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Site-Specific Safety Plan Checklist- <br /> Complete this checklist at every jobsite before beginning work. <br /> Customer: Site Address: <br /> Xerxes Site Supervisor: Date: <br /> List the specific jobs you will be doing while on this site: <br /> Personal Protective Equipment (PPE) - Put your PPE on right away. While on any construction <br /> site,you must always wear, at a minimum, safety glasses with side shields, hard hat, steel-toed shoes and <br /> reflective safety vest. You may need to wear additional PPE (such as a respirator,goggles, gloves and <br /> coveralls)depending on the job. <br /> Work Area Protection - Establish a safe work zone by physically placing work-area protection <br /> equipment(barricades, warning tape, cones, etc.)around the work area so you are fully protected: Refer to <br /> Appendix G—'Work Area Protection Supplement'which contains additional information on this subject. <br /> ❑ If possible, park your vehicle so it can be used as a barrier to vehicles and pedestrians. <br /> Emergency Information and Equipment - Determine the location and phone numbers of the <br /> nearest local emergency fire and rescue services. <br /> Phone number of emergency fire and rescue: <br /> Route for emergency evacuation: <br /> ❑ Verify fire extinguisher, first-aid kit, eyewash bottles are readily available. <br /> ❑ Verify spill cleanup supplies are readily available. <br /> Prework Assessment -Assess the site for potential hazards that you may encounter. If the customer <br /> and other contractors are on site, share safety information. Verify that all contractor requirements are met. <br /> ❑ Review this site-specific information with the entire Xerxes crew before beginning work. <br /> Chemical Hazards— Determine what chemicals you may be working with and/or may be around. <br /> ❑ Obtain the material safety data sheets(MSDS) and review them. Identify what <br /> the typical symptoms of overexposure are. <br /> ❑ If there has been a chemical pill in the area that you will be wor4ng around, determine <br /> chemical(s) involved and attempt to get a MSDS from the customer. <br /> Form s5PC1 Eff.2/06 <br />