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F. OTHER HAZARDS <br /> Heat Stress? FX Yes ❑ No If yes,please specify precautions to be taken: <br /> Take a break in a cool place; monitor personnel using pulse rate and/or blood pressure, body <br /> temperature take frequent brakes in a shaded area. Provide drinking water and/or electrolyte <br /> replacement drink. Record time and duration of all breaks and results of personnel monitoring. <br /> Heat stroke victims must receive emergency medical care. <br /> Cold Stress? F—] Yes x❑ No If yes,please specify precautions to be taken: <br /> Wear layers of warm clothing. Take breaks inside warm building. <br /> Excessive Noise? x❑ Yes F7No If yes,please specify precautions to be taken: <br /> Wear ear plugs <br /> Confined Space Entry? ❑ Yesx❑ No If yes,attach copy of Confined Space Entry Permit. <br /> Excavations 4' or greater in depth? ❑ Yesx❑ No If yes, specify precautions to be taken: <br /> Welding,Cutting&Brazing? F—] Yesx❑ No If yes, specify precautions to be taken: <br /> Heavy Equipment Operation? x0 Yes 0 No If yes, specify precautions to be taken: <br /> Caution around drilling rig. <br /> Slip,Trip or Fall Hazards? x❑ Yes ❑ No If yes, specify precautions to be taken: <br /> Exercise caution while walking on uneven surfaces. <br /> Presence of Overhead Utilities <br /> Are overhead utilities present at the project site? x❑ Yes F—� No <br /> *If so,always maintain suitable clearance from overhead lines. Reference manual section 12.* <br /> Specify location: <br /> Appendix 7-4 (Form HS 003) <br /> Page 4 of 11 <br /> Revised: 3/03 <br />