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SITE INSPECTION LOGMASP SIGNATURE PAGE <br /> PROJECT NAME:Tracy Corners Shopping Center LOCATION:3081 North Tracy Blvd.,Tracy California 95376 <br /> PROJECT NUMBER:14-129814 DATE: <br /> PROJECT MANAGER:Debbie Soukup COMPLETED BY:D.Monteverde <br /> SITE DESCRIPTION AND NATURE OF WORK:Site characterization including the investigation of soil, soil gas,and groundwater. <br /> HAZARD COMMUNICATION EXCAVATIONS and TRENCHES <br /> [ ]Chemical hazards identified [ ]All personnel and storage at least 2 feet from top edge of <br /> [ ]All containers properly labeled excavation <br /> [ ]MSDS/workplace notebook on-site [ ]Ladder in place <br /> [ ]Site safety briefing completed and documented [ ]Guarding/barriers in place <br /> ACCIDENTS/EMERGENCY INFO VEHICULAR TRAFFIC <br /> [ ]First aid personnel identified [ ]All vehicular traffic routes which could impact worker <br /> [ ]Hospital location identified safety identified and communicated <br /> [ ]Police/fire/ambulance phone numbers available [ ]Barriers or other methods established to prevent injury from <br /> [ ]Fire extinguisher present moving vehicles <br /> STORAGE PEDESTRIAN TRAFFIC/SITE CONTROL <br /> [ ]Tools/drill equipment/supplies safely stacked to prevent [ ]All walkways which could be impacted by site activities <br /> rolling or collapse identified and communicated <br /> [ ]Work areas and passage ways kept clear [ ]Barriers or other methods established to prevent pedestrian <br /> injury from site activities <br /> UNDERGROUND HAZARDS <br /> [ ]All underground hazards identified and communicated to AIR MONITORING <br /> workers on-site [ ]PID on-site for air monitoring of work breathing space <br /> [ ]Utility/USA clearance confirmed [ ]PID calibrated daily and recorded in log book <br /> [ ]Clearance dates:N/A [ ]Operational action levels communicated and PPE present <br /> [ ]Clearance ID#:N/A for use,if required <br /> OVERHEAD HAZARDS COMMENTS/OTHER 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 /> 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 August 15,2016 <br />