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ALLWASTE ENVIRONMENTAL SERVICES <br /> HAZARD ANALYSIS/TAILGATE SAFETY MEETING FORM <br /> Meeting conducted by: Date: <br /> Signature: Job Number <br /> Supervisor: Facility: <br /> Specific Location: Equip.# <br /> Description of Work: <br /> ❑ MSDS Product Name: <br /> CHEMICAL CONTAMINANT <br /> ❑Corrosive ❑Poison ❑Hi Tox ❑Skin Abs <br /> ❑Flammable Liquid❑Flammable Solid ❑Water Reaction ❑Oxidizer <br /> ❑Other..... <br /> RESPIRATORY PROTECTIVE EQUIPMENT TYPES OF CARTRIDGES <br /> ❑SCBA ❑Organic Vapor <br /> ❑Airline Respirator w/5 min. bottle ❑Acid Gas <br /> ❑PAPR ❑Organic Vapor/Acid Gas <br /> ❑Full Face Respirator ❑HEPA <br /> ❑Half Face Respirator ❑Dust/Mist Pre-filter <br /> ❑Other ❑Other <br /> PROTECTIVE CLOTHING <br /> ❑Nomex ❑Paper Tyvek ❑PVC Gloves ❑Tyvek Booties <br /> ❑Hard Hat ❑Poly Tyvek ❑Neoprene Gloves ❑Chem Boots <br /> ❑Steel Toe Boots ❑Saranex ❑Viton Gloves ❑ <br /> ❑Hearing Protection ❑Rain Gear ❑Inner Gloves ❑ <br /> ❑Safety Glasses ❑Acid Suit ❑Cotton Gloves ❑ <br /> ❑Goggles ❑Face Shields ❑Leather Gloves ❑ <br /> DISPOSAL OF MATERIAL <br /> ❑Vacuum Truck ❑Bill of Lading ❑On-Site Transfer <br /> ❑Roll-Off Box ❑Manifest ❑Off-Site Transfer <br /> ❑Barrel ❑Profile ❑Other <br /> PHYSICAL HAZARDS <br /> ❑Walk Thru Locked/Tagged Out ❑Surface Condition(Slippery) <br /> ❑Equipment Grounded ❑Ladders Secured <br /> ❑Work Area Isolated ❑Scaffolding Rails in Place <br /> ❑Safety Harness and Lines ❑Subgrade Excavation <br /> ❑Walk Thru Work Area Isolated/Barricaded ❑Other ___-- <br /> WEATHER <br /> ❑Wind Direction ❑Conditions <br /> JOB CLASSIFICATION/CHECKLIST/PERMIT <br /> ❑Hydroblasting ❑Steam Cleaning ❑Acid Cleaning ❑Guzzler <br /> ❑Tank Cleaning ❑Site Remediation ❑PCB ❑Vacuum <br /> ❑Confined Space ❑Lab Pack ❑Other ❑Other ----- <br /> Confined Space Entry Permit Completed By: <br />