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APPENDIX C <br /> HASP Daily Tailgate Meeting <br /> Page—of <br /> All completed forms are to be archived in the Project File. <br /> Name of Project/Site: Project No: <br /> Project/Site Location: <br /> Employee Completing Form: Date: <br /> (Print and Sign): <br /> Employee Acknowledgement: <br /> The following signatures indicate that these personnel have read and/or been briefed on this Health and Safety Plan(HASP)and <br /> understand the potential hazards/controls for the work to be performed. <br /> Important Notice to Subcontractor(s): <br /> Subcontractors are responsible for developing,maintaining,and implementing their own health and safety programs, policies, <br /> procedures and equipment as necessary to protect their workers,and others,from their activities.Subcontractors shall operate <br /> equipment in accordance with their standard operating procedures as well as manufacturer's specifications. <br /> Name Company Signature Name Company Signature <br /> Planned Daily Activities <br /> (Describe the activities that are planned to be performed today) <br /> Potential Hazards and Topics Discussed <br /> (Describe the potential hazards and controls that may be associated with planned activities) <br /> ❑ I Electrical I ❑ I Chemical I ❑ I Biological I ❑ I Physical ❑ I Other(specify): <br /> 10275-4 <br /> D U D E K C-1 June 2017 <br />