Information Collection

Contractor Safety

IC 257819 under ICR 202606-1910-001 · OMB 1910-5203.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BPA F 5480.28e EXCAVATION / TRENCHING PERMIT Contractor Safety	Form
Form BPA F 6410.15e CONTRACTOR’S REPORT OF INJURY OR ILLNESS Contractor Safety	Form
Form BPA F 6410.42e CONTRACT ENERGIZED ELECTRICAL WORK PERMIT Contractor Safety	Form and Instruction
Form BPA F 6410.18e CONTRACTOR’S REPORT OF INCIDENT/NEAR-HIT 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 6410_42e .pdf	Form and Instruction
BPA F 6410.18e CONTRACTOR’S REPORT OF INCIDENT/NEAR-HIT BPA F 6410.18e.pdf	Form

IC Title:

Contractor Safety

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BPA F 5480.28e	Yes	Yes	Fillable Fileable Signable
Form	BPA F 6410.15e	Yes	Yes	Fillable Fileable Signable
Form and Instruction	BPA F 6410.42e	Yes	Yes	Fillable Fileable Signable
Form	BPA F 6410.18e	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 %

table that charts list of burden
	Requested	Previously Approved
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

table that charts IC Documents
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.

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