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REMEDIATION MANAGEMENT-AUTHORIZATION TO WORK <br /> �q� ,mac <br /> KI <br /> ..;"" ,i,. .r� <br /> 'ta3s ' „ '3 i. t. . ,s'� ` :07T i y. 3 AAy� icr <br /> 11-7 <br /> j 2. 2. <br /> 4. 4. <br /> 5. 5. <br /> 6. 6. <br /> 5..p. <br /> I.J . ❑Hydrogen SuIJ-ule _ 2. Benzene 13. ❑Diesel 14. X ffydrocarbon S. ❑Acid 6.❑Lead <br /> 7. Carbon Monoxide 8. Asbestos 9. ❑Causticl0.X Gasoline ll. ❑Heavy Metals <br /> l2. NORMS 13. Other. �e <br /> I <br /> 119. ❑ Radiation 20. Electric 121. ❑ Pneumatic 122. ❑ Thermal-steam <br /> 23._❑Hydraulic 124. Pressure 125. Mechanical 26. Fluids&Gases <br /> 27. ❑ Gravitational [28. El Other. <br /> 34. ❑Walking!Working Surfaces _ 35. ❑Trajc 36. ❑Working at Heights 37. inch Points <br /> 38. ❑Weather 139. ❑Noise 140. ❑Grinding 1 41. ❑Heavy equipment 42. Sharp Edges <br /> 43. ❑Hot Work T44. ❑Security 45. ❑Congested Area 46.❑Overhead Work <br /> 47. ❑Body Position 148. ❑Static Posture 49. ❑Wind 1 50. ❑Rotating Equipment 51. ❑Ljfting <br /> 52, Housekeeping 153. ❑Spills 54. ❑Underground Utility 55. Slopes and Terrain <br /> 56. ❑Confined Space 57. ❑Vibration 58. ❑Ground Disturbance 159. ❑Rigging <br /> 60. Lk Vehicle Safety-Driving 61. ❑Repetitive Motion 62.❑ Container/Drum Labelr <br /> 63. D Waste 164. ❑HeadCold Stress 65. ❑Hand&Power Tools 66.JR Fitness to Work <br /> 167. ❑Open Pipe 1 68. ❑Boom Swing 69.©Lighting 70. ❑Exposure to poisonous plank/animals/bugs <br /> 71. ❑Overhead Electrical 72. ❑Auger/Drill Stem 73. ❑Other: <br /> X914.:F..` F. i;.' rr _._ .j. '3., <br /> 79.E Safe Glasses 80 ❑ G1. <br /> iles 81. D Face Shield 82. 83. jN Rejkctive Vest <br /> 84. Hard Hat 18.5. ❑ Escape Pak86. Safety Toe Shoes.87,❑Ear Mus 88. ❑Respirator. <br /> 89_ ] FRC 90. ❑ Supplied Air 91._n Topical Creams/Repellants 92. Gloves: <br /> 93. ❑ Fire Watch 94. F1 Drip Pans 95. M Plastic Sheeting 96.D Vac Truck 97. Fall Protection <br /> 98. (� Barricade 99. Fire Blanket I00. V wind AreasAreas Checked I01.[�Warnin Si ns <br /> 102.❑ Flag Off Area E 103.❑ Life Lines 104. Fire Extinguisher at Jobsite 105. Sam lin Prohibited <br /> 106.0 Seal Manholes,Sewers,and Catch Basins 107.❑Communication Method 108.[] Welding Shields <br /> I09 Continuous Monitoring 1I0.❑ Wet Down Area lll. Ladder Tie..9 <br /> 1112.Q Ta Lines _ I13.M Active Site Hazard Communication <br /> 114.❑Fence Off Area IS.❑ Other. <br /> 13EQ1lIR_ED PROCEDURES r� - ' . .k..` ;,: uF; <br /> ❑Drilling ❑MR ❑Trar.Control ❑LOITOIBUnding ❑HoistlLifting 1 ❑Journey Hazard Assessment <br /> w C <br /> 2.-' 3 1- Q <br /> "R IRE.. RE--, '71 <br /> E. v .. . <br /> []Hot Work j❑Ground Disturbance ! ❑Confine Space ❑Wo .ng m Heights ❑None <br /> I havc reviewed and understand the of 2• <br /> day pmtdt,and Il'attartmmvs I will RPQt hazwdws uondtttons w wz daWfied on <br /> job site to my supervisor and/or BP rept tafive so they can be corrected as ncenmy. <br /> 5. 6. 7. 8. <br /> 9. 10. 11. <br /> Onsite Project Manager ate: / :; al- I Location of Site Work: <br /> Site ��j "� Dat tmeIssued: G� �m Date/TimeExpires:/ antm� <br /> Is HASP onsite? nsite? ,kls ISA onsite? <br /> Authorization Signature. �� �• <br /> �evuim Pm,Pte:oZ(rlfp5 <br />