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JOL XIFIC HEALTH&SAFETY PROCEDURE(t. ') <br /> Job Number:0082-0002 Job Description: Grab Sampling/ Drilling and Soil Sampling Date of Work: February 2015 <br /> Location:Stockton, California Contact: Dan McIntyre Phone: 858-200-6042 <br /> Allwyn Manager Name: Dan McIntyre Unbilled Phone: 858-200-6042 <br /> Allwyn Field Representative: Dan McIntyre Field Rep Phone: 858-200-6042 <br /> Other Allwyn Staff on Site: N/A <br /> SubContractor Name: Vironix Technical Services, LLC Sub Name (if applicable): <br /> Subontractor Site Contact: Contact Phone: <br /> Other Site Personnel: N/A <br /> Scope: Grab soil and water sampling; Dril and soil sampling soil boring to 10' <br /> Equipment Being Used: Direct push drilling rig 55 gallon drums hand and power tools PID sampling equipment <br /> Hazards Present: Exposure to VOCs; slip/trips/falls; overhead electrical lines and/or subsurface utilities; operation of <br /> drilling equipment <br /> Nearest Hospital: Dameron Hospital Address: 525 West Acacia Street Stockton, CA 95203_ <br /> Hospital Phone: 209-944-5550 Directions: See Reverse Side <br /> Special Procedures to Notify 9-1-1: Call 9-1-1 <br /> *Please categorize job,training needed(in parenthesis),and PPE needed below* <br /> Level 1 Job Type: no traffic, electrocution, fall, confined space, etc. hazards,job is basic and simple, hand tools only <br /> Level 2 Job Type:job is relatively easy, hand tools and minor power tools used, minor traffic present, no utilities <br /> Level 3 Job Type:job is relatively easy, hand tools and power tools used, major traffic present, utilities&overhead haz <br /> Level 4 Job Type:job is more complex,there are hazards present (fall/CS/LOTO/etc),smaller diesel machinery used <br /> Level 5 Job Type:job is complex, larger diesel machinery used, utilities present, multiple hazards present <br /> Level 6 Job Type: major job, large machinery in use, utilities being moved, major hazards present that pose a threat <br /> Level 1 Level 2 Level 3 <br /> O Safety Boots O all from level 1 O all from level 1 <br /> O High Visibility Vest/Clothing O Eye Protection O all from level 2 <br /> O Hand Protection O Pedestrian Safety O Traffic Routing Signage <br /> O Immediate Work-Zone Mark-out O High Visibility Work-Zone Markings O Utility Mark-Out Awareness <br /> O Driving Safety O Power Tool Awareness O Head Protection <br /> O HAZCOM Awareness O Hearing Protection <br /> O Biological Hazards O Bloodborne Pathogens <br /> Level 4 Level 5 Level 6 <br /> O all from level 1 O all from level 1 O all from level 1 <br /> O all from level 2 O all from level 2 O all from level 2 <br /> O all from level 3 O all from level 3 O all from level 3 <br /> O Fall Protection Awareness O all from level 4 O all from level 4 <br /> O Confined Space Awareness O Fall Protection Certified O all from level 5 <br /> O Lockout/Tagout Awareness O Confined Space Certified O job HASP required from sub <br /> O Machinery Awareness O Lockout/Tagout Certified O First Aid Trained <br /> Was the tailgate safety meeting performed complete with sign-in sheet? O Yes Topic? <br /> Signing below signifies that all needs and oversight for the safety of this job number have been discussed,documented,and the technician is aware of the concerns. It <br /> also means that all safety training was reviewed prior to job start date. <br /> Allwyn PM Sign: Field Tech Sign: Sub Sign: <br />