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Table <br />Potential Physical Hazards <br />— <br />YES NO <br />Heat exposure <br />Cold exposure <br />Oxygen deficiency <br />Confined space <br />Noise <br />Ionizing radiation <br />Non-ionizing radiation <br />Fire/Explosion <br />Electrical <br />Biological <br />Mechanical/Moving Parts <br />Stored Energy (i.e. pressurized pipe/lines) <br />Overhead/underground hazards <br />Overhead (describe) <br />Power Lines <br />Underground (describe) <br />Unidentifed Utilties <br />Equipment hazards <br />Geoprobe <br />Drilling <br />Excavation <br />Machinery <br />Work Surfaces <br />Holes/ditches <br />Steep grades <br />Slippery surfaces <br />Uneven terrain <br />Unstable surfaces <br />Elevated work surfaces <br />Page 1 of 1 The Source Group, Inc.