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i J <br /> INSTRUCTION SHEET FOR COMPLETION OF SITE SAFETY PLAN <br /> Section of SSP Location/ Action <br /> Page: <br /> Cover Sheet cover .• Substitute the client site name, address, date, <br /> month where indicated by bracket. <br /> Site Erne�rgency Form i • Complete.each blank line of this form. <br /> Hospital Location Map ii • Attach-photocopy of the map showing the <br /> location of the closest hospital. <br /> '• Indicate with a colored marker the most <br /> direct route to the hospital. - i <br /> .• Give detailed driving directions from the site <br /> location to the designated hospital. <br /> • <br /> Complete Hospital Information box. <br /> Site Location Map iii • Attach';photocopy of site plan with overhead <br /> and underground utilities marked. <br /> • Mark Iocations of site phone, emergency <br /> shutoff switches, and fire extin ishers. <br /> Introduction • Substitute site specific information in the <br /> bracket of the first sentence. s <br /> Appendix A-1 Appendix • Any changes in project work scope and/or <br /> Amendment Sheet A-1 site conditions must be written on this form. <br /> Appendix A-2 Appendix • This sheet must be signed by all Applied <br /> Agreement&Acknowledgement A-2 Earth Sciences, Inc, personnel who work on <br /> site. <br /> Appendix A-3 Appendix • All visitors to the site trust read and sign this <br /> Trainee/Observer Agreement A-3 form. <br /> Appendix A-4 Appendix • Complete this form(handwritten is okay)to <br /> Injury/Exposure.Report A-4 report any incidents related to project work. <br /> Appendix B-2 Appendix 0 Attach a photocopy of appropriate MSDSs <br /> MSDSs B-2 for materials present on the site. <br /> Appendix B-3 Appendix 0 Record results of site air monitoring each <br /> Vapor Monitoring Form B-3 - time testing is performed. <br /> Appendix C-1 Appendix 0 Identify equipment and operations where <br /> Lockout/Tagout Form. C=1 lockout/tagout must be performed. <br /> • List on'the form the identified equipment and <br /> all procedures for lockout/ta out. <br /> r <br /> 4: <br />