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Stantec <br />Stantec Field Safety Reference Binder Checklist <br />Instructions: Review your Stantec Field 5 naer pror to starting wort and ensure appicabe contents are included. Sign <br />cr d dc'e Vie cneckist and include wth tre HASP. <br />Included <br />General Corietd Comments <br />Yes No N/A <br />Ste Spec-ft WorKplan f des -cc crd applicable <br />Permts and Access Ailreemerts if des-red ard applicable <br />K ck-Off Meeting Materias <br />Fed and Safety Supplies Chectist <br />Traffic Corte> Planis) <br />Vehicle Inspection Checklist <br />Vehicle Colision Kit <br />SWP 213a Pre Ground Disturbance Worksheet <br />SWP 213b Ground Gsturbance Form <br />Ar Mortorng and Eauipment Caibration Logs <br />Dril-ng B. kr Knie Checkist C°..revron Sites: clear to aft <br />Sampàia red Data Sreets <br />Boring Logs <br />Well Constriction Logs <br />Safety Certiications <br />Included <br />Client Specific Content (Chevron) Cornmenh <br />Yes No NIA <br />Job Safety Ana ysis <br />Emergency Di), Form <br />SAFE Observation Forms <br />Hal ID / Stop Work Form <br />Hard Safety Expectations <br />Cc , Prone Policy <br />Ground Dist.gbarce Revew Checklist <br />Well Abaraonment Rev -ew Checklist <br />SSE Form <br />Operationa Disciplire - <br />Managemert of Charge Form <br />On-Ste I nspecror Form <br />End of JOD Evaluation Form <br />AJdit GJiclance <br />Onte Waste s. Recyclable Materdl irspectior <br />Form <br />Signature: Date: <br />For quest ors concerning the contents of this field binder, please contact Brent at <br />brertlucykastantec.com or Kim at timaingmanistanlec.com <br />Version 6- Apri 2015