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TAn GATE SAFEi rY�u G FORM <br /> Project Name Number <br /> - Date Start`Time rAimpleted " <br /> Site Location_ <br /> Type of Work(General) <br /> PQOiaOf Pf OMfff MMPf O0ptf0••p••fi06M8tPOOMOfif OiPGiiMi4iOf MPOpfiiOMM00i4MiiOM00Afif Oi POtOPOfr00 <br /> SAFETY ISSIJES. <br /> Tasks(this shift) <br /> Protective Clothin&Mquipment <br /> Chemical Hazards <br /> Physical Hazards <br /> Control Methods <br /> Special Equipmenu Techniques <br /> Nearest Phone <br /> Hospital Name/Address <br /> Special Topics (incidents,actions,taken,etc.) <br /> aPoaaeosassoossoratssatsfaaefssoasssessoses�o+�s'.PpM�s�sgoytsssssassastssosfsffsfasirssfsffsorfMsssrrst <br /> AY d Ei�LEES <br /> Print Name Sign Name <br /> Meeting conducted by. <br /> coo**4 VO 0 Do*.QS q*moo 0 00*0*44 too *So 0#00 00 0 0*00*9 <br /> END-OF-S=d S V 1V31 LAR 1 <br /> Personal Proiective equipment Used (Level A,B, C,or D) <br /> Respiratory Protection Used: None Half-Pace Full-Face Airline SCBA_ <br /> Cartridges: <br /> Completed By: <br /> TAtt.,GATSC M Rev.112690 <br />