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STATE OF CALIFORNIA - DEPARTMENT OF TRANSPORTATION <br />SAFETY MEETING REPORT <br />PIN -5-0110 (REV. 02/2006) <br />ACTION AND DISTRIBUTION: <br />1. First-line supervisor conducts meeting, completes, and sign form. Note: See Chapter Z <br />2, First-line supervisor retains and posts one copy. Saftly Meetings, in <br />3. First-line supervisor sends original to second -line supervisor for review. the Caftens Safety <br />F-] 4. secDnd-line supervisor reviews, signs original, and returns to first-line supervisor to file. Manual for details. <br />F-1 5. Additional routing to: <br />MEETING DATE 1OFFICE/CREW/PROJECT NAME COST CENTER/PROJECT NUMBER <br />06/0812011 Shop 10 Stockton 13234 <br />A-ATfwr)ANrr,.SIGNATWRE OFIE(Add additional shedW require(W 77 'Oe^� — A <br />E <br />Clean Ur) and Prevention <br />For individuals with sensory disabilities, this document is available in afternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or Wrft <br />ADANotice Records and Forms Management, 1120 N StreaL MS -89, Sacramento, CA 95814. <br />SAFETY SUGGESTIONSICOMMENTS <br />FIRST -AND/OR SECOND -LIKE SUPERVISOR'S COMMENTS <br />FIRST-LINE SUPERVISOR SIGNATURE <br />SUGGESTED TOPICS FOR DISCUSSION <br />Z Safe work habits <br />Z safe work conditions <br />N Codes of Safe OperatingfWork Practice <br />❑ First aid treatment <br />DATE 4E SUPERVISOR SIGNATURE <br />107/28/2011 <br />0 Maintenance, Chapter 8 ❑ Respirator safety <br />0 Traffic controvfiagging ❑ confined spaces <br />Ej Sliptirip/fall hazards F-1 Hard hats <br />El Protective vehicles F-1 Safety glasses <br />❑ <br />F-1 <br />❑ <br />I DATE <br />Orange/Green Vest <br />Body protection <br />Foot protection <br />For individuals with sensory disabilities, this document is available in afternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or Wrft <br />ADANotice Records and Forms Management, 1120 N StreaL MS -89, Sacramento, CA 95814. <br />