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HEALTH AND SAFETY PROGRAM FOR BROWN AND Attachment C--Site Safety and Health Plan CALDWELL Safety Plan Implementation Checklist Project Name Project Location (city and state) Date Name of Site Safety Coordinator Weather Conditions Project Number BC Staff Present Name Office Indicate the status of each of the following: 1. Is a copy of the Site Safety and Health Plan (SSHP)on site? YES NO 0 N/A 2. Is the personal protective equipment required by the SSHP available and being used correctly? 0 YES NO 0 N/A 3. Have the work zones been delineated? YES NO ❑ N/A 4. Has a decontamination station been set up as required by the SSHP? YES NO O N/A 5. Are the decontamination procedures being followed? YES NO N/A 6. Is access to the exclusion zone being controlled? ❑ YES ❑ NO N/A 7. Has the site activities briefing and tailgate safety meeting been provided? 0 YES ONO O N/A 8. Is the list of emergency telephone numbers posted at the support zone? YES 0 NO N/A 9. Are directions to nearest emergency medical assistance posted at support zone? YES 0 NO N/A 10. Is emergency equipment available and functional, as required by the SSHP? YES ❑ NO 0 N/A 11. Has the nearest toilet facility been identified or a portable facility been set up? ❑ YES 0 NO ❑ N/A 12. Has an adequate supply of drinking water been provided? ❑ YES NO ❑ N/A 13. Has water for decontamination been provided? 0 YES NO ❑ N/A 14. Have the instruments for environmental and exposure monitoring been calibrated and set up as required by the SSHP? [:] YES NO 0 N/A 15. Are the instruments being used properly and periodically checked during the shift for battery charge status? 0 YES NO N/A 16. Have the trenches and excavations been clearly marked? ❑ YES ❑ NO N/A 17. Have trenches and excavations been shored or sloped as required by soil type and work activities? YES ONO N/A 18. Are dust suppression measures being used? YES [:J NO N/A 19. Is food and tobacco consumption being restricted to the support zone? [:J YES ❑ NO N/A 20. Has a confined space been identified as part of this project? 0 YES ❑ NO N/A 21. Are the confined space entry procedures being correctly implemented? 0 YES NO N/A 22. Has the work/rest cycle for the shift been established? ❑YES NO 0 N/A TIME ON (minutes): TIME OFF (minutes): 23. Has a shaded rest area been set up in the support zone? 0 YES ❑ NO 0 N/A NOTE: Place completed form in project file. HS-18 REV. 06/98