RFP Onsite Safety Consultant Services Village of Schaumburg EPW

December 13, 2017

Proposal Submitted in Response to RFP for

Onsite Safety Consulting Services to the
Village of Schaumburg Engineering and
Public Works Division

Alliance Risk Control Services, LLC

Amos Kaffenbarger
412 South Stewart Ave.
Lombard, IL 60148
akaffenbarger@alliancercs.com
Phone: 847.757.4807
Fax: 630.596.0822

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RFP Onsite Safety Consultant Services Village of Schaumburg EPW

Contents
1. Executive Summary
2. Scope of Services (Village of Schaumburg RFP)
3. Statement of Qualifications
4. Schedule of Services
5. Fee Schedule
6. Service Team and Contacts
7. References
8. Conditions of Service

Appendix A – Safety Training Matrix

Appendix B – Amos Kaffenbarger Bio
Appendix C – Michael Kelly Bio
Appendix D – EPW Monthly Safety Managers Report
Appendix E – Certificate of Insurance – Proof of Coverage

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RFP Onsite Safety Consultant Services Village of Schaumburg EPW

1. Executive Summary
Alliance Risk Control Services, LLC is a professional consulting firm that provides
Safety, Health and Loss Control Services. Alliance is located in Lombard, Illinois and
has experience servicing the following industries:

 Municipal
 Emergency Services
 Construction
 Transportation
 Waste Services
 Temporary Staffing
 Scholastic
 Aviation
 Food Manufacturing
 Light-Medium-Heavy Manufacturing
 Distribution
 Hospitality
 Oil and Gas

Alliance is responding to the Village of Schaumburg’s RFP to provide an onsite Safety

Consultant to conduct the Safety Program for the Engineering and Public Works.
Alliance will perform and carry out, in a professional and satisfactory manner, the
necessary services required to complete the requirements included in the Village of
Schaumburg’s RFP. Our Safety Consultant will report directly to the Director of
Engineering and Public Works and will provide at a minimum the services outlined in the
Minimum Scope of Services section of the RFP.

2. Scope of Services
Alliance will provide an onsite Safety Consultant for a one (l) year contract, to be
renewed by mutual consent and approval by the Village Board for each additional year,
for a maximum total of three (3) years.

We are providing a proposal to provide an onsite Safety Consultant to manage the Health
and Safety of the Engineering and Public Works Department. The Engineering and
Public Works Department consists of ten (10) divisions as follows:

1. Administration and clerical, 13 personnel

2. Engineering, 8 personnel
3. Fleet services, 12 personnel over 2 shifts
4. Building maintenance, 7 personnel
5. Storm sewers, 9 personnel
6. Sanitary sewers, 7 personnel

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RFP Onsite Safety Consultant Services Village of Schaumburg EPW

7. Public water supply, 12 personnel, includes weekends

8. Streets and signs, 11 personnel
9. Landscape (includes forestry), 9 personnel
10. Electrical and customer service, 9 personnel over 2 shifts

Approximately 8 additional seasonal workers in the summer.

Alliance will provide a Safety Consultant onsite 20 hours per week for a period of 52
weeks. Alliance’s Safety Consultant will be responsible to provide the following services
while onsite:

Summary of Services

 Safety committee
 Review of all accidents
 Staff training
 Safety inspections
 Record keeping and reporting
 Drive Cam program
 STARS safety incentive program

Detailed Summary of Services

• Create, modify and distribute a monthly training program schedule to all

supervisors. (See Appendix A for included training)

• Lead and participate in all EPW safety committee meetings (minutes of the
meetings will be taken by village staff).

• Review all accidents, and provide recommendations for changes to mitigate or

prevent recurrences, as appropriate. Recommend corrective action for safety
violations, in accordance with village policy.

• Develop training program recommendations and budget.

• Conduct on-site training for as many OSHA and IDOL required topics as is
reasonably performed by the Safety Consultant for all applicable EPW staff.

• Recommend additional OSHA and IDOL required training, not performed by

the Safety Consultant on-site, to be performed in a cost-effective manner.
(Example: NFPA Arc Flash training would be provided by an organization
that has a partnership with Alliance Risk Control Services, LLC)

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RFP Onsite Safety Consultant Services Village of Schaumburg EPW

• Recommend other training programs for those programs that the Safety
Consultant cannot perform on-site. (Example: Certified Welder Program)

• Provide onsite management training for any aspect of the Safety Program that
of necessity needs to be performed by existing village staff to those required
to administer it. For example, if Foremen would be expected to conduct
periodic safety audits, training shall be provided to them by the Safety
Consultant to enable them to perform this work.

• Provide inspection of at least two (2) village facilities on a monthly basis and
2 to 4 EPW work sites, also on a monthly basis, and provide recommendations
to help mitigate or prevent accidents at each facility and work site. The
recommendations shall be submitted to the Director of Engineering and Public
Works and also be discussed at the EPW safety committee meetings.

• Conduct 2 to 4 ride-along or other individual job safety inspections each

month.

• Maintain accident frequency and severity records to provide a basis for

evaluating the effectiveness of the safety program. Provide leading/lagging
indicator report, as well as a monthly Safety Manager’s Report, which shall
include recommendations from that month’s safety inspections. (See
Appendix D)

• Receive, review, evaluate and recommend actions for down-loaded Drive

Cam events (approximately 45 units).

• Become familiar with and administer the EPW Department’s STARS safety
incentive program. Only rank and file union members will be included in the
program.

• Review EPW Departmental SOPs and recommend updates on safety concerns.

• Continue required documentation of the safety program as specified in the

American Public Works Association’s accreditation program.

• Provide an evaluation of the Safety Program by December 1 st of each year

with budget recommendations for the following year’s program.

• All Alliance RCS’ staff will be required to pass the Village’s designated
background check if they will have access to Village office space.

• Interface with police and fire department safety coordinators on matters of

mutual concern.

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3. Statement of Qualifications
Alliance will provide staff that has working knowledge of current OSHA and IDOL
requirements and of best management practices for workplace safety in municipal public
works and engineering departmental functions, as well as basic knowledge of
construction practices in the areas of highway construction and utilities maintenance.
Onsite Safety Consultant’s will have a minimum five years of experience in providing
onsite safety consultant services for each part of the work outlined in the RFP.

OSHA / IDOL Compliance and Training

The Occupational Safety and Health Administration (OSHA) and Illinois Department of
Labor (IDOL) are the governing bodies responsible for determining workplace safety
regulations and the enforcement of those regulations. OSHA and the IDOL maintain
standards that each employer must meet and adhere to in order to keep employees and
working conditions safe.

The regulations put forth by OSHA and the IDOL are numerous and consistently change.
Companies have the difficult task of not only knowing and understanding the regulations,
but must constantly remain informed on any and all changes in order to keep employees
trained. A great example is the new Global Harmonization Standard.

Alliance will serve as the knowledge resource and training expert for the EPW. By
partnering with Alliance, EPW will have a dedicated consultant to help guide EPW staff
in developing and sustaining a Safety Program.

Note: Reference Appendix A – Safety Training Matrix for OSHA CFR 1910 and CFR
1926 proposed training.

Insurance

Errors and Omissions, Auto and General Liability insurance are carried by Alliance Risk
Control Services, LLC. Limits are as follows:

E and O – $1,000,000 million per occurrence / $1,000,000 aggregate

Auto - $1,000,000 per occurrence / $1,000,000 aggregate
General Liability - $1,000,000 million per occurrence / $2,000,000 aggregate
Umbrella - $2,000,000 million per occurrence / $2,000,000 aggregate
Workers Compensation and Employers Liability – Statutory Limit is provided for WC.

Note: Village of Schaumburg will need to communicate the required coverage’s and
limits so Alliance can provide certificates of insurance.

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4. Schedule of Services
Alliance has provided a Safety Training Matrix for review. The document contains
approximately 37 regulatory topics that require training to comply with OSHA and
IDOL. A total of 1,040 hours / 130 days of service are being proposed. Below is a
sample of the Safety activities that will be completed:

May 2018 Safety Activity Schedule

Week of May 1st

 (1) Facility and (1) Worksite Inspection

 Supervisor Training
o Accident Investigation Training
o Behavior Based Safety Observation Training
 Review any Incidents / Drive Cam Reports – Email supervisors “Root Cause” and
“Recommendation” to be included in their next Toolbox Safety Talk
 Complete Weekly Report

Week of May 7th

 (1) Facility and (1) Worksite Inspection

 (1) Ride Along
 Employee Training
o Hazard Communication – New Global Harmonization Standard
o Hearing Protection
o Respiratory Protection
 Review any Incidents / Drive Cam Reports – Email supervisors “Root Cause” and
“Recommendation” to be included in their next Toolbox Safety Talk
 Complete Weekly Report

Week of May 14th

 (1) Facility and (1) Worksite Inspection

 (1) Ride Along
 Employee Training
o Workplace Violence
o Operations of Powered Platforms
o Fall Protection
 Review any Incidents / Drive Cam Reports – Email supervisors “Root Cause” and
“Recommendation” to be included in their next Toolbox Safety Talk
 Complete Weekly Report

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Week of May 21st

 (1) Facility and (1) Worksite Inspection

 (1) Ride Along
 Employee Training
o 1st Aid / CPR
o Bloodborne Pathogens
o Accident Prevention
 Review any Incidents / Drive Cam Reports – Email supervisors “Root Cause” and
“Recommendation” to be included in their next Toolbox Safety Talk
 Complete Weekly Report

Week of May 28th

 (1) Facility and (1) Worksite Inspection

 Review any Incidents / Drive Cam Reports
 Safety Committee Meeting
 Completion of Monthly Safety Recordkeeping / Reporting Activities
 Email all supervisors Toolbox Safety Talks for June

5. Fee Schedule
The following Fee Schedule has been proposed for the following 3 Fiscal Years.

o Fiscal Year 18/19 (May 1, 2018 through April 30, 2019)

o Fiscal Year 19/20 (May 1, 2019 through April 30, 2020)
o Fiscal Year 20/21 (May 1, 2020 through April 30, 2021)

Alliance’s onsite Safety Consultant fee during the fiscal year 18/19 is $111,930 dollars.
The fee includes 20 hours of onsite service per week for duration of 52 weeks. The
hourly rate is $107.63 dollars. The onsite Safety Consultant fee covers all training
activity except for the items highlighted in yellow in Appendix A. Those items have
been listed in the “Breakdown of Services” provided below. The total cost of the
program is not to exceed $260,487.61 dollars. The total hours worked by the onsite
Safety Consultant is not to exceed 20 hours per week / 1,040 hours per year.

Breakdown of Services Service Cost

Onsite Safety Consultant $111,930
Confined Space Entry $6,080
Asbestos Transite Pipe $12,540
Portable Fire Extinguisher $5,320
DOT 60/60 Drug and $100
Alcohol Supervisor Training

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Respirator Flow Test of $2,840

Tanks and Regulators
Full Face Mask Flow Test $1,200
Electrical Subpart S $4,015
2018 NFPA 70E and 2017 $24,475.11
NEC (National Electrical
Code)
Chain Saw Safety, PPE and $14,250
Skills Training
Basics of Electricity, Basics $17,692.50
of Industrial Electricity and
Troubleshooting, Grounding
and Bonding
Rigging $7,600
Machine Specific Lockout $48,380
Tagout Procedures
Noise Study $3,900
Total Not to Exceed Service $260,487.61
Cost

This proposal will be a one-year agreement for the services indicated in “Scope of
Services” at the not to exceed cost of $111,930 dollars for the onsite Safety Consultant
and $260,487.61 dollars if the Village of Schaumburg approves the additional
$148,557.61 dollars for Specialty Training Services.

The year two and three agreements will be based on a proposal submitted by Alliance
Risk Control Services, LLC. The value of the proposals for year two and year three shall
not exceed the value percentage of the professional services and the year one
(FY2018/19) approved budget. The Safety Consultant fee will increase each additional
year based on the Consumer Price Index. Any Specialty Training Services increase in
this percentage for year two and three will be based on the Consumer Price Index and or
be based on additional services not included in the year one agreement.

If Alliance seeks an increase in the percentage as described above, the new proposal will
need to be approved by the Village board and Alliance understands that other firms may
be requested to provide a proposal for services.

Invoices

Service will be billed in twelve (12) monthly installments. The Invoice Schedule is listed
below:

o Fiscal Year 18/19 (May 1, 2018 through April 30, 2019)

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o Twelve (12) installments of $9,327.50 starting May 01, 2018 to April 01,
2019.
o Each installment is due the first of day of the month.
o Specialty Services will be billed as they are incurred, and payment will be
due 30 days from the service date. Specialty services include:

Breakdown of Services Service Cost

Confined Space Entry $6,080
Asbestos Transite Pipe $12,540
Portable Fire Extinguisher $5,320
Respirator Flow Test of $2,840
Tanks and Regulators
DOT 60/60 Drug and $100
Alcohol Supervisor Training
Full Face Mask Flow Test $1,200
Electrical Subpart S $4,015
2018 NFPA 70E and 2017 $24,475.11
NEC (National Electrical
Code)
Chain Saw Safety, PPE and $14,250
Skills Training
Basics of Electricity, Basics $17,692.50
of Industrial Electricity and
Troubleshooting, Grounding
and Bonding
Rigging $7,600
Machine Specific Lockout $48,380
Tagout Procedures
Noise Study $3,900
Total Specialty Service Cost $148,557.61

o Fiscal Year 19/20 (May 1, 2019 through April 30, 2020)

o Twelve (12) installments of $9,327.50 starting May 01, 2019 to April 01,
2020 (Pending Increase in Consumer Price Index)
o Each installment is due the first of day of every month
o Specialty Services will be billed as they are incurred and payment will be
due 30 days from the service date. Specialty services include:

Specialty Services Service Cost

Excavation Safety Training $6,080
Asbestos Transite Pipe $12,540
Portable Fire Extinguisher $5,320

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Respirator Flow Test of $2,840

Tanks and Regulators
Full Face Mask Flow Test $1,200
Electrical Subpart S $4,015
Total Specialty Service Cost $31,995

o Fiscal Year 17/18 (May 1, 2020 through April 30, 2021)

o Twelve (12) installments of $9,327.50 starting May 01, 2020 to April 01,
2021 (Pending Increase in Consumer Price Index)
o Each installment is due the first of day of every month
o Specialty Services will be billed as they are incurred and payment will be
due 30 days from the service date. Specialty services include:

Specialty Services Service Cost

Confined Space Training $6,080

Asbestos Transite Pipe $12,540
Portable Fire Extinguisher $5,320
Respirator Flow Test of $2,840
Tanks and Regulators
Full Face Mask Flow Test $1,200
Electrical Subpart S $4,015
Total Specialty Service Cost $31,995

6. Service Team & Contact Information

An onsite Safety Consultant will be provided with a minimum of 5 years of experience in
Highway Construction and Utilities Maintenance. The onsite Safety Consultant can be
replaced at the request of the Director of Engineering and Public Works.

Core Service Team

Amos Kaffenbarger, President, Risk Control Consultant

Alliance Risk Control Services, LLC
412 South Stewart Ave.
Lombard, IL 60148
Cell : (847) 757-4807
Email: akaffenbarger@alliancercs.com
Website: www.alliancercs.com

Responsibilities: The primary contact for the Village of Schaumburg; establishes Action
Plans and coordinates schedules to perform desired service. Conducts loss analysis to

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identify trends and problem areas. Oversee and conduct training, program development,
and hazard identification activities per the direction of the client.

Michael J. Kelly, Director

The Start Group
P.O. Box 180

Bloomingdale, IL 
60108
Office: 630-894-0298
Cell: (708) 287-3209
Email: startgroup@ameritech.net
Website: www.startgrouptraining.com

Responsibilities: Mike’s team may be utilized if the following activities are identified as
an exposure:

 Emergency Preparedness
 Traffic Control
 Emergency Medical Training
 Confined Space Entry and Rescue
 Respirator Fit Test

7. References
Mark Rooney, Village Manager, Village of Carpentersville
Phone: 224.293.1660
Email: mrooney@cville.org

John Keigher, Director of Systems and HR, Midwest Transit Equipment, Inc.
Phone: 1.800.933.2412 X 1427
Email: john.keigher@midwesttransit.com

Brad Bull, General Manager, ATS Medical Services, LLC

Phone: 815.739.7921
Email: bradbull@atsambulance.com
Note: Additional references are available at the request of the Village of Schaumburg

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6. Conditions of Service
Alliance does not have the authority to control the daily operations of Engineering and
Public Works Department. Therefore, service performed by Alliance Risk Control
Services, LLC is related solely to current and potential loss exposures. The service is
neither intended to nor does it imply, guarantee or warrant in any way that Village of
Schaumburg is in compliance with any federal, state or local codes, laws or regulations
governing property or operation. Furthermore, the service performed by Alliance Risk
Control Services, LLC does not and is not intended to imply, guarantee, assure or warrant
in any way that compliance with the recommendations made by Alliance Risk Control
Services, LLC will eliminate all current and potential losses identified by the service.

Alliance Risk Control Services, LLC

Amos Kaffenbarger
412 South Stewart Ave.
Lombard, IL 60148
akaffenbarger@alliancercs.com
Phone: 847.757.4807
Fax: 630.596.0822

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 Appendix A

Safety Training Matrix

 APPENDIX A

Village of Schuamburg OSHA Safety Training Requirements

29 CFR 29 CFR
1910. 1926.
General Construc- Training Taught or
Type of Activity/Training Industry tion Who Receives Frequency Arranged By:
Exposed Employees and
Asbestos Training 1001 Inspectors Annually 3rd Party TBD
ATSSA Flagger Training Every 3 years IDOT
Accident Prevention Signs
and Tags 145 200 All Initial / Periodic Alliance RCS
Employees with occupational
Bloodborne Pathogens 1030 exposure, first aid responders Initial / Annual Alliance RCS
Empoyees working with Chain
Chain Saw 266 Saws Initial / Periodic 3rd Party TBD
Employees using compressed
Compressed Gas Safety 101 gases Initial Alliance RCS

Control of Hazardous Employees that may service or

Energy (Lockout/Tagout) 147 407, 432 maintain equipment Initial / Periodic Alliance RCS

Rigging, Crane, derrick, and Employees using/operating Initial/Regularly

hoist safety Subpart N 550 applicable equipment thereafter ATS
Electrical Safety-Related Employees working with electrical Initial / Annual - 3
Work 332 Subpart K equipment Day Class Technical Training LLC
Ergonomics All Employees Initial / Periodic Alliance RCS
Initial / Periodic
Change in Plan /
NFPA Arc Flash Training Regulation Technical Training LLC
NEC Training for Initial / Every 3 years -
Electricians 5 Day Class Technical Training LLC
Initial / Periodic
Emergency Action Plan 38 35 All Change in Plan Alliance RCS
Equipment Operator Subpart O Operators Initial / Periodic Village of Schaumburg
Excavation Subpart P All Initial / Annual Start Group
Initial / Periodic
New Hazard or
Fall Protection 66 App C 501-503 All exposed workers Equipment Alliance RCS
Fire Prevention Plan 38 All Initial / Periodic Alliance RCS

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 29 CFR 29 CFR
1910. 1926.
General Construc- Training Taught or
Type of Activity/Training Industry tion Who Receives Frequency Arranged By:
All employees exposed to hazardous
chemicals (excluding labs), infectious Initial / Periodic New
Hazard Communication 1200 agents, or pesticides Hazard Alliance RCS
Employees working in high noise
Hearing Protection 95 52 areas Initial / Annual Alliance RCS
Subpart I, Employees exposed to workplace
Job Hazard Analysis App B hazard Initial/New Hazards Alliance RCS
Employees using applicable Initial/Change in
Ladder Safety 25, 26, 27 1053 ladders equipment Alliance RCS
Medical Services and First Every 2 years for
Aid (recommended for First aid providers and any other providers; 1 year for
general employees) 151 Subpart D employee others Village of Schaumburg FD
Initial / Periodic
Machine Guarding / portable Employees exposed to workplace New Hazard or
equipment / tools Subpart O hazard Equipment Alliance RCS

Multi Piece and Single Piece

Rims Shop / Maintenance employees Initial / Annual Alliance RCS

New Employee Orientation All Initial Alliance RCS

Operations of Powered Employees using powered
Platforms 66 platforms Initial / Periodic Alliance RCS

Permit Required Confined 1. Authorized entrants/attendants, 1. Initial / Periodic 2.

Space 146 26(6) 2. rescue personnel Initial/Annual Start Group
Personal Protective Initial / Change in
Equipment 132 Subpart E Employees required to use PPE work place/PPE use Alliance RCS
Employees with extinguishers in their
Portable Fire Extinguishers 157 work area Initial / Annual Start Group
All designated operators or
Powered Industrial Trucks 178 602 D forklifts Initial / Every 3 years Alliance RCS
Respiratory Protection, Fit
Testing, Face Mask, Tanks
and Regulator Flow Testing
and Supplied Air Field All employees required to wear a Initial / Annually New
Training 134 103 respirator of any type Hazard Alliance RCS

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 29 CFR 29 CFR
1910. 1926.
General Construc- Training Taught or
Type of Activity/Training Industry tion Who Receives Frequency Arranged By:
Signs, Signals and Initial / refresher
Barricades Subpart G every 2 yrs IDOT
All personnel who perform
Storage and Handling of LP installation, removal, operation or
Gases 110 153 maintenance Initial / Periodic Alliance RCS
Storage of Flammable and Employees who handle, store, or
Combustible Liquids 106 152 dispense these products Initial / Periodic Alliance RCS
Employees that are exposed at or above
Toxic and Hazardous the limits for air contaminant listed in
Substances 1000 Table Z-1*. Initial / Periodic Alliance RCS

Violence in the Workplace General

(recommended) Duty Clause Any Initial Alliance RCS
All employees who perform
Welding 253 Subpart J welding /cutting operations Initial / Periodic National Safety Council
The term periodic training generally means training that occurs at regular intervals (e.g. 1 to 3 years). Annual refresher training is
recommended in order to maintain the understanding/skill level required by most performance-based standards. All training must be
documented.

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 Appendix B

Amos Kaffenbarger Bio

 Amos Kaffenbarger
President – Alliance Risk Control Services, LLC
TECHNICAL
EXPERIENCE: 13 years of experience in safety and risk control activities.

President of Alliance Risk Control Services and has experience providing

safety and risk control services to scholastic, municipal, captive insurance
and individual clients.

Lines of coverage include:

 Workers Compensation
 Auto
 General Liability
 Property Casualty

Industries Serviced:
 Aviation
 Municipal
 Scholastic
 Food Manufacturing
 Light-Medium-Heavy Manufacturing
 Temporary Staffing
 Construction
 Emergency Services
 Distribution
 Transportation
 Hospitality
 Oil and Gas
 Waste Services

Services include comprehensive analyses and evaluations of loss exposures,

safety programs and compliance programs. Assists clients with the review,
development, implementation and training of safety policies, procedures and
programs.

EDUCATION: Bachelor of Science Degree in Industrial Technology with a Major in

Occupational Safety
Northern Illinois University, DeKalb, Illinois

PROFESSIONAL
AFFILIATIONS: ASSE

SPECIAL SKILLS:
Scaffold Training Institute Outreach Trainer
Stormwater, Erosion and Sedimentation Control Inspector
Authorized OSHA General Industry 10 hr and 30 hr Trainer
Authorized OSHA Construction 10 hr and 30 hr Trainer
 Noise Monitoring
Noise Exposure and Hearing Conservation Programs
Physical Hazard Assessments
PPE Assessment
Safe Operating Standard Assessments (Ex. Lockout/Tagout, Confined
Space)
Transitional Work Programs
Regulatory Compliance Training
Loss Analysis
Health and Safety Program Development
Accident Investigation
Drug Free Work Place Programs
Ergonomic Assessments
Confined Space Awareness Training and Program development
Fall Protection Training and Program Development

LOCATION: Lombard, Illinois

 Appendix C

Michael Kelly Bio

 Appendix D

EPW Monthly Safety Report

Monthly Onsite Safety
Consulting Report

Village of Schaumburg
Engineering and Public Works
Division

Amos Kaffenbarger, President

December 05, 2017

Alliance Risk Control Services, LLC

444 East Roosevelt Rd, Suite 256

Lombard, IL 60148

P: 847.757.4807

F: 630.596.0822
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 Prepared By Amos Kaffenbarger, President

SERVICE SUMMARY

Week 26 – October 31st to November 4th of 2017

Days Onsite: 1

Hours Completed: 11.75 hrs

Week 27 – November 5th to November 11th of 2017

Days Onsite: 2

Hours Completed: 21.50 hrs

Week 28 – November 12th to November 18th of 2017

Days Onsite: 2

Hours Completed: 19.75 hrs

Week 29 – November 19th to November 25th of 2017

Days Onsite: 1

Hours Completed: 9.75 hrs

Week 30 – November 26th to November 30th of 2017

Days Onsite: 2

Hours Completed: 20.25 hrs

Contract Allocation

Beginning Month’s Amount: 587 hours

Amount Used This Month: 83.00 hours

Amount Remaining: 395.25

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TRAINING

November Training

 November 01 – Respirator Training and Fit Testing

 November 08 – Respirator Training and Fit Testing
 November 15 – Respirator Training and Fit Testing
 November 22 – No Training - Thanksgiving
 November 29 – No Training

December Training

 No Training – Snow and Ice

OUTSTANDING ITEMS AND RECOMMENDATIONS

Item 1: Electrical Safety and Lockout Tagout Program: Electrical and Lockout
Tagout program items reviewed are:

1) Machine Specific Procedures for equipment / systems with more than one
energy source.
a. Status: Individual procedures do not exist.
b. Dave Hellmer is working on developing
2) Periodic Audits – Periodic audits are not completed.
a. Status: Periodic audits are not completed.
b. We will be requesting each foreman complete in 2014
3) Annual Administrative Review – Program was not previously reviewed
annually.
a. Program has been reviewed and does not meet OSHA and NFPA 70
E standards for the type of work EPW electricians perform.
b. A proposal was requested by NTT to complete an onsite assessment
and help develop a comprehensive Electrical Safety program for the
Village of Schaumburg.
c. Alliance has recommended via email that EPW outsource electrical
work until the Electrical Safety program is in compliance with OSHA
and NFPA 70 E standards and employees have received required
training.

Status: Project may start early 2018 depending on available funds.

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Item 2: Arc Flash Analysis

Personal Protective Equipment has been purchased and received for the
Electrical division. Employees have also received required OSHA training.

Identification and labeling of systems is still outstanding. A meeting was held

on April 4, 2013 to expedite the identification of Village owned electrical
systems that require analysis and labeling.

Status: Final revised study was delivered in November. A meeting was held
on November 22nd to develop an action plan to mitigate hazards identified in
the study. The following action plan has been implemented:

Item 1 is Incomplete: Dave Hellmer will review the

recommendations and formally identify fuses / protective devices his
team can replace or adjust to reduce the Arc Flash rating. Dave H. will
budget and schedule the work his team can perform internally. Dave
H. will keep a list of recommendations completed so we can
benchmark progress and know which recommendations still require
attention.

Item 2 is Incomplete: Dave Hellmer will provide a list of

recommendations that his team cannot perform internally. Dave H.
will provide the list by January 3, 2016. Mike Hall will include the
recommendations in the Electrical Maintenance RFP.

Item 3 is Complete: Job Safety Analysis will be updated to include

PPE requirements for Julie Locates when employees remove covers at
the bottom of street light poles. The Uniform SOP will be reviewed
and updated.

Item 4 is Complete: PPE – We will move forward with purchasing

the budgeted Arc Flash rated suits, gloves, etc. Purchase will occur in
May after the budget is approved and the new fiscal year starts.

Item 3: Revising Accident Investigation SOP

A meeting was held on February 11th to discuss improving the Accident

Investigation process. The following items will be added to SOP 15.14

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 All Superintendents and Foremen will be notified within 24 hrs after

an incident occurs.
 Documents must be filed neatly on the S Drive.
 An Incident Review form will be developed and will be used to review
root cause and action taken to prevent future occurrence with all field
employees.
 Discipline log will be developed to ensure discipline / corrective
action is consistent across all departments for incidents.

Status: Discipline log was completed by John Williams but is not being
used. Recommend adding to Barb Casso’s current spreadsheet she uses
to track STARS. Sample log reviewed with Mike Hall during December
Monthly Safety Report review.

Item 4: Village Wide Electrical Systems Maintenance

Electrical systems such as panels and switch gears require maintenance per
NFPA 70E. A meeting was held on June 23, 2015 with John Williams, Dennis
Gatza, Brian Wagner and Amos Kaffenbarger to develop an action plan for
compliance. Below is the current action plan:

1. Move forward with scheduling cleaning of Electrical Systems for

Village owned electrical systems. Brian Wagner will complete by
December 2015.
2. Collect information on manufacturers to identify if manuals are
available to identify preventative maintenance requirements per the
manufacturer. Include manufacturer requirement in RFP per page 6
of IEEE 3007.2. Brian Wagner will complete by December 2015.
3. Include single line diagrams from Arc Flash Analysis in RFP per page 6
of IEEE 3007.2. Brian Wagner will include in RFP after the Arc Flash
Analysis project is completed.
4. Work with 3rd party consultant to develop a Preventative
Maintenance program and Critical Matrix for identifying Catastrophic,
Critical, Marginal or Minor failure. Plan for next budget year – 2016 /
2017. Brian Wagner, John Williams and Dennis Gatza will work
together to complete this item.

Status: Criticality Matrix has been removed from the action plan. TJ
Countryman has approached additional contractors for bid.

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Item 5: Excavation Safety

Alliance is working on revising the Excavation Safety Program and Policy for
work near electrical exposures. At this time, Alliance has recommended EPW
outsource work if electrical will be exposed or there is risk of contacting an
energized cable during excavation.

Status: Reopened to discuss working in and around exposed electrical with

proper PPE and blanketing.

Item 6: Electrical Training

A budget item should be developed for New Hire Electrical training.

Employees need the following training:

Malcolm Jackson and Greg Evans

 NFPA 70 E
 Basics of Electricity and Troubleshooting
 Grounding and Bounding

John Williams

 NFPA 70 E

John Pavlis

 NFPA 70 E
 Basics of Electricity and Troubleshooting
 Grounding and Bounding

Electrical Division – Has two vacancies’.

 NFPA 70 E
 Basics of Electricity and Troubleshooting
 NEC – National Electric Code
 Grounding and Bounding Grounding and Bounding
 Hands on Street Light Locating Training

Status: Budget has been developed and will be included in next year’s Fiscal
Budget.
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INCIDENTS / INJURIES

No employee injuries in November.

LAGGING INDICATORS

Loss Analysis

The Village of Schaumburg experienced Zero (0) worker’s compensation claim in

November.

The following bullet points communicate the claim count and total incurred costs for the
current fiscal year (May 1, 2017 to April 30, 2018).

 May 2017 - One (1) Claim, Total Incurred: $448.63

 June 2017 – Zero (0) Claims, Total Incurred: $0
 July 2017 – Two (2) Claims, Total Incurred: $513.65
 August 2017 – Three (3) Claims, Total Incurred: $4,225.43
 September 2017 – One (1) Claim, Total Incurred: $600.00
 October 2017 – One (1) Claim, Total Incurred: $550.00
 November 2017 – Zero (0) Claims, Total Incurred: $0

As of December 01, 2017, 2017 / 2018 fiscal year Workers Compensation Cost per Labor
Hour is 05 cents. 2016 / 2017 fiscal year Workers Compensation Cost Per Labor-Hour is
currently .92 cents. Shawn Courtney’s claim accounts for approximately 82 percent of the
Cost Per Labor Hour. 2015 / 2016 fiscal year Workers Compensation Cost Per Labor-Hour
was 70 cents. Joseph Giovenco’s injury accounts for 84 percent of the Cost Per Labor Hour.
2014 / 2015 fiscal year was 94 cents. Pete Piers’ injury accounts for 82 percent of the Cost
Per Labor Hour. The Village of Schaumburg continues to have one severe claim a year that
accounts for most of the costs. The employees are over the age of 40 and the injuries are
soft tissue related.

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The following chart and graphs document the Village of Schaumburg’s Workers
Compensation Costs by Fiscal Year (May 1st to April 30th) from 2009 to 2017. Data is
valued as of December 1st 2017.
Total Workers Workers
Compensation Compensation Cost Number of Average
Fiscal Year Hours Worked Losses per Labor-Hour Claims Claim Cost
2009 193,218 $149,305.16 0.77 11.00 $13,573.20
2010 204,541 $488,195.17 2.39 14.00 $34,871.08
2011 198,912 $592,429.89 2.98 12.00 $49,369.16
2012 198,733 $49,168.13 0.25 12.00 $4,097.34
2013 207,866 $251,147.21 1.21 19.00 $13,218.27
2014 210,218 $315,744.46 1.50 14.00 $22,553.18
2015 210,629 $221,633.67 1.05 11.00 $20,148.52
2016 204,144 $143,371.66 0.70 10.00 $14,337.17
2017 207,252 $189,899.50 0.92 12.00 $15,824.96
2018 125,766 $5,818.46 0.05 8.00 $727.31

The following graph documents the Village’s Average Claim Cost by Fiscal Year

$60,000.00
Average Claim Cost
$50,000.00

$40,000.00

$30,000.00

$20,000.00 Average Claim Cost

$10,000.00

$0.00

8 OF 11
 Prepared By Amos Kaffenbarger, President

The following graph documents the Village’s Workers Compensation Cost per Labor-
Hour by Fiscal Year

$3.50
WC Cost Per Man-Hour
$3.00

$2.50

$2.00

$1.50 WC Cost Per Man-

Hour
$1.00

$0.50

$0.00
2010 2011 2012 2013 2014 2015 2016 2017 2018

The following chart and graph document the Village of Schaumburg’s OSHA
Recordable Rate and DART Rate for the calendar year from 2008 to 2017. Data is
valued as of November 1st 2017.

EPW
DART BLS
BLS NAICS Cases NAICS
(23) (Days (23)
Industry Away, Industry
EPW Total OSHA EPW OSHA Restriction OSHA EPW
Calendar Hours Recordable Recordable Recordable or DART DART
Year Worked Cases Rate Rate Transfer) Rate Rate
2008 193,218 15 9 15.53 11 4.60 11.39
2009 204,541 13 12.2 12.71 9 5.30 8.80
2010 198,912 7 13 7.04 4 6.10 4.02
2011 198,733 16 9.5 16.10 10 5.00 10.06
2012 203,333 12 8.7 11.80 9 4.70 8.85
2013 208,298 14 10.2 13.44 2 4.80 1.92
2014 207,916 10 10.2 9.62 6 4.80 5.77
2015 212,817 11 10.2 10.34 3 4.80 2.82
2016 198,316 9 10.2 9.08 5 4.80 5.04

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 Prepared By Amos Kaffenbarger, President

2017 190,157 9 10.2 9.47 0 4.80 0.00

The following graph documents the Village’s OSHA Recordable Rate compared to the
Bureau of Labor Statistics NAICS (23) Local Government Construction Industry
Average OSHA Recordable Rate

18
16
14
12
10 BLS - Industry
Recordable Rate
8
EPW Recordable
6 Rate
4
2
0

The following graph documents the Village’s OSHA DART Rate compared to the
Bureau of Labor Statistics NAICS (23) Local Government Construction Industry
Average OSHA DART Rate

12.00

10.00

8.00
BLS - Industry DART
6.00 Rate
EPW Dart Rate
4.00

2.00

0.00
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017

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ADDITIONAL COMMENTS

Current items / Comments:

Attachments:

Training Calendar

Time Card

11 OF 11
 Appendix E

Certificate of Insurance – Proof of Coverages

 ALLIRIS-01 RCONSITT
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/13/2017
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.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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).
PRODUCER CONTACT
NAME:
Mesirow Insurance Services, Inc. PHONE FAX
353 N. Clark St 11th fl (A/C, No, Ext): (312) 595-6200 (A/C, No):
E-MAIL
Chicago, IL 60654 ADDRESS: chc-inscerts@alliant.com
INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : Harleysville Insurance Company 23582

INSURED INSURER B : Harleysville Lake States Insurance Company 14516

Alliance Risk Control Services, LLC INSURER C : Hartford Accident and Indemnity Company 22357
412 S. Stewart Ave. INSURER D :
Lombard, IL 60148 INSURER E :
INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR BOP00000073914Q 04/30/2017 04/30/2018 PREMISES (Ea occurrence) $ 300,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO-
X POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea accident) $ 1,000,000
B ANY AUTO BA00000073425Q 04/30/2017 04/30/2018 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS (Per accident) $

X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000

B EXCESS LIAB CLAIMS-MADE CMB00000073915Q 04/30/2017 04/30/2018 AGGREGATE $ 2,000,000
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY
X STATUTE ER
Y/N
C ANY PROPRIETOR/PARTNER/EXECUTIVE 83WECBY6496 04/30/2017 04/30/2018 E.L. EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? N N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The Village of Schaumburg is listed as an Additional Insured with respect to the General Liability coverage.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Village of Schaumburg ACCORDANCE WITH THE POLICY PROVISIONS.
101 Schaumburg Ct
Schaumburg, IL 60193
AUTHORIZED REPRESENTATIVE

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD