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DAMN fAILGATE SAFETY MEETING CHECKLIST <br />Project: 5025157007.01410 Site: SFOBB Maintenance Facilities <br />Date: <br /> <br />Location: Off of Burma Road in Oakland, CA <br />To be reviewed on the first day of site activities and when new workers arrive on site: <br />Alternate for Health & Safety: <br />Location of on-site HASP: <br />Site training requirements: <br />Specific medical surveillance requirements: <br />Scott Graham <br />Inside Truck <br />See HASP <br />See HASP <br />Date Agenda: <br />During the project, one or more of the agenda items could be selected for the required daily site <br />training. <br />Planned work for this day (discuss — include review of applicable AHAs) <br />Physical hazards and controls (discuss/review) <br />Chemical hazards and controls (discuss/review) <br />Biological hazards and controls (discuss/review) <br />Personal protective equipment Modified D <br />Personal protective equipment required per the hazard assessment in AHA: <br />SPECIFY TYPE <br />Check-off: <br />1:1111E1111111111E11 <br />111E1110E1111E1 i <br />111E100E1E1E <br />E10111111111DE <br />E111111111[11111111 <br />111111111EICIEE <br />Reflective Vest Class II Vest <br />Safety glasses/goggles ANSI approved <br />Hard hat ANSI approved <br />Foot protection Safety toe boots <br />Work gloves Leather Gloves <br />Chemical gloves Nitrile inner if needed <br />Hearing protection Ear Plugs <br />Other <br /> Review inspection, decon, and maintenance procedures and the limitations of the <br />above stated PPE. EL <br /> Decontamination procedure (discuss/review) ED <br /> Exclusion zone maintained EL <br /> Site emergency response plan (discuss/review) 0 <br /> Signs and symptoms of overexposure to chemicals anticipated on site 0 <br /> General health and safety rules El <br /> Specific health and safety requirements relating to site activities including: <br />(discuss/review) 0 0 <br /> Drilling/boring ED <br />15, UST ELI <br /> Excavations (including UG utility locations) E <br /> Heavy equipment 0 <br /> Slips, trips, and falls 0 <br /> Lockout/tagout ED <br /> Working in temperature extremes D 0 <br /> Rain or other weather advisories LIE <br /> Other health & safety issues (discuss/note) CIO <br /> Issued Daily Work Permit 00 1:100001=10000 El =EEC 0 DEED <br />I have participated in the daily safety meeting discussing the topics indicated and fully understand my responsibility for complying <br />with all health and safety requirements. I have had the opportunity to have my questions on site health and safety issues and <br />procedures answered. <br />Employee Name Employee Signature Date