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Sheet_S_of_ <br /> Attach additional sheets as necessary <br /> Job Safety Briefing Record <br /> By: Date: Project: Job No.: <br /> Time: Lomtlon/Milepost: <br /> Weather Conditions: Forecasted Temperature(°F): <br /> Maximum: Minimum: <br /> BNSF Project Representative: BNSF Person-in-Charge: <br /> PERSONS ATTENDING Use additional forms If needed to list all attendees <br /> Training Dates KJ personnel Only <br /> Name Affiliation BNSF First PPE Sign Below—HASP <br /> Contractor Aid/CPR <br /> Acknowledgementl'I <br /> Safety <br /> (a)By signing the abme HASP acknowledgement,KJ perwnnel are acknowledging they have reccrved and read the Health and Safety Plan(and <br /> addendal associated with their work activities at BNSF Fueling Sites. <br /> Work ActivRles: Hazardous Heavy Equipment Ops Work within 25' Environmental. <br /> Materials of Track Assess./Sampling <br /> Work Description Summary: <br /> DOCUMENTATION <br /> BNSF SAFETY K/J H&S PLAN TRACK PROTECTION EMERGENCY PREPAREDNESS PLAN <br /> ACrION PIAN (Specify type of protection) <br /> Yes No Yes No Yes NA Yes No <br /> BNSF Bend OR <br /> oncavPoea.emhee�m.hea December 2015 <br />