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Aktnx Site Safety Tailgate Meeting <br /> Installation/Site Name Project Number <br /> Event Name Safety Representative <br /> Date Field Team Leader <br /> Weather Forecast: <br /> Participants (attach loose-leaf sheet if additional space is needed) <br /> Printed Name and Initials Affiliation Role Signature <br /> Scope of Today's Work <br /> Health and Safety Topics Discussed(✓applicabletopics) <br /> ❑ Weather Factors ❑ Chem. of Concern ❑ Lifting Safety ❑ Sanitation <br /> ❑ AHA Review ❑ PPE Requirements ❑ Recent near ❑ <br /> ❑ Site emergency SOP, ❑ Slip/Trip/Fall Hazards miss/injuries/lessons ❑ <br /> rally point, etc. ❑ Site Controls ❑ BBS Hazard Triggers['] ❑ <br /> ❑ Changed Conditions ❑ Biological Hazards ❑ BBS Trigger Controlsi21 ❑ <br /> ❑ Equipment Hazards ❑ COVID 19 SOPS ❑ Traffic Control ❑ <br /> [1] Behavior-based Safety Hazard Triggers:Distractions,rushing,short-cuts,frustration,exhaustion,complacency,anger,multi-tasking,not focusing on task <br /> [2] Behavior-based Safety Trigger Controls:Communicating,accountability,patience,relaxation techniques,healthy lifestyle,and adequate sleep <br /> Comments: <br /> The individual in the Safety Representative role acknowledges that the checked (J)topics were discussed. <br /> Name (Print) Signature Date <br /> Ahtna Southwest Environmental SWE-FFRM-200(April 2022) <br />