topic’s handout. The sign -off sheet for each topic is foryou to use in documentation and record keeping of employee training on that particular topic with thatparticular handout. Each sign-off sheet is on the flip-side of the handout it goes with lists the pointscovered in the handout for that particular topic, and is labeled “Sign -Off Sheet” at the bottom of thepage. This sheet may be copied to provide you with enough lines for all employees participating to signit.

CONDUCTING THE SAFETY TOOLKITS
If you use the preparation techniques described in this chapter, actually conducting the toolkit talkshould not be too difficult. You will have all the necessary tools already laid out for you.

Revised by CJ – 03/21/2024
Technical Proposal for
Contracted Janitorial Services
Project ID: 4457
Additional Narrative
for
City of Palmdale

RFP NO. 25-002-3400
April 28, 2025
Submitted by: Servicon Systems, Inc.
3965 Landmark Street, Culver City, CA 90232

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

2 Table of Contents
Executive Summary 3
Servicon Differentiators 4
Our Diversity 7
Environmental, Social, and Governance 8
Learning and Development 10
Innovation 11
Awards and Recognition 12

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

3 Executive Summary
Summary of Servicon’s Janitorial Services Program

Servicon is a complex environmental and commercial cleaning company based in Southern California, with our headquarters in Culver City. We are woman-owned, with 52 years of Janitorial experience. We are experts in compliance for a variety of complex environments. Because we are a local, privately held company, we are agile and can make quick decisions that support our people and our clients instead of shareholders. Servicon's strength and success lie in our stringent adherence to our values and the coming together of different ethnic backgrounds, cultures, and beliefs to achieve our purpose: to elevate the industry and provide healthy environments for people to thrive.

People
• Create a passionate and caring culture
• Ensure the training and development of our staff to meet regulatory and industry requirements • Understand and prioritize employee needs to ensure employees feel supported

Processes
• Follow and validate compliance to regulatory and industry standards and each client’s SOP/SOW • Drive constant innovation, be forward looking with technology solutions • Implement change management processes that include all stakeholders

Performance
• Maximize engagement to reduce employee turnover
• Compliance with all SOP/SOW and regulatory and industry standards to ensure we are audit-ready at all times

At Servicon, we understand the core of cleaning complex environments is having the right people. This requires recruiting, hiring, training, and retaining top talent. Our experienced talent acquisition team is local, ensuring we have a pulse on Southern California’s current needs, struggles, and cultures. At the height of the pandemic, when other employers were struggling to find workers, we hired more than 600 employees—41% of whom were employee referrals.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

4 Our primary purpose:

To elevate the industry and provide healthy environments for people to thrive.

Our key differentiators highlight our unique capabilities to serve you.

People Focused Culture
Servicon believes in the philosophy of building a people-focused culture, both with our team and through genuine interactions with clients, quality teams and manufacturing stakeholders. When janitorial technicians understand the importance of their jobs, they are motivated to do great work and strictly follow all client SOPs/SOWs.

Labor costs make up the majority of the janitorial cleaning costs, so fostering a healthy work environment that promotes employee satisfaction and engagement is imperative. We’ve seen first-hand how prioritizing people impacts referral and retention. A part of our successful recruitment is based on our high referral rates.

While what we do for our manufacturing clients is critical and essential, we do it with compassion; this sets Servicon apart. Our carefully selected leaders possess the behavioral skills necessary to manage the janitorial technicians with care and concern for their overall wellbeing.

Servicon’s people-first philosophy is not what we do; it is who we are. With this guiding principle, we seek partners whose values align and build upon our own.

Servicon Differentiators

Incorporated in California in 1973, Servicon is a privately held, woman-owned company. This allows us to offer our
clients maximum customization and flexibility, which sets us apart from our competitors.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

5 Purpose Driven
Servicon is solely focused on elevating the cleaning industry and providing healthy environments for people to thrive. We are also committed to supporting the R+D and manufacturing process so our clients can succeed in their mission. We are an important part of these world changing innovations.

Servicon is not distracted by competing priorities; instead, we focus on cleaning areas within Southern California’s most complex facilities.

Our goal is to become your trusted partner, not an outsourced vendor.

As your partner, Servicon becomes deeply invested in your people, processes, and priorities. We take the time to learn about your unique needs and create sustainable solutions that drive outcomes.

With this goal in mind, we hire, train, and support the right team of people for a successful operation. As a company that lives its purpose of providing healthy environments for people to thrive, each team member lives that passion.

Local
Servicon is headquartered in Culver City, California and uniquely placed in the marketplace to understand the specific needs of City of Palmdale facilities. Our support team and field staff are readily available to provide quick, practical solutions.

Our California-based corporate team supports the execution of day-to-day operations, allowing us to adapt and pivot quickly to the needs of our people and clients. Servicon’s local talent acquisition team has a pulse on the cultures, challenges, and unique needs of Southern California. As a result, we recruit and train talented individuals that not only support their families but help uplift local communities as well.

Servicon lives and works in the heart of your communities. We are right sized to provide system excellence with innovation. We are agile enough to offer a personalized solution for Abbott.

Privately Held
Incorporated in California in 1973, Servicon is a privately held company, allowing us to offer our clients maximum customization and flexibility.

With annual revenues exceeding $110 million and more than 2,000 trained team members, we are large enough to provide world-class service while fostering a caring environment in which people can flourish.

Founded by Richard Mahdesian, an Air Force Veteran, we have almost 52 years of experience providing environmental services.

Servicon is beholden to our clients and people rather than shareholders. Being privately owned allows us to focus on the interests of Abbott and your unique needs. Freedom within a framework ensures the best possible outcomes while prioritizing patient and employee engagement.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

6 Woman-Owned & Operated
Being woman-owned and operated means that Servicon is elevating the industry in diversity, pushing forward with equal opportunity corporately and on every level. Celebrating different cultures, backgrounds, and talents ensures balanced, healthy, and thriving environments for all.

Servicon is approved by the Women's Business Enterprise Council for its WBENC certification. This prestigious, trusted, highly respected women-owned business certification is provided to large firms that are majority-owned, controlled, and operated by women.

Employee/Leadership Engagement and Retention
• Our leadership engagement is something we take pride in, and it shows in our employee net promoter score (eNPS). The average eNPS in America is 26. Servicon’s eNPS is 66.37.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

7 Our Diversity

At Servicon, we celebrate diversity. We appreciate our janitorial technicians, who make up 95% of our diverse workforce. We value and respect them for their vital role on the front line of infection prevention.

We appreciate their dedication to improving the patient experience and their passion for serving others.

Servicon is a woman-owned and operated business based in Southern California. We believe our company’s strength and success lies in the coming together of different ethnic backgrounds, cultures, and beliefs to achieve our mutual purpose—to elevate the industry and provide healthy environments for people to thrive.

Tier I Spend
Servicon is a Southern California-based certified (WBENC) woman-owned business. All dollars spent with Servicon qualify as Tier 1 spend to a woman-owned business.

Current Diverse Suppliers
• RJB Properties • Chemco Products Co. • Monogram It
• Merriweather Holding LLC • Chem-Tel, Inc. • Imber Court Reporters, Inc. • Bielski • Clean Communications • Four Letter Consulting LLC • Smart Party Rents • Clean Sweep Supply Co. • Lauter Communications • All In One Poster Co., Inc • IMI Data Search, Inc. • Marketing Maven

Membership in Local/National Diverse Supplier Councils
• California Diversity Council

Current Outreach Program
We look for small, minority-owned businesses with which to conduct business. We primarily find these partners through the Servicon supplies division. We source from multiple vendors for cleaning supplies and equipment lines. Our staff has a process of ensuring that at least one of the three to four vendors we choose for each line falls under our diversity profile.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

8 Environmental, Social, and Governance
At Servicon, Environmental, Social, and Governance (ESG) is not about stockholders or investments; it’s about doing the right things. We use the three components below to ensure our culture and the actions we take have a positive impact on the environment as well as our clients, employees, and the communities we serve.

• Environmental. When we look to reduce our negative impact on the environment, we consider the resources procured, used, and wasted and the pollution emitted. With a LEED Platinum-certified training center and numerous sustainability awards under our belt, we can help Abbott adopt additional environmentally friendly practices.

• Social. To be genuinely sustainable requires a culture that respects and embraces the authenticity of all stakeholders. We strive to always do the right thing with our employees and partners. We embrace and actively promote positivity and progress in such areas as occupational health and safety, diversity, non-discrimination, equal opportunity, training, and education. We bring these same values to the communities in which we work and live.

• Governance. We pride ourselves on the efficiency of our internal processes and procedures as well as our strong leadership. Our founder, Richard Mahdesian, built Servicon through his hard work, diligence, and significant business acumen. He focused on helping his workers thrive. His goal was to help them be financially stable, to be able to buy their first homes and send their children to college.

Our current president and CEO, Laurie Sewell, has continued this firm yet caring leadership. She believes that empowering individuals and providing them with pathways to continued growth creates an experienced and dedicated team and exceptional leaders.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

9 Servicon Cares is the philanthropic arm of Servicon dedicated solely to giving back to the communities of our employees. At Servicon, we believe in giving back to the communities that have been essential to us, our workforce, and their families. We do this through our foundation, Servicon Cares.

• Our vision is to inspire systematic change and foster the development of these communities through funding, volunteering, participation, and skill-building.

• We provide resources, including engagement, volunteerism, and scholarships/financial aid to help marginalized groups thrive on their own terms.

• We align with organizations focused on education, civic engagement, and social justice and support organizations that empower communities to stabilize and thrive.

• We give to those in need to create a better, more just environment.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

10 Learning and Development
Servicon takes pride in its investment in people and training. Proper new-hire onboarding and continuous training are key to the extraordinary service and results we deliver. In all our training, we emphasize the "what" and "how" as well as the critical "why." Our janitorial technicians are empowered and well prepared for their roles maintaining regulatory and industry standards and each client’s SOP/SOW, which drives engagement and consistency in approaches and outcomes.

Continuous Learning for Servicon Managers includes:
• Individualized development plans
• Monthly spot training
• Local educational resources
• Servicon Learning Hub—a state-of-the-art online LMS available 24/7.

Servicon also offers extensive training for frontline employees ranging from technical and safety fundamentals to empathy and compassion. This training has been proven to impact results in employee recruitment, engagement, and retention. We look forward to sharing this training with you.

Specialized Janitorial Training for Assigned Personnel

In addition to leadership training and general onboarding and orientation with specialized instruction required by Federal, State and Local Regulations, as a minimum, we provide an in-depth training on technical and safety fundamentals customized to each client’s janitorial requirements.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

11 Innovation

At Servicon, we are enthusiastic about staying abreast of the latest developments that support effective infection prevention for our clients. Our company vision is to elevate the industry, and innovation drives much of that movement. We keep on top of innovations via our Innovation Council, which relies on science- backed research to properly vet, monitor, and approve strict safety and infection prevention effectiveness standards while reducing costs for our clients. Below are a few key innovations we are currently using or evaluating.

i-mop Floor Scrubber®
A sweeper mop and wet/dry vacuum all in one that reduces labor by 70% and produces 90% cleaner surfaces compared to conventional mopping.

Square Scrub Pivot®
Orbital floor machine cleans, scrubs, polishes, and
strips floors efficiently and effectively—either dry or with water—using no harsh chemicals (although
chemicals can be used). It works on all types of
flooring—from wood and tile to LTV and concrete.

Doodle Scrub®
Weighs only 21 pounds to get into smaller areas,
delivers the same psi as the larger Square Scrub
Pivot, and cleans up to 500 square feet per floor
pad.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

12 Awards and Recognition
Servicon has received the following awards and industry recognition during the past five (5) years:

• “Best Vendor Partner” by Exxon Mobil, a current
client (rated by Exxon Mobil employees globally) Also
numerous Companies safety awards & GREF
Excellence Awards.
• Boeing: Outstanding Conservation Achievement
Award
• BOMA: Numerous TOBY Awards
• CBRE: Numerous TOBY Awards
• Inc. 500: One of the Fastest Growing Private
Companies in the U.S.
• LABJ: Best Place to Work
• LABJ: Fastest Growing Private Company Award
• RAYTHEON: Recycling Award
• The Ashkin Group Green Champion Award
• Servicon has achieved Tier 2 (the highest level)
Sustainable Business Certification from City of Culver
City (our business location). This certification is an
indicator of two qualities. First, our company meets
all the criteria of a sustainable business in Energy,
Water & Waste reduction, Pollution Prevention, and
Transportation. Additionally, Servicon demonstrates
innovative practices in environmental stewardship,
community engagement, and social responsibility.

Additional Narrative for City of Palmdale - RFP NO. 25-002-3400

13 EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost

PARK SITES
1 Ana Verde Park 2820 Greenbrier St Park Restrooms 144 1 7 365 12 16.57 16.57 115.98 503.98 6,047.71 2 Courson Park (2 times per day) 38226 10th St E Park Restrooms 156 2 14 365 12 32.70 65.41 915.71 1,989.50 23,873.98 3 Desert Sands Park (2 times per day) 39117 3rd St E Park Restrooms 243 2 14 365 12 32.79 65.59 918.23 1,994.97 23,939.61 4 Domenic Massari Park (2 times per day) 37716 55th St E Park Restrooms 230 2 14 365 12 32.78 65.56 917.86 1,994.15 23,929.80 5 Foothill Park 2525 The Groves Park Restrooms 144 1 7 365 12 16.57 16.57 115.98 503.98 6,047.71 6 Joshua Hills Park 3110 Fairfield Park Restrooms 144 1 7 365 12 16.57 16.57 115.98 503.98 6,047.71 7 Manzanita Heights Park 431 Mesa Verde Ave. Park Restrooms 144 1 7 365 12 16.57 16.57 115.98 503.98 6,047.71 8 Marie Kerr Park - Best of the West Softball Complex 2723-G W. Rancho Vista Blvd Park Restrooms 1,050 1 7 365 12 34.71 34.71 242.99 1,055.85 12,670.25 9 Marie Kerr Park (2 times per day) 39700 30th St W Park Restrooms 680 2 14 365 12 65.79 131.58 1,842.08 4,002.13 48,025.57 10 McAdam Park (2 times per day) 38115 30th St E Park Restrooms 144 2 14 365 12 32.69 65.38 915.37 1,988.74 23,864.93 11 Pelona Vista Park North (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 65.91 131.82 1,845.55 4,009.67 48,116.10 12 Pelona Vista Park South (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 65.91 131.82 1,845.55 4,009.67 48,116.10 13 Rancho Vista Park 40437 35th St W Park Restrooms 102 1 7 365 12 16.48 16.48 115.38 501.34 6,016.02 14 Sam Yellen Park (2 times per day) 5100 E Ave S Park Restrooms 120 2 14 365 12 32.67 65.33 914.67 1,987.24 23,846.82

FACILITY SITES
15 City Hall (All Suites) 38300 Sierra Hwy, Suites A-D Prof Office Bldg, Lobby, Restrooms, Multi-Use (Ste. B) 27,200 1 5 260 12 207.95 207.95 1,039.74 4,505.52 54,066.22 16 Desert Sands Recreation Building 39117 3rd St E Multi-Use, Restrooms 8,400 1 5 260 12 64.22 64.22 321.09 1,391.41 16,696.92 17 Development Services 38250 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 34,000 1 5 260 12 259.93 259.93 1,299.67 5,631.90 67,582.78 18 Joe Davies Heritage Air Park Office Trailer 2001 E Ave P Prof Office Bldg 640 1 3 156 12 6.13 6.13 18.39 79.70 956.41 19 Joe Davies Heritage Air Park Shop 2001 E Ave P Multi-Use, Restrooms 5,700 1 3 156 12 54.60 54.60 163.81 709.84 8,518.03 20 Legacy Commons 930 E Ave Q-9 Wood Flooring, Kitchen, Restrooms, Multi-Use 18,376 1 7 365 12 54.25 54.25 379.76 1,650.13 19,801.62 21 Library (1 time per day) 700 E Plamdale Blvd Multi-Use, Kitchen, Restrooms 12,650 1 7 365 12 85.99 85.99 601.91 2,615.46 31,385.50 21a Library (2 times per day) 700 E Plamdale Blvd Restrooms only 190 2 7 365 12 1.10 2.19 15.33 66.62 799.47 22 Marie Kerr Park Community Room 39700 30th St W Multi-Use 2,810 1 7 365 12 19.10 19.10 133.71 580.98 6,971.80 23 Marie Kerr Park Recreation Center 2723-A Rancho Vista Blvd Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 129.15 129.15 904.06 3,928.36 47,140.28 24 Oasis Recreation Center 3850-A E Ave S Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 129.15 129.15 904.06 3,928.36 47,140.28 25 Palmdale Playhouse, C.A.B. and Green Room 38334 10th St E Kitchen/Bar, Restrooms, Multi-Use 22,660 1 7 365 12 154.03 154.03 1,078.21 4,685.08 56,220.98 26 Parks & Recreation 827 E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 38.23 38.23 191.13 828.22 9,938.64 27 Public Safety Building (AERO) 38256 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 17,500 1 5 260 12 133.79 133.79 668.95 2,898.77 34,785.25 28 Maintenance Yard Admininstration 39110 3rd St E, Suite C Prof Office Bldg, Lobby, Restrooms 6,688 1 5 260 12 51.13 51.13 255.65 1,107.83 13,293.93 29 Maintenance Yard Fleet Shop 39110 3rd St E, Suite B Kitchen/Bar, Restrooms, Multi-Use 2,100 1 5 260 12 16.05 16.05 80.27 347.85 4,174.23 30 Maintenance Yard Traffic House 39110 3rd St E, Suite A Prof Office Bldg, Lobby, Restrooms 3,200 1 5 260 12 24.46 24.46 122.32 530.06 6,360.73 31 Maintenance Yard Warehouse 39110 3rd St E, Suite D Kitchen/Bar, Multi-Use, Restrooms 2,600 1 5 260 12 19.88 19.88 99.39 430.67 5,168.09 32 Records Center 616 E Ave P Multi-Use, Restrooms 4,500 1 5 260 12 34.40 34.40 172.01 745.40 8,944.78 33 S.A.V.E.S. 1002 E Ave Q-12 Kitchen/Bar, Restrooms, Multi-Use 9,700 1 5 260 12 74.16 74.16 370.79 1,606.75 19,280.97 34 State Assembly Office 823-B E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 38.23 38.23 191.13 828.22 9,938.64 YEAR 1: FISCAL YEAR 2025-26

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost
YEAR 1: FISCAL YEAR 2025-26

AQUATIC FACILITIES & WATER PARK
35 Courson Pool Building 38226 10th St E Pool 4,590 1 6 312 12 32.87 32.87 197.23 854.66 10,255.89 36 Marie Kerr Pool Building 2723-C W Rancho Vista Blvd Pool 3,525 1 6 312 12 25.24 25.24 151.47 656.35 7,876.25 37 McAdam Pool Building 38115 30th St E Pool 4,160 1 6 312 12 29.79 29.79 178.75 774.59 9,295.10 38 Oasis Pool Building 3850-C E AveS Pool 3,525 1 6 312 12 25.24 25.24 151.47 656.35 7,876.25 39 Drytown Water Park Administration (Off-Season: Oct 01 - Mar 31) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 2 52 6 26.05 26.05 52.09 112.87 677.21 40 Drytown Water Park Administration (In-Season: Apr 01 - Sept 30) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 7 182 6 12.03 12.03 84.18 182.40 1,094.39 41 Drytown Water Park Kitchen Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 45 1 7 182 6 32.82 32.82 229.73 497.75 2,986.51 42 Drytown Water Park Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 1,308 1 7 182 6 38.05 38.05 266.38 577.15 3,462.90 43 Drytown Water Park Slide Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 63 1 7 182 6 32.89 32.89 230.25 498.88 2,993.30

TRANSIT SITES
44 Palmdale Transportation Center (1 time per day) 39000 Clock Tower Plaza Dr Palmdale Transportation Center (including restrooms) 6,037 1 7 365 12 41.04 41.04 287.25 1,248.18 14,978.20 44a Palmdale Transportation Center (4 times per day) 39000 Clock Tower Plaza Dr Restrooms only 291 4 28 365 12 118.42 473.67 13,262.64 14,407.33 172,887.94

JOB CENTER
45 America’s Job Center of California 38510 Sierra Hwy Multi-Use, Restrooms, Kitchen 10,977 1 5 260 12 83.92 83.92 419.60 1,818.27 21,819.30

NEIGHBORHOOD HOUSES
46 Manzanita Neighborhood Center 38627 32nd St E Multi-Use, Restrooms 1,064 1 5 260 12 32.73 32.73 163.67 709.26 8,511.07 47 Tumbleweed Neighborhood House 1129 E Ave R-4 Multi-Use, Restrooms 1,562 1 5 260 12 34.18 34.18 170.90 740.56 8,886.76 48 Yucca Neighborhood House 503 E Ave Q-3 Multi-Use, Restrooms 1,732 1 5 260 12 34.67 34.67 173.37 751.25 9,015.00 GRAND TOTAL 273,400 3,392.20 35,967.68 89,132.16 1,058,371.65 Formula Key
Price per Visit: VENDOR/BIDDER ENTRY
Price per Day: Price per Visit * Cleanings per Day
Price per Week: Price per Day * Cleanings Visits per Week Monthly Price: (Price per Day * Cleaning Days per Year) / 12

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning Visits
per Week
Cleaning Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost

PARK SITES
1 Ana Verde Park 2820 Greenbrier St Park Restrooms 144 1 7 365 12 17.56 17.56 122.94 534.21 6,410.57 2 Courson Park (2 times per day) 38226 10th St E Park Restrooms 156 2 14 365 12 34.67 69.33 970.66 2,108.87 25,306.42 3 Desert Sands Park (2 times per day) 39117 3rd St E Park Restrooms 243 2 14 365 12 34.76 69.52 973.33 2,114.67 25,375.99 4 Domenic Massari Park (2 times per day) 37716 55th St E Park Restrooms 230 2 14 365 12 34.75 69.49 972.93 2,113.80 25,365.59 5 Foothill Park 2525 The Groves Park Restrooms 144 1 7 365 12 17.56 17.56 122.94 534.21 6,410.57 6 Joshua Hills Park 3110 Fairfield Park Restrooms 144 1 7 365 12 17.56 17.56 122.94 534.21 6,410.57 7 Manzanita Heights Park 431 Mesa Verde Ave. Park Restrooms 144 1 7 365 12 17.56 17.56 122.94 534.21 6,410.57 8 Marie Kerr Park - Best of the West Softball Complex 2723-G W. Rancho Vista Blvd Park Restrooms 1,050 1 7 365 12 36.80 36.80 257.57 1,119.21 13,430.47 9 Marie Kerr Park (2 times per day) 39700 30th St W Park Restrooms 680 2 14 365 12 69.74 139.47 1,952.60 4,242.26 50,907.11 10 McAdam Park (2 times per day) 38115 30th St E Park Restrooms 144 2 14 365 12 34.65 69.31 970.29 2,108.07 25,296.82 11 Pelona Vista Park North (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 69.87 139.73 1,956.28 4,250.26 51,003.07 12 Pelona Vista Park South (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 69.87 139.73 1,956.28 4,250.26 51,003.07 13 Rancho Vista Park 40437 35th St W Park Restrooms 102 1 7 365 12 17.47 17.47 122.30 531.42 6,376.98 14 Sam Yellen Park (2 times per day) 5100 E Ave S Park Restrooms 120 2 14 365 12 34.63 69.25 969.55 2,106.47 25,277.63

FACILITY SITES
15 City Hall (All Suites) 38300 Sierra Hwy, Suites A-D Prof Office Bldg, Lobby, Restrooms, Multi-Use (Ste. B) 27,200 1 5 260 12 220.42 220.42 1,102.12 4,775.85 57,310.20 16 Desert Sands Recreation Building 39117 3rd St E Multi-Use, Restrooms 8,400 1 5 260 12 68.07 68.07 340.36 1,474.89 17,698.74 17 Development Services 38250 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 34,000 1 5 260 12 275.53 275.53 1,377.65 5,969.81 71,637.75 18 Joe Davies Heritage Air Park Office Trailer 2001 E Ave P Prof Office Bldg 640 1 3 156 12 6.50 6.50 19.50 84.48 1,013.79 19 Joe Davies Heritage Air Park Shop 2001 E Ave P Multi-Use, Restrooms 5,700 1 3 156 12 57.88 57.88 173.64 752.43 9,029.11 20 Legacy Commons 930 E Ave Q-9 Wood Flooring, Kitchen, Restrooms, Multi-Use 18,376 1 7 365 12 57.51 57.51 402.54 1,749.14 20,989.71 21 Library (1 time per day) 700 E Plamdale Blvd Multi-Use, Kitchen, Restrooms 12,650 1 7 365 12 91.15 91.15 638.03 2,772.39 33,268.63 21a Library (2 times per day) 700 E Plamdale Blvd Restrooms only 190 2 7 365 12 1.16 2.32 16.25 70.62 847.44 22 Marie Kerr Park Community Room 39700 30th St W Multi-Use 2,810 1 7 365 12 20.25 20.25 141.73 615.84 7,390.11 23 Marie Kerr Park Recreation Center 2723-A Rancho Vista Blvd Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 136.90 136.90 958.30 4,164.06 49,968.69 24 Oasis Recreation Center 3850-A E Ave S Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 136.90 136.90 958.30 4,164.06 49,968.69 25 Palmdale Playhouse, C.A.B. and Green Room 38334 10th St E Kitchen/Bar, Restrooms, Multi-Use 22,660 1 7 365 12 163.27 163.27 1,142.90 4,966.19 59,594.24 26 Parks & Recreation 827 E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 40.52 40.52 202.60 877.91 10,534.96 27 Public Safety Building (AERO) 38256 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 17,500 1 5 260 12 141.82 141.82 709.08 3,072.70 36,872.37 28 Maintenance Yard Admininstration 39110 3rd St E, Suite C Prof Office Bldg, Lobby, Restrooms 6,688 1 5 260 12 54.20 54.20 270.99 1,174.30 14,091.57 29 Maintenance Yard Fleet Shop 39110 3rd St E, Suite B Kitchen/Bar, Restrooms, Multi-Use 2,100 1 5 260 12 17.02 17.02 85.09 368.72 4,424.68 30 Maintenance Yard Traffic House 39110 3rd St E, Suite A Prof Office Bldg, Lobby, Restrooms 3,200 1 5 260 12 25.93 25.93 129.66 561.86 6,742.38 31 Maintenance Yard Warehouse 39110 3rd St E, Suite D Kitchen/Bar, Multi-Use, Restrooms 2,600 1 5 260 12 21.07 21.07 105.35 456.52 5,478.18 32 Records Center 616 E Ave P Multi-Use, Restrooms 4,500 1 5 260 12 36.47 36.47 182.34 790.12 9,481.47 33 S.A.V.E.S. 1002 E Ave Q-12 Kitchen/Bar, Restrooms, Multi-Use 9,700 1 5 260 12 78.61 78.61 393.04 1,703.15 20,437.83 34 State Assembly Office 823-B E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 40.52 40.52 202.60 877.91 10,534.96 YEAR 2: FISCAL YEAR 2026-27

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning Visits
per Week
Cleaning Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost
YEAR 2: FISCAL YEAR 2026-27

AQUATIC FACILITIES & WATER PARK
35 Courson Pool Building 38226 10th St E Pool 4,590 1 6 312 12 34.84 34.84 209.06 905.94 10,871.24 36 Marie Kerr Pool Building 2723-C W Rancho Vista Blvd Pool 3,525 1 6 312 12 26.76 26.76 160.55 695.74 8,348.83 37 McAdam Pool Building 38115 30th St E Pool 4,160 1 6 312 12 31.58 31.58 189.48 821.07 9,852.80 38 Oasis Pool Building 3850-C E AveS Pool 3,525 1 6 312 12 26.76 26.76 160.55 695.74 8,348.83 39 Drytown Water Park Administration (Off-Season: Oct 01 - Mar 31) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 2 52 6 27.61 27.61 55.22 119.64 717.84 40 Drytown Water Park Administration (In-Season: Apr 01 - Sept 30) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 7 182 6 12.75 12.75 89.23 193.34 1,160.05 41 Drytown Water Park Kitchen Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 45 1 7 182 6 34.79 34.79 243.52 527.62 3,165.70 42 Drytown Water Park Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 1,308 1 7 182 6 40.34 40.34 282.36 611.78 3,670.68 43 Drytown Water Park Slide Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 63 1 7 182 6 34.87 34.87 244.07 528.82 3,172.90

TRANSIT SITES
44 Palmdale Transportation Center (1 time per day) 39000 Clock Tower Plaza Dr Palmdale Transportation Center (including restrooms) 6,037 1 7 365 12 43.50 43.50 304.49 1,323.07 15,876.89 44a Palmdale Transportation Center (4 times per day) 39000 Clock Tower Plaza Dr Restrooms only 291 4 28 365 12 125.52 502.09 14,058.39 15,271.77 183,261.22

JOB CENTER
45 America’s Job Center of California 38510 Sierra Hwy Multi-Use, Restrooms, Kitchen 10,977 1 5 260 12 88.96 88.96 444.78 1,927.37 23,128.46

NEIGHBORHOOD HOUSES
46 Manzanita Neighborhood Center 38627 32nd St E Multi-Use, Restrooms 1,064 1 5 260 12 34.70 34.70 173.49 751.81 9,021.74 47 Tumbleweed Neighborhood House 1129 E Ave R-4 Multi-Use, Restrooms 1,562 1 5 260 12 36.23 36.23 181.15 785.00 9,419.96 48 Yucca Neighborhood House 503 E Ave Q-3 Multi-Use, Restrooms 1,732 1 5 260 12 36.75 36.75 183.77 796.33 9,555.90 GRAND TOTAL 273,400 3,595.73 38,125.74 94,480.09 1,121,873.95 Formula Key
Price per Visit: VENDOR/BIDDER ENTRY
Price per Day: Price per Visit * Cleanings per Day
Price per Week: Price per Day * Cleanings Visits per Week Monthly Price: (Price per Day * Cleaning Days per Year) / 12

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost

PARK SITES
1 Ana Verde Park 2820 Greenbrier St Park Restrooms 144 1 7 365 12 18.62 18.62 130.34 566.36 6,796.30 2 Courson Park (2 times per day) 38226 10th St E Park Restrooms 156 2 14 365 12 36.75 73.50 1,029.00 2,235.63 26,827.50 3 Desert Sands Park (2 times per day) 39117 3rd St E Park Restrooms 243 2 14 365 12 36.85 73.70 1,031.80 2,241.71 26,900.50 4 Domenic Massari Park (2 times per day) 37716 55th St E Park Restrooms 230 2 14 365 12 36.83 73.66 1,031.24 2,240.49 26,885.90 5 Foothill Park 2525 The Groves Park Restrooms 144 1 7 365 12 18.62 18.62 130.34 566.36 6,796.30 6 Joshua Hills Park 3110 Fairfield Park Restrooms 144 1 7 365 12 18.62 18.62 130.34 566.36 6,796.30 7 Manzanita Heights Park 431 Mesa Verde Ave. Park Restrooms 144 1 7 365 12 18.62 18.62 130.34 566.36 6,796.30 8 Marie Kerr Park - Best of the West Softball Complex 2723-G W. Rancho Vista Blvd Park Restrooms 1,050 1 7 365 12 39.00 39.00 273.00 1,186.25 14,235.00 9 Marie Kerr Park (2 times per day) 39700 30th St W Park Restrooms 680 2 14 365 12 73.92 147.84 2,069.76 4,496.80 53,961.60 10 McAdam Park (2 times per day) 38115 30th St E Park Restrooms 144 2 14 365 12 36.73 73.46 1,028.44 2,234.41 26,812.90 11 Pelona Vista Park North (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 74.06 148.12 2,073.68 4,505.32 54,063.80 12 Pelona Vista Park South (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 74.06 148.12 2,073.68 4,505.32 54,063.80 13 Rancho Vista Park 40437 35th St W Park Restrooms 102 1 7 365 12 18.52 18.52 129.64 563.32 6,759.80 14 Sam Yellen Park (2 times per day) 5100 E Ave S Park Restrooms 120 2 14 365 12 36.70 73.40 1,027.60 2,232.58 26,791.00

FACILITY SITES
15 City Hall (All Suites) 38300 Sierra Hwy, Suites A-D Prof Office Bldg, Lobby, Restrooms, Multi-Use (Ste. B) 27,200 1 5 260 12 233.65 233.65 1,168.25 5,062.42 60,749.00 16 Desert Sands Recreation Building 39117 3rd St E Multi-Use, Restrooms 8,400 1 5 260 12 72.16 72.16 360.80 1,563.47 18,761.60 17 Development Services 38250 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 34,000 1 5 260 12 292.06 292.06 1,460.30 6,327.97 75,935.60 18 Joe Davies Heritage Air Park Office Trailer 2001 E Ave P Prof Office Bldg 640 1 3 156 12 6.89 6.89 20.67 89.57 1,074.84 19 Joe Davies Heritage Air Park Shop 2001 E Ave P Multi-Use, Restrooms 5,700 1 3 156 12 61.35 61.35 184.05 797.55 9,570.60 20 Legacy Commons 930 E Ave Q-9 Wood Flooring, Kitchen, Restrooms, Multi-Use 18,376 1 7 365 12 60.96 60.96 426.72 1,854.20 22,250.40 21 Library (1 time per day) 700 E Plamdale Blvd Multi-Use, Kitchen, Restrooms 12,650 1 7 365 12 96.62 96.62 676.34 2,938.86 35,266.30 21a Library (2 times per day) 700 E Plamdale Blvd Restrooms only 190 2 7 365 12 1.23 2.46 17.22 74.83 897.90 22 Marie Kerr Park Community Room 39700 30th St W Multi-Use 2,810 1 7 365 12 21.46 21.46 150.22 652.74 7,832.90 23 Marie Kerr Park Recreation Center 2723-A Rancho Vista Blvd Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 145.11 145.11 1,015.77 4,413.76 52,965.15 24 Oasis Recreation Center 3850-A E Ave S Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 145.11 145.11 1,015.77 4,413.76 52,965.15 25 Palmdale Playhouse, C.A.B. and Green Room 38334 10th St E Kitchen/Bar, Restrooms, Multi-Use 22,660 1 7 365 12 173.07 173.07 1,211.49 5,264.21 63,170.55 26 Parks & Recreation 827 E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 42.95 42.95 214.75 930.58 11,167.00 27 Public Safety Building (AERO) 38256 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 17,500 1 5 260 12 150.33 150.33 751.65 3,257.15 39,085.80 28 Maintenance Yard Admininstration 39110 3rd St E, Suite C Prof Office Bldg, Lobby, Restrooms 6,688 1 5 260 12 57.45 57.45 287.25 1,244.75 14,937.00 29 Maintenance Yard Fleet Shop 39110 3rd St E, Suite B Kitchen/Bar, Restrooms, Multi-Use 2,100 1 5 260 12 18.04 18.04 90.20 390.87 4,690.40 30 Maintenance Yard Traffic House 39110 3rd St E, Suite A Prof Office Bldg, Lobby, Restrooms 3,200 1 5 260 12 27.49 27.49 137.45 595.62 7,147.40 31 Maintenance Yard Warehouse 39110 3rd St E, Suite D Kitchen/Bar, Multi-Use, Restrooms 2,600 1 5 260 12 22.33 22.33 111.65 483.82 5,805.80 32 Records Center 616 E Ave P Multi-Use, Restrooms 4,500 1 5 260 12 38.66 38.66 193.30 837.63 10,051.60 33 S.A.V.E.S. 1002 E Ave Q-12 Kitchen/Bar, Restrooms, Multi-Use 9,700 1 5 260 12 83.32 83.32 416.60 1,805.27 21,663.20 34 State Assembly Office 823-B E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 42.95 42.95 214.75 930.58 11,167.00 YEAR 3: FISCAL YEAR 2027-28

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost
YEAR 3: FISCAL YEAR 2027-28

AQUATIC FACILITIES & WATER PARK
35 Courson Pool Building 38226 10th St E Pool 4,590 1 6 312 12 36.93 36.93 221.58 960.18 11,522.16 36 Marie Kerr Pool Building 2723-C W Rancho Vista Blvd Pool 3,525 1 6 312 12 28.36 28.36 170.16 737.36 8,848.32 37 McAdam Pool Building 38115 30th St E Pool 4,160 1 6 312 12 33.47 33.47 200.82 870.22 10,442.64 38 Oasis Pool Building 3850-C E AveS Pool 3,525 1 6 312 12 28.36 28.36 170.16 737.36 8,848.32 39 Drytown Water Park Administration (Off-Season: Oct 01 - Mar 31) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 2 52 6 29.27 29.27 58.54 126.84 761.02 40 Drytown Water Park Administration (In-Season: Apr 01 - Sept 30) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 7 182 6 13.51 13.51 94.57 204.90 1,229.41 41 Drytown Water Park Kitchen Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 45 1 7 182 6 36.88 36.88 258.16 559.35 3,356.08 42 Drytown Water Park Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 1,308 1 7 182 6 42.76 42.76 299.32 648.53 3,891.16 43 Drytown Water Park Slide Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 63 1 7 182 6 36.96 36.96 258.72 560.56 3,363.36

TRANSIT SITES
44 Palmdale Transportation Center (1 time per day) 39000 Clock Tower Plaza Dr Palmdale Transportation Center (including restrooms) 6,037 1 7 365 12 46.11 46.11 322.77 1,402.51 16,830.15 44a Palmdale Transportation Center (4 times per day) 39000 Clock Tower Plaza Dr Restrooms only 291 4 28 365 12 133.05 532.20 14,901.60 16,187.75 194,253.00

JOB CENTER
45 America’s Job Center of California 38510 Sierra Hwy Multi-Use, Restrooms, Kitchen 10,977 1 5 260 12 94.29 94.29 471.45 2,042.95 24,515.40

NEIGHBORHOOD HOUSES
46 Manzanita Neighborhood Center 38627 32nd St E Multi-Use, Restrooms 1,064 1 5 260 12 36.78 36.78 183.90 796.90 9,562.80 47 Tumbleweed Neighborhood House 1129 E Ave R-4 Multi-Use, Restrooms 1,562 1 5 260 12 38.40 38.40 192.00 832.00 9,984.00 48 Yucca Neighborhood House 503 E Ave Q-3 Multi-Use, Restrooms 1,732 1 5 260 12 38.96 38.96 194.80 844.13 10,129.60 GRAND TOTAL 273,400 3,811.46 40,412.95 100,148.39 1,189,179.61 Formula Key
Price per Visit: VENDOR/BIDDER ENTRY
Price per Day: Price per Visit * Cleanings per Day
Price per Week: Price per Day * Cleanings Visits per Week Monthly Price: (Price per Day * Cleaning Days per Year) / 12

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost

PARK SITES
1 Ana Verde Park 2820 Greenbrier St Park Restrooms 144 1 7 365 12 19.74 19.74 138.16 600.34 7,204.08 2 Courson Park (2 times per day) 38226 10th St E Park Restrooms 156 2 14 365 12 38.96 77.91 1,090.74 2,369.76 28,437.15 3 Desert Sands Park (2 times per day) 39117 3rd St E Park Restrooms 243 2 14 365 12 39.06 78.12 1,093.71 2,376.21 28,514.53 4 Domenic Massari Park (2 times per day) 37716 55th St E Park Restrooms 230 2 14 365 12 39.04 78.08 1,093.11 2,374.92 28,499.05 5 Foothill Park 2525 The Groves Park Restrooms 144 1 7 365 12 19.74 19.74 138.16 600.34 7,204.08 6 Joshua Hills Park 3110 Fairfield Park Restrooms 144 1 7 365 12 19.74 19.74 138.16 600.34 7,204.08 7 Manzanita Heights Park 431 Mesa Verde Ave. Park Restrooms 144 1 7 365 12 19.74 19.74 138.16 600.34 7,204.08 8 Marie Kerr Park - Best of the West Softball Complex 2723-G W. Rancho Vista Blvd Park Restrooms 1,050 1 7 365 12 41.34 41.34 289.38 1,257.43 15,089.10 9 Marie Kerr Park (2 times per day) 39700 30th St W Park Restrooms 680 2 14 365 12 78.36 156.71 2,193.95 4,766.61 57,199.30 10 McAdam Park (2 times per day) 38115 30th St E Park Restrooms 144 2 14 365 12 38.93 77.87 1,090.15 2,368.47 28,421.67 11 Pelona Vista Park North (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 78.50 157.01 2,198.10 4,775.64 57,307.63 12 Pelona Vista Park South (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 78.50 157.01 2,198.10 4,775.64 57,307.63 13 Rancho Vista Park 40437 35th St W Park Restrooms 102 1 7 365 12 19.63 19.63 137.42 597.12 7,165.39 14 Sam Yellen Park (2 times per day) 5100 E Ave S Park Restrooms 120 2 14 365 12 38.90 77.80 1,089.26 2,366.54 28,398.46

FACILITY SITES
15 City Hall (All Suites) 38300 Sierra Hwy, Suites A-D Prof Office Bldg, Lobby, Restrooms, Multi-Use (Ste. B) 27,200 1 5 260 12 247.67 247.67 1,238.35 5,366.16 64,393.94 16 Desert Sands Recreation Building 39117 3rd St E Multi-Use, Restrooms 8,400 1 5 260 12 76.49 76.49 382.45 1,657.27 19,887.30 17 Development Services 38250 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 34,000 1 5 260 12 309.58 309.58 1,547.92 6,707.64 80,491.74 18 Joe Davies Heritage Air Park Office Trailer 2001 E Ave P Prof Office Bldg 640 1 3 156 12 7.30 7.30 21.91 94.94 1,139.33 19 Joe Davies Heritage Air Park Shop 2001 E Ave P Multi-Use, Restrooms 5,700 1 3 156 12 65.03 65.03 195.09 845.40 10,144.84 20 Legacy Commons 930 E Ave Q-9 Wood Flooring, Kitchen, Restrooms, Multi-Use 18,376 1 7 365 12 64.62 64.62 452.32 1,965.45 23,585.42 21 Library (1 time per day) 700 E Plamdale Blvd Multi-Use, Kitchen, Restrooms 12,650 1 7 365 12 102.42 102.42 716.92 3,115.19 37,382.28 21a Library (2 times per day) 700 E Plamdale Blvd Restrooms only 190 2 7 365 12 1.30 2.61 18.25 79.31 951.77 22 Marie Kerr Park Community Room 39700 30th St W Multi-Use 2,810 1 7 365 12 22.75 22.75 159.23 691.91 8,302.87 23 Marie Kerr Park Recreation Center 2723-A Rancho Vista Blvd Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 153.82 153.82 1,076.72 4,678.59 56,143.06 24 Oasis Recreation Center 3850-A E Ave S Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 153.82 153.82 1,076.72 4,678.59 56,143.06 25 Palmdale Playhouse, C.A.B. and Green Room 38334 10th St E Kitchen/Bar, Restrooms, Multi-Use 22,660 1 7 365 12 183.45 183.45 1,284.18 5,580.07 66,960.78 26 Parks & Recreation 827 E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 45.53 45.53 227.64 986.42 11,837.02 27 Public Safety Building (AERO) 38256 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 17,500 1 5 260 12 159.35 159.35 796.75 3,452.58 41,430.95 28 Maintenance Yard Admininstration 39110 3rd St E, Suite C Prof Office Bldg, Lobby, Restrooms 6,688 1 5 260 12 60.90 60.90 304.49 1,319.44 15,833.22 29 Maintenance Yard Fleet Shop 39110 3rd St E, Suite B Kitchen/Bar, Restrooms, Multi-Use 2,100 1 5 260 12 19.12 19.12 95.61 414.32 4,971.82 30 Maintenance Yard Traffic House 39110 3rd St E, Suite A Prof Office Bldg, Lobby, Restrooms 3,200 1 5 260 12 29.14 29.14 145.70 631.35 7,576.24 31 Maintenance Yard Warehouse 39110 3rd St E, Suite D Kitchen/Bar, Multi-Use, Restrooms 2,600 1 5 260 12 23.67 23.67 118.35 512.85 6,154.15 32 Records Center 616 E Ave P Multi-Use, Restrooms 4,500 1 5 260 12 40.98 40.98 204.90 887.89 10,654.70 33 S.A.V.E.S. 1002 E Ave Q-12 Kitchen/Bar, Restrooms, Multi-Use 9,700 1 5 260 12 88.32 88.32 441.60 1,913.58 22,962.99 34 State Assembly Office 823-B E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 45.53 45.53 227.64 986.42 11,837.02 YEAR 4: FISCAL YEAR 2028-29

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost
YEAR 4: FISCAL YEAR 2028-29

AQUATIC FACILITIES & WATER PARK
35 Courson Pool Building 38226 10th St E Pool 4,590 1 6 312 12 39.15 39.15 234.87 1,017.79 12,213.49 36 Marie Kerr Pool Building 2723-C W Rancho Vista Blvd Pool 3,525 1 6 312 12 30.06 30.06 180.37 781.60 9,379.22 37 McAdam Pool Building 38115 30th St E Pool 4,160 1 6 312 12 35.48 35.48 212.87 922.43 11,069.20 38 Oasis Pool Building 3850-C E AveS Pool 3,525 1 6 312 12 30.06 30.06 180.37 781.60 9,379.22 39 Drytown Water Park Administration (Off-Season: Oct 01 - Mar 31) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 2 52 6 31.03 31.03 62.05 134.45 806.68 40 Drytown Water Park Administration (In-Season: Apr 01 - Sept 30) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 7 182 6 14.32 14.32 100.24 217.20 1,303.17 41 Drytown Water Park Kitchen Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 45 1 7 182 6 39.09 39.09 273.65 592.91 3,557.44 42 Drytown Water Park Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 1,308 1 7 182 6 45.33 45.33 317.28 687.44 4,124.63 43 Drytown Water Park Slide Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 63 1 7 182 6 39.18 39.18 274.24 594.19 3,565.16

TRANSIT SITES
44 Palmdale Transportation Center (1 time per day) 39000 Clock Tower Plaza Dr Palmdale Transportation Center (including restrooms) 6,037 1 7 365 12 48.88 48.88 342.14 1,486.66 17,839.96 44a Palmdale Transportation Center (4 times per day) 39000 Clock Tower Plaza Dr Restrooms only 291 4 28 365 12 141.03 564.13 15,795.70 17,159.02 205,908.18

JOB CENTER
45 America’s Job Center of California 38510 Sierra Hwy Multi-Use, Restrooms, Kitchen 10,977 1 5 260 12 99.95 99.95 499.74 2,165.53 25,986.32

NEIGHBORHOOD HOUSES
46 Manzanita Neighborhood Center 38627 32nd St E Multi-Use, Restrooms 1,064 1 5 260 12 38.99 38.99 194.93 844.71 10,136.57 47 Tumbleweed Neighborhood House 1129 E Ave R-4 Multi-Use, Restrooms 1,562 1 5 260 12 40.70 40.70 203.52 881.92 10,583.04 48 Yucca Neighborhood House 503 E Ave Q-3 Multi-Use, Restrooms 1,732 1 5 260 12 41.30 41.30 206.49 894.78 10,737.38 GRAND TOTAL 273,400 4,040.15 42,837.73 106,157.29 1,260,530.39 Formula Key
Price per Visit: VENDOR/BIDDER ENTRY
Price per Day: Price per Visit * Cleanings per Day
Price per Week: Price per Day * Cleanings Visits per Week Monthly Price: (Price per Day * Cleaning Days per Year) / 12

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost

PARK SITES
1 Ana Verde Park 2820 Greenbrier St Park Restrooms 144 1 7 365 12 20.92 20.92 146.45 636.36 7,636.32 2 Courson Park (2 times per day) 38226 10th St E Park Restrooms 156 2 14 365 12 41.29 82.58 1,156.18 2,511.95 30,143.38 3 Desert Sands Park (2 times per day) 39117 3rd St E Park Restrooms 243 2 14 365 12 41.40 82.81 1,159.33 2,518.78 30,225.40 4 Domenic Massari Park (2 times per day) 37716 55th St E Park Restrooms 230 2 14 365 12 41.38 82.76 1,158.70 2,517.42 30,209.00 5 Foothill Park 2525 The Groves Park Restrooms 144 1 7 365 12 20.92 20.92 146.45 636.36 7,636.32 6 Joshua Hills Park 3110 Fairfield Park Restrooms 144 1 7 365 12 20.92 20.92 146.45 636.36 7,636.32 7 Manzanita Heights Park 431 Mesa Verde Ave. Park Restrooms 144 1 7 365 12 20.92 20.92 146.45 636.36 7,636.32 8 Marie Kerr Park - Best of the West Softball Complex 2723-G W. Rancho Vista Blvd Park Restrooms 1,050 1 7 365 12 43.82 43.82 306.74 1,332.87 15,994.45 9 Marie Kerr Park (2 times per day) 39700 30th St W Park Restrooms 680 2 14 365 12 83.06 166.11 2,325.58 5,052.60 60,631.25 10 McAdam Park (2 times per day) 38115 30th St E Park Restrooms 144 2 14 365 12 41.27 82.54 1,155.56 2,510.58 30,126.97 11 Pelona Vista Park North (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 83.21 166.43 2,329.99 5,062.17 60,746.09 12 Pelona Vista Park South (2 times per day) 37800 Tierra Subida Ave. Park Restrooms 800 2 14 365 12 83.21 166.43 2,329.99 5,062.17 60,746.09 13 Rancho Vista Park 40437 35th St W Park Restrooms 102 1 7 365 12 20.81 20.81 145.66 632.94 7,595.31 14 Sam Yellen Park (2 times per day) 5100 E Ave S Park Restrooms 120 2 14 365 12 41.24 82.47 1,154.61 2,508.53 30,102.37

FACILITY SITES
15 City Hall (All Suites) 38300 Sierra Hwy, Suites A-D Prof Office Bldg, Lobby, Restrooms, Multi-Use (Ste. B) 27,200 1 5 260 12 262.53 262.53 1,312.65 5,688.13 68,257.58 16 Desert Sands Recreation Building 39117 3rd St E Multi-Use, Restrooms 8,400 1 5 260 12 81.08 81.08 405.39 1,756.71 21,080.53 17 Development Services 38250 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 34,000 1 5 260 12 328.16 328.16 1,640.79 7,110.10 85,321.24 18 Joe Davies Heritage Air Park Office Trailer 2001 E Ave P Prof Office Bldg 640 1 3 156 12 7.74 7.74 23.22 100.64 1,207.69 19 Joe Davies Heritage Air Park Shop 2001 E Ave P Multi-Use, Restrooms 5,700 1 3 156 12 68.93 68.93 206.80 896.13 10,753.53 20 Legacy Commons 930 E Ave Q-9 Wood Flooring, Kitchen, Restrooms, Multi-Use 18,376 1 7 365 12 68.49 68.49 479.46 2,083.38 25,000.55 21 Library (1 time per day) 700 E Plamdale Blvd Multi-Use, Kitchen, Restrooms 12,650 1 7 365 12 108.56 108.56 759.94 3,302.10 39,625.21 21a Library (2 times per day) 700 E Plamdale Blvd Restrooms only 190 2 7 365 12 1.38 2.76 19.35 84.07 1,008.88 22 Marie Kerr Park Community Room 39700 30th St W Multi-Use 2,810 1 7 365 12 24.11 24.11 168.79 733.42 8,801.05 23 Marie Kerr Park Recreation Center 2723-A Rancho Vista Blvd Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 163.05 163.05 1,141.32 4,959.30 59,511.64 24 Oasis Recreation Center 3850-A E Ave S Gymnasiums, Wood Flooring, Restrooms, Multi-Use 19,000 1 7 365 12 163.05 163.05 1,141.32 4,959.30 59,511.64 25 Palmdale Playhouse, C.A.B. and Green Room 38334 10th St E Kitchen/Bar, Restrooms, Multi-Use 22,660 1 7 365 12 194.46 194.46 1,361.23 5,914.87 70,978.43 26 Parks & Recreation 827 E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 48.26 48.26 241.29 1,045.60 12,547.24 27 Public Safety Building (AERO) 38256 Sierra Hwy Prof Office Bldg, Lobby, Restrooms 17,500 1 5 260 12 168.91 168.91 844.55 3,659.73 43,916.80 28 Maintenance Yard Admininstration 39110 3rd St E, Suite C Prof Office Bldg, Lobby, Restrooms 6,688 1 5 260 12 64.55 64.55 322.75 1,398.60 16,783.21 29 Maintenance Yard Fleet Shop 39110 3rd St E, Suite B Kitchen/Bar, Restrooms, Multi-Use 2,100 1 5 260 12 20.27 20.27 101.35 439.18 5,270.13 30 Maintenance Yard Traffic House 39110 3rd St E, Suite A Prof Office Bldg, Lobby, Restrooms 3,200 1 5 260 12 30.89 30.89 154.44 669.23 8,030.82 31 Maintenance Yard Warehouse 39110 3rd St E, Suite D Kitchen/Bar, Multi-Use, Restrooms 2,600 1 5 260 12 25.09 25.09 125.45 543.62 6,523.40 32 Records Center 616 E Ave P Multi-Use, Restrooms 4,500 1 5 260 12 43.44 43.44 217.19 941.16 11,293.98 33 S.A.V.E.S. 1002 E Ave Q-12 Kitchen/Bar, Restrooms, Multi-Use 9,700 1 5 260 12 93.62 93.62 468.09 2,028.40 24,340.77 34 State Assembly Office 823-B E Ave Q-9 Prof Office Bldg, Lobby, Restrooms 5,000 1 5 260 12 48.26 48.26 241.29 1,045.60 12,547.24 YEAR 5: FISCAL YEAR 2029-30

EXHIBIT J

FEE SCHEDULE

RECURRING SERVICES

FACILITY INFORMATION CLEANING FREQUENCY
ID Facility Name Address Facility Type(s) Cleanable
Square
Footage
Cleaning
Visits
per Day
Cleaning
Visits
per Week
Cleaning
Days
per Year
Total
Months
in Service
Price
per Visit
Price
per Day
Price per
Week
Monthly Price Annual
Cost
YEAR 5: FISCAL YEAR 2029-30

AQUATIC FACILITIES & WATER PARK
35 Courson Pool Building 38226 10th St E Pool 4,590 1 6 312 12 41.49 41.49 248.97 1,078.86 12,946.30 36 Marie Kerr Pool Building 2723-C W Rancho Vista Blvd Pool 3,525 1 6 312 12 31.87 31.87 191.19 828.50 9,941.97 37 McAdam Pool Building 38115 30th St E Pool 4,160 1 6 312 12 37.61 37.61 225.64 977.78 11,733.35 38 Oasis Pool Building 3850-C E AveS Pool 3,525 1 6 312 12 31.87 31.87 191.19 828.50 9,941.97 39 Drytown Water Park Administration (Off-Season: Oct 01 - Mar 31) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 2 52 6 32.89 32.89 65.78 142.51 855.08 40 Drytown Water Park Administration (In-Season: Apr 01 - Sept 30) 3850 E Ave S Prof Office Bldg, Lobby, Restrooms 1,353 1 7 182 6 15.18 15.18 106.26 230.23 1,381.37 41 Drytown Water Park Kitchen Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 45 1 7 182 6 41.44 41.44 290.07 628.48 3,770.89 42 Drytown Water Park Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 1,308 1 7 182 6 48.05 48.05 336.32 728.68 4,372.11 43 Drytown Water Park Slide Restrooms (In-Season: Apr 01 - Sept 30) 3850 E Ave S Restrooms 63 1 7 182 6 41.53 41.53 290.70 629.85 3,779.07

TRANSIT SITES
44 Palmdale Transportation Center (1 time per day) 39000 Clock Tower Plaza Dr Palmdale Transportation Center (including restrooms) 6,037 1 7 365 12 51.81 51.81 362.66 1,575.86 18,910.36 44a Palmdale Transportation Center (4 times per day) 39000 Clock Tower Plaza Dr Restrooms only 291 4 28 365 12 149.49 597.98 16,743.44 18,188.56 218,262.67

JOB CENTER
45 America’s Job Center of California 38510 Sierra Hwy Multi-Use, Restrooms, Kitchen 10,977 1 5 260 12 105.94 105.94 529.72 2,295.46 27,545.50

NEIGHBORHOOD HOUSES
46 Manzanita Neighborhood Center 38627 32nd St E Multi-Use, Restrooms 1,064 1 5 260 12 41.33 41.33 206.63 895.40 10,744.76 47 Tumbleweed Neighborhood House 1129 E Ave R-4 Multi-Use, Restrooms 1,562 1 5 260 12 43.15 43.15 215.73 934.84 11,218.02 48 Yucca Neighborhood House 503 E Ave Q-3 Multi-Use, Restrooms 1,732 1 5 260 12 43.78 43.78 218.88 948.47 11,381.62 GRAND TOTAL 273,400 4,282.56 45,407.99 112,526.73 1,336,162.21 Formula Key
Price per Visit: VENDOR/BIDDER ENTRY
Price per Day: Price per Visit * Cleanings per Day
Price per Week: Price per Day * Cleanings Visits per Week Monthly Price: (Price per Day * Cleaning Days per Year) / 12

EXHIBIT K

FEE SCHEDULE

ADDITIONAL CUSTODIAL SERVICES MENU
# Item Unit of Measure Year 1
FY 2025-26
Year 2
FY 2026-27
Year 3
FY 2027-28
Year 4
FY 2028-29
Year 5
FY 2029-30
1 Straight Time Hourly Rate Per hour 32.25 34.19 36.24 38.41 40.71 2 Straight Time Hourly Rate (Out of Scope Services) Per hour 32.25 34.19 36.24 38.41 40.71 3 Overtime Hourly Rate (Saturday) Per hour 48.38 51.28 54.35 57.62 61.07 4 Overtime Hourly Rate (Sunday & Holiday) Per hour 48.38 51.28 54.36 57.62 61.08 5 Emergency Response - Overtime Labor Rate Per hour 48.38 51.28 54.36 57.62 61.08 6 Emergency Response Fee, if applicable Per emergency N/A N/A N/A N/A N/A 7 Burnish Composition Flooring Per hour 35.50 37.63 39.89 42.28 44.82 8 Window Cleaning - below 10 ft Per hour 32.25 34.19 36.24 38.41 40.71 9 Window Cleaning - above 10 ft (includes 2nd Story windows) Per hour 55.00 58.30 61.80 65.51 69.44 10 Carpet Steam Cleaning - Portable Per square foot 55.00 58.30 61.80 65.51 69.44 11 Carpet Steam Cleaning - Van Mounted Per square foot 55.00 58.30 61.80 65.51 69.44 12 Carpet Cleaning (Spin Bonneted) Per square foot 55.00 58.30 61.80 65.51 69.44 13 Wood Floor Auto Scrubbing Per square foot 55.00 58.30 61.80 65.51 69.44 14 Stripping, Buffing and Waxing Vinyl/Composition Flooring Per square foot 55.00 58.30 61.80 65.51 69.44 15 Seal Concrete Flooring Per square foot 55.00 58.30 61.80 65.51 69.44 16 Film Stage Cleaning (Multi-use facility type) Per visit 200.00 212.00 224.72 238.20 252.50 17 Chair/Upholstery Cleaning Per chair 32.25 34.19 36.24 38.41 40.71 18 Tot Lot/Playground Cleaning
Includes: Cleaning (pressure washing to remove grime and built-up residue), sanitizing, and disinfecting all touch surfaces
Per service 250.00 265.00 280.90 297.75 315.62 19 High-Pressure Hot Water Pressure Washing Per hour 35.50 37.63 39.89 42.28 44.82

City Council Staff Report

DATE: AUGUST 19, 2025

TO: HONORABLE MAYOR PRO TEM AND CITY COUNCIL

FROM: PUBLIC WORKS DEPARTMENT

CAPITAL IMPROVEMENT PROGRAM DIVISION

DISTRICT: 2

SUBJECT: AWARD CONSTRUCTION AGREEMENT WITH EMPIRE
LANDSCAPE, INC., FOR PN 591-D, FISCAL YEAR 2025-26 UPPER

AMARGOSA CREEK RECHARGE HABITAT RESTORATION /

MITIGATION PROGRAM (HRMP) FOR A TOTAL NOT TO EXCEED
AMOUNT OF $ 2,217,281 FOR A TERM OF 240 WORKING DAYS

FROM THE DATE OF THE NOTICE TO PROCEED AND POST
INSTALLATION MAINTENANCE/MONITORING FOR 5 YEARS

RECOMMENDATION

Staff recommend that the City Council:

1. Award Construction Agreement No. A-9461 with Empire Landscape, Inc., for PN 591-D, FY 2025 -26 Amargosa Creek Recharge Habitat Restoration/Mitigation Program (HRMP) for a total not to exceed amount of $ 2,217,281, which includes a contract amount of $2,015,710, plus a 10% contingency amount of $201,571 for a term of 240 working days from the date of the Notice to Proceed;

2. Authorize the City Manager Pro Tem or his designee to execute the Agreement No. A-9461 with Empire Landscape , Inc. , including minimal and/or non - substantial changes; and,

3. Authorize the City Manager Pro Tem or his designee to approve change orders for additional or changed scope of work up to the 10% contingency amount approved by the Council.

BACKGROUND

Amargosa Creek Recharge Habitat Restoration/Mitigation Program Project will provide restoration services for the installation and maintenance of the Habitat Restoration/Mitigation Program (HRMP) and the Native Desert Preservation Plan (NDPP) of transplanted Joshua trees [Yucca brevifolia] for the Upper Amargosa Creek Recharge Report to Mayor Pro Tem and City Council
Re: Award of PN 591-D, Agrmt No. A-9461 with Empire Landscape, Inc.

August 19, 2025