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i *ETIC SITE SAFETY CHECKLIST <br /> ENGINEERING <br /> 1 ,jAgSL`li�j [ <br /> Project Number: Date: <br /> Project Task: ���� Completed by: <br /> 1tfy: (Haz-Woper&LPS Training k3-verify: Operators licenses fined space entry <br /> cards are current) f}.ylbration related injuries .2r1PSA:Safe Performance Self <br /> 1 9-Tehicle:Chock Wheels Q,,S/Piott-Service workers<1 yrs As sment <br /> Revlew: Emergency Assembly ,��vvorkers >5 yrs experience PPE:Head-Hard hat,form fitting <br /> Area Evacuation Route safety glasses,Goggles,hearing <br /> ' -Revfew HASP:Update as needed, E Safety is everyones responsibility protection, Face-shield <br /> signed and understood by all directions to hospital .O`PPE: Hands-Leather gloves,cut <br /> eview Job Safety Analysis JSA : resistant, Kevlar,nitrile or as <br /> y ( ) lips,trips,and falls s cified in JSA <br /> 1 ID tasks,hazards,and how to Excavationftrenching <br /> mitigate hazard. Revise as needed PPE: Feet-Steel toe boots/shoes, <br /> work scope <br /> inspections/document rubber steel toe boots, <br /> �f� Daily <br /> r-the-counter medications Q�E:Body-High visibility vest, <br /> 1 Emergency protocol and equipment �cts from the night before <br /> 9 6"Frafffc Safety Control: note traffic <br /> 14 PEmergency fuel shutoff at bldgs.and <br /> equipment. Locate and understand nown allergies such as bee patterns,volume, and visibllHy wfth <br /> e <br /> q respect to work location <br /> use stings,latex,other <br /> �Ite extinguisher locations Hazards-Insects,plantsite security,vandalism <br /> -IfAnficipated/Unwanted visitors First-aidlburn kit and PPE Vehide safety and driving/road <br /> location conditions <br /> peen pits,excavations,and siteB�ehide and equipment rkin <br /> hazards Shade and sun-block 2���^^ g <br /> warp object, rebar,and scrap metal decontamination procedures 1�eacking up hazards and use of <br /> hazards ><ye wash station location spotter <br /> 1 �verhead utilitylocations and Hot work sourcpermites <br /> note potential <br /> .E�Orderiy site and housekeeping ignition sources and fuels <br /> clearance <br /> 0'Public safety and fences trains and sprains <br /> 1 ❑ ipment and machinery <br /> familiarization,line of fire <br /> �oking in designated areas 1ylQoise hazards <br /> /e_E_pi excavator swing and loading 'p-!F�Iectdcai lockout tag out and GFI eat and cold stress <br /> AErVortable tool safety and awareness e mployee Right-To-Know/MSDS Flying debris hazards <br /> Subsurface Work: Complete location Refueling <br /> subsurface clearance forms,follow �ust and vapor control <br /> protocol for excavations do horseplay <br /> p Cell phones In exclusion zone <br /> 1 Incidents are costly <br /> Discussion/Comments/Follow-up Actions: <br /> NAME COMPANY SIGNATURE <br /> 1 (Emergency ContaaNamefrelepboneNumber) <br /> 1 Instruction:Conduct a daily safety meeting prior to beginning each day's site activities.Complete form by checking off specific <br /> topics and/or hazards. <br />