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SITE PERSONNEL AND CERTIFICATION STATUS <br /> Subcontractor's Health and Safety Program Evaluation <br /> Name of Subcontractor W-00<1/-Uoi. yrJ <br /> Address PUr Boy' -33� � t FJ V I �f � C� -5 7 <br /> Activities to Be Conducted by Subcontractor <br /> T t if t-k <br /> Evaluati Crlterta <br /> Medical program"Weft OSHAMESTON Cntena Personal praedwe OquMment wVaAabN <br /> on-e rrtorrtorxeg aatnpmerr[narleble cairbrated aIM <br /> Operated prop" <br /> ceptable �� ��� <br /> ❑Unacceptabh ❑lJnacceplabla ❑Unadcap!*b4 <br /> Cdn,rt,ertba N�� <br /> Comrrter+ft <br /> S*ta warkin <br /> 9 procedures clearry specified Trac <br /> ^'n9 meets OSKA/WFSTON cmena <br /> Enwgerxy procedures <br /> Ac�abteabie <br /> ❑UnacceVtable t-��[cceplable <br /> ❑Unaccetxabte ❑UnaccepLatw <br /> Comments Comments <br /> Comments <br /> Oecontaminatgn procedures General heats and sof <br /> �''�// e!y program eraluatwn Addr[ronai comments <br /> i LSI AccaplaCla L.1 pccePtabte <br /> ❑Unacceptable �l1GOntrapor has agleed to and pelt coNdrm wdh <br /> ❑Unacceptable the WESTON HASP for tho N"cL <br /> Cammenis. Comment& <br /> ❑SWbCamfadOr"it wort older hrs awn HASp.1W. <br /> has boon acts"["by Corporal*Health and <br /> Safety <br /> Evaluation Conducted by- l Date �• 3 <br /> Subcontractor <br /> Name <br /> Title Name <br /> Task(s) Title <br /> Certification Level or Description Task(s) <br /> Certification Level or Description <br /> ❑Medical Cunent ❑Traening Current ❑Medical Currevn <br /> ❑Tnuryng Lunen! <br /> ❑Fri Test Current fGwl_} ❑Fit Test Crrern puant.l ❑ ❑ <br /> Fit Test Currant(Dual) FA Test Ciannt{puanl,) <br /> Name <br /> Title Name <br /> Task(s) Title <br /> Certification Level or Description Tasks) <br /> Certification Level or Description <br /> ❑M*dwar Current ❑Trav ir'3 Current 13Mod"Current ❑Trarnrng Current <br /> ❑FA Test Current KQual) ❑Fit Test Crnen!iOuanp 13 FA Test Cunard IOual) ❑FO Fest Currant <br /> r <br /> Name <br /> Title Name <br /> Task(s) Title <br /> Certification Level or Description Task(s) <br /> Certification Level or Description <br /> ❑Medical Currant ❑Ttarn.ng Current ❑Medica!Cu <br /> rr;n! ❑Tremrrg Current <br /> ❑R Test Current(Oual ❑Fa'est Current(Quant I ❑ <br /> Fd Test Current Iflual) ❑Fr!Test Current rOuant) <br /> ..� Cfate lea' a^:! .Sate"! Fags �r �� <br />