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PHYSICAL HAZARDS <br /> u <br /> u <br /> Heat ✓ S1ip,Trip Fall _ _Excavations/Trenches <br /> Cold _/Noise _Moving Equipment (PRiL n.W.) <br /> Rain ✓ U�r Haz r d SIO?ao�S <br /> Undergroundd Hazards CNK *- Other <br /> Fog ✓ Overhead Hazards <br /> PERSONAL PROTECTIVE EQUIPMENT- R = Required A = As Needed <br /> R Hard Hat _ TK Safety Eyewear (Type) 5AFr--� GrLa55E5 <br /> Safety Boots - A ' Respirator(Type) t!'2 { qct <br /> _A Orange Vest Filter Type o2C-rnn!I t. t(A POIZ_ <br /> �y_Hearing Protection A Gloves (Type) MIMILF IVINKI— <br /> _A Tyvek Coveralls Other <br /> 5 Minute Escape Respirator <br /> MONITORING EQUIPMENT <br /> Organic Vapor Analvzer ✓ PID with lamp of /d•6 eV <br /> Oxygen Meter Draeger Tube <br /> Combustible Gas Meter Passive Dosimeter <br /> H2S Meter Air Sampling Pump <br /> WB.G.T. Filter Media <br /> ONSITE SAFETY MEETING ATTENDEES <br /> Signature Name (Printed) Date <br /> PERSONAL AIR MONITORING <br /> Sample # Sample # <br /> Name Name <br /> Date Date <br /> Time On Off Time On Off <br /> Laboratory Used <br /> uc(omm- ).,,4 �a loon <br />