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SITE INS _,CTION LOG/HASP SIGNA.RE PAGE <br />PROJECT NAME: LOCKIIOS : 604 and 606 11 est Il th Street <br />PROJECT NUMBER: 17-186468.2 DATE: <br />PROJECT MANA(;1:12: COMPLETED B\: <br />SITE DESCRIPTION AND NATURE OF WORK: <br />HAZARD COMMUNICATION <br />[ ]Chemical hazards identified <br />[ ]All containers properly labeled <br />[ ]MSDS/workplace notebook on-site <br />[ ]Site safety briefing completed and documented <br />ACCIDENTS/EMERGENCY INFO <br />[ ]First aid personnel identified <br />[ ]Hospital location identified <br />[ ]Police/fire/ambulance phone numbers available <br />[ ]Fire extinguisher present <br />STORAGE <br />[ ]Tools/drill equipment/supplies safely stacked to prevent <br />rolling or collapse <br />[ ]Work areas and passage ways kept clear <br />UNDERGROUND HAZARDS <br />[ ]All underground hazards identified and communicated to <br />workers on-site <br />[ ]Utility/USA clearance confirmed <br />[ ]Clearance dates: <br />[ ]Clearance <br />OVERHEAD HAZARDS <br />[ ]15-foot minimum clearance maintained <br />[ ]All sources of falling objects/swinging loads/ <br />rotating equipment identified <br />[ ]Barriers or other methods in place to prevent injury due to <br />overhead hazards <br />EXCAVATIONS and TRENCHES <br />[ ]All personnel and storage at least 2 feet from top edge of <br />excavation <br />[ ]Ladder in place <br />[ ]Guarding/barriers in place <br />VEHICULAR TRAFFIC <br />[ ]All vehicular traffic routes which could impact worker <br />safety identified and communicated <br />[ ]Barriers or other methods established to prevent injury from <br />moving vehicles <br />PEDESTRIAN TRAFFIC/SITE CONTROL <br />[ ]All walkways which could be impacted by site activities <br />identified and communicated <br />[ ]Barriers or other methods established to prevent pedestrian <br />injury from site activities <br />AIR MONITORING <br />[ ]PID on-site for air monitoring of work breathing space <br />[ ]PID calibrated daily and recorded in log book <br />[ ]Operational action levels communicated and PPE present <br />for use, if required <br />COMMENTS/OTHER HAZARDS <br />x = OK NA = Not Applicable <br />Signing below indicates that the individual understands the hazards involved with the project and the necessary <br />procedures in the event of an emergency. <br />Name Signature Company Date <br />Partner Site-Specific Health and Safety Plan Page 12 <br />Version 1.02 July 6, 2017