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AECOM <br /> All employees: <br /> • STOP WORK if concerned/uncertain about safety/hazard or additional precaution is not recorded on the THA. <br /> • Be alert and communicate any changes in personnel or conditions at the worksite to the supervisor. <br /> • Reassess task, hazards, &mitigations on an ongoing basis; amend the THA if needed. <br /> SITE WORKERS(including AECOM Contractors and Subcontractors): Your signature below means that you understand: <br /> •The requirement to participate in creating, reviewing, &updating hazard assessments(THA)applicable to your task(s). <br /> •The hazards&control measures associated with each task you are about to perform. <br /> •The permit to work requirements applicable to the work you are about to perform (if it includes permitted activities). <br /> •That no tasks or work is to be performed without a hazard assessment. <br /> •Your authority&obligation to"Stop Work" intervene, speak up/listen up. <br /> Your initials(right columns)certify that you arrived&departed fit for duty,&have reported all incidents/near misses; meaning: <br /> •You are physically and mentally fit for duty and have inspected your required PPE to ensure satisfactory condition. <br /> •You are not under the influence of any type of medication,drugs,or alcohol that could affect your ability to work safely. <br /> •You are aware of your responsibility to immediately report any illness, injury(regardless of where or when it occurred), or <br /> impairment/fatigue issue to the AECOM Supervisor. <br /> •You signed out as fit/uninjured unless you have otherwise informed the AECOM Supervisor. <br /> Initials & Sign In Initials & Sign <br /> Print Name & Company Signature Time Out Time <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> In & Fit Out& Fit <br /> (Attach additional Site Worker sign-in/out sheets if needed)Identify number of attached sheets: <br /> SITE VISITOR/SITE REPRESENTATIVE <br /> Name Company Name Arrival Time Departure Time Signature <br /> Daily Tailgate Meeting(S3AM-209-FM5) <br /> Revision 10 June 1,2021 <br /> PRINTED COPIES ARE UNCONTROLLED.CONTROLLED COPY IS AVAILABLE ON COMPANY INTRANET. 2 of 2 <br />