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Injury and Illness <br /> Prevention Program 2.22 <br /> *EQUIPMENT INVOLVED THAT CONTRIBUTED TO H&S NEAR LOSS-Select all that apply <br /> 1.Air Stripper 25. Fire Extinguisher 51. Maintenance Tool, 77. Safety Shoes/Boots 98. Vapor Extraction Systei <br /> 2.API Separator 26. Forklift General 78. Safety Vest/Clothinc)9. Vapor-Phase Treatment <br /> 3.Automobile 27. Front End Loader 52. Manifold 79. Rope System <br /> 4. Boom Material 28. Grader 53, Manlift/Basket/Cherry 80. Bailer 100. Other System, Type:_ <br /> 5. Bulldozer 29. Hammer Picker 81. Geoprobe 101. Surge Tank <br /> 6. Cable 30. Knife 54. Motor, Electric 82. Hand Auger 102. Underground Tank <br /> 7. Carbon Drum/Vessel 31. Non-Powered 55. Oxidizer 83. PID 103. Telemetry System <br /> 8. Chain Block Equipment 56. Pallet 84. Multi-Gas Meter 104. Testing Devices <br /> 9. Compressor,Air 32. Powered 57. Piping 85. Sample Container 105. Tractor Trailer <br /> 10. Control Panel (local) Equipment 58. Piping, Hose 86. Split-Spoon Sampler 106. Truck, Flatbed <br /> 11. Crane(mobile) 33. Drill 59. Piping, 87. Sling 107. Truck, Pickup <br /> 12. Drill Rig 34. Grinder Injection/Mixing Point 88. Snow Blower 108. Truck,Tank Truck <br /> 13. Drilling Equipment, 35. Hydraulic Torque 60. Hydrojet 89. Snow Plow 109. Truck,Vacuum <br /> Vacuum Wrench 61. Centrifugal Pump 90. Space Heater 110. Safety Valve <br /> 14. Drum, Vertical 36. Powered Saw 62. Diaphragm Pump 91.Air Sparging System 111. Block Valve <br /> 15. Dump Truck 37. Impact Wrench 63. Reciprocating Pump 92. Carbon Treatment Sy: 112. Extraction Well <br /> 16. Electric Heater 38. Saw 64. Regenerative Pump 93. Chemical Oxidation S, 113. Monitoring Well <br /> 17. Electrical Power 39. Screwdriver 65. Rotary Pump 94. Dual Phase Product 114. Recovery Well <br /> Supply 40. Shears 66. Transfer Pump Recovery System 115. Winch <br /> 18. Engine, Combustion 41. Shovel 67. Submersible Pump 95. Groundwater Pump 116. Wire Rope <br /> 19. Equipment Safety 42. Snip 68. Face Shield and Treat System 117. No Equipment Involve <br /> Grounding 43.Wrench 69. Fall Protection 96. POET System 118. MPT-Traffic Control <br /> 20. Excavator/Power 44. Hoist 70. Gloves 97. Shed or Trailer Devices <br /> Shovel 45, 71. Hard Hat /Helmet 118. Not in List(describe):_ <br /> 21. Exclusion Zone Hook/Clamp/Buckle, 72• Hearing Protection <br /> Equipment etc. 73. Respiratory PPE <br /> 22 Fan /Blower 46. Jack (Chemical) <br /> 23 Fencing 47. Ladder, 74. Respiratory PPE <br /> 24 Filter Extension (Particulate) <br /> 48. Ladder, Platform 75. Safety Glasses <br /> 49. Ladder, Step 76. Safety Goggles <br /> 50. Lock Out/Tag <br /> Out <br /> 03/2025 Corporate Health and Safety Management Program I ROUX <br />