Information Collection

Contractor Safety

IC 257819 under ICR 202301-1910-001 · OMB 1910-5203.

Documents and Forms

Document Name Document Type
Form BPA F 5480.28e Contractor Safety Form
BPA F 5480.28e EXCAVATION / TRENCHING PERMIT BPA F 5480.28e.pdf Form
BPA F 6410.15e CONTRACTOR’S REPORT OF INJURY OR ILLNESS BPA F 6410.15e.pdf Form
BPA F 6410.42e CONTRACT ENERGIZED ELECTRICAL WORK PERMIT BPA F 6410.42e.pdf Form and Instruction
BPA F 6410.18e CONTRACTOR’S REPORT OF INCIDENT/NEAR-HIT BPA F 6410.18e.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Contractor Safety	Agency IC Tracking Number:	Stephanie Noell

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BPA F 5480.28e	EXCAVATION / TRENCHING PERMIT	BPA F 5480.28e.pdf	Yes	Yes	Fillable Fileable Signable
Form	BPA F 6410.15e	CONTRACTORâS REPORT OF INJURY OR ILLNESS	BPA F 6410.15e.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	BPA F 6410.42e	CONTRACT ENERGIZED ELECTRICAL WORK PERMIT	BPA F 6410.42e.pdf	Yes	Yes	Fillable Fileable Signable
Form	BPA F 6410.18e	CONTRACTORâS REPORT OF INCIDENT/NEAR-HIT	BPA F 6410.18e.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: DOE-38 Occupational and Industrial Accident Records	FR Citation: 74 FR 993

Number of Respondents: 190	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	2,018	2,018

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.