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• HEALTH AND SAFETY EVALUATION <br /> Hazard Assessment <br /> Background Review- PCIrnplete ❑Partial If partial why? <br /> Activities Covered Under This Plan <br /> No Task/Subtask Descnpbon Schedule <br /> ey-ounclt,t,lAi-ii',r 1 rtst`ct[ted. _Se-ftembeer t1% <br /> PW e✓ery <br /> sp i E SQt.i�les <br /> Z) Co Lc1e�-� ►rc7vwvltat� e ; 2 sccM Pt4 <br /> e5 sepfi. d�fir <br /> 7�t if11 <br /> Types of Hazards- <br /> 0 Numbers refer to one of the toikymnq hazard evaluation forms Complete hazard evaivation forms for each aooroi>nate hazard Oass <br /> Phystochemical Chemically Toxic Radiation Biological <br /> L�testion alatfon IJ Carcinogen Ionizing ❑Etiological <br /> VAgent <br /> El Flammable [IMutagen Internal exposure ❑Other (Plant insect animal) <br /> fn <br /> ❑Explosive ❑pentact ❑Teratogen <br /> Q'Absorbtron ❑OSHA 1910 1000 ❑External exposure <br /> ❑Corrosive Substance <br /> ❑Reactive <br /> Non-ionizing <br /> Q <br /> ❑ ❑ Specitic Hazard Sub Standard <br /> z �� Describe <br /> ❑UV ❑IR ❑Physical Hazards El <br /> ❑OZ Deficient ❑RF ❑MicroW ❑Construction Actabes <br /> ❑Laser <br /> Source/Location of Contaminants and Hazardous Substances <br /> Directly Related to Tasks Indirectly Related to Tasks- Nearby Process(es) Thai Could Affect Team <br /> Members <br /> ❑Air <br /> ❑Other Surface ❑Client Facility <br /> DlGGroundwater ❑Nearby Non-client Facility <br /> Mil Describe <br /> ❑Surface Water <br /> ❑Other <br /> • ❑Client Briefing Arranged <br />