This government document is issued by General Services for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:xg1tju_bfd4&q=https://www.dgs.pa.gov/Design-and-Construction/Documents/Worker%2520Protection%2520Form%2520Public%2520Works.pdf&sa=U&ved=2ahUKEwiB3argju6FAxWWgf0HHenRALc4MhAWegQICBAC&usg=AOvVaw3AkjV7t6QpyV1tqHu6PztX