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r - <br /> REMEDIATION MANAGEMENT-AUTHORIZATION TO WORK <br /> NMI <br /> z. 2. <br /> 3• 3. i <br /> 4. 4. <br /> i <br /> IS 5 <br /> 6. <br /> R11,1 <br /> i <br /> aa! eJis��rw6. __ 4s �r r <br /> E!_❑Hydrogen Su <br /> 1J`ede i 2_�Benzene }3. ❑Diesel 4. ydrocarbon ;5. ❑Acid 6.❑Lead <br /> 7 ❑Carbon Monoxide 8. Asbestos 119. -❑Caustic I0.-Gasoline _-ill. ❑Heavy Metals <br /> j <br /> 11. NORMS 13.-❑.Other: <br /> �19. ❑ Radiation 20.>9Electric 121. Pneumatic w�21. C1 Thermal-Steam <br /> 23._ Hydraulic 24. Pressure 25.XNechanical _ 26. 11 Fluids&Gases <br /> C27. ❑ Gravitational 28. ❑ Other: <br /> Em m <br /> 34. ❑Walking/Working Surfaces 135. Traffic 136. ❑Working at Heights 37,Rg Pinch Points <br /> 38. ❑Weather 39, ❑Noise 140.❑Grinding 41. ❑Heavy equipment 42. Sharp Edges <br /> 43. ❑Hot Work 44. ❑Security -`45.❑Congested Area 146.❑Overhead Work j <br /> 47. ❑Body Position 48. ❑Static Posture 149.❑Wind 50. ❑Rotating Equipment I S1. ❑Lifting <br /> 52, IRLHousekeeping 53. ❑Spills I54. ❑Underground Utility 55. Ej Slopes and Terrain <br /> 56. ❑Confined Spaci, S7. ❑Vibration 58. ❑Ground Disturbance 59. ❑Rigging �...J <br /> 60. JK Vehicle Safety-Driving 161.,W Repetitive Motion 62. ❑ ConkunerlDrum Labels'l <br /> 63. ❑Waste 164. ❑Heat/Cold Stress 65.IgHand&Power Tools 66. &ffFitness to Work <br /> X67. ❑Open Pipe 6.L...B'._._❑Boom Swing 69.❑Lighting 170. ❑Exposure to poisonous plants/animals/bugs <br /> 171. ❑Overhead Electrical 172.❑AugerlDrill Stem 173. ❑Other: <br /> 79. AK Sae Glasses 1 80. Gaggles 8I. Face Shield 81. Ear Plus 83. a cave Vest <br /> 84 fig Hard Hat i 85. ❑ Esc Pak 8b. Sajely Toe Shoes 187.❑Ear Muffs 88. Respirator: <br /> 89. 15 FRC 90. Su litdAir 191. R Topical Creams lRepeltants 92. Gloves: <br /> 93. [_1 Fire Watch 94. ❑ Drip Pans 195. Plastic Sheetin 96. Vac Truck 97. FaUProtectian <br /> '98. Barricade 99. Fire Blanket 100. _Upwind Areas Checked 101. Warning Signs I <br /> 116249 Flag VArea 1103 Life Lines 104Fire Extinguisher at]obsite I D5. 5am in Prohibited 1 <br /> 106,❑ Seal Manholes,Sewers,and Catch Basins x107.❑Communication Method 108. Welding Shields <br /> 109. Continuous Monilorin I II0. Wet Down Area1 IIl. Ladder Tie Off <br /> 1112. Ta Lines 113.Q Active Site Hazard Communication <br /> 114.❑Fence Off Area 115.❑ Other: <br /> 1itED'3P..ROCED[JRESs }: t: aR - } <br /> o-d _ <br /> ❑Drilling OMOC - ❑Traffic Control ❑LOITOIBIInding a ❑HolsdLiftcng ,tourney Hazard Assessm t <br /> a ,�,'�•, .$;� -`F: x °�" : REGII[RED P_ERM[TSEk. <br /> ❑Hot Work I❑Ground Disturbance ❑Conf ed Sparn rom Height-None �- <br /> Cpnu= icll Fmdnyct(s)Simnkm , 1 have rrAcwed sm wndexstand rhe 'fiwu of 1. 2. <br /> iris pamil,aril if$arWchrnaAs. twill report basilars oaditio[n a acta' ' <br /> job sire m my supervisor and/or BP represenutire so they cm bo aonucted as an 3 ,,.....,. <br /> 5. 6. 7. 8. <br /> 9. 10, 11. 12. <br /> Onsite Project Manager:ASJ t .r ate: I pL Location of Site Work:A/-" <br /> Site a Dated r p �mDat ime Expire"/,,,arr,40 <br /> Is HASP ons'e? RP onsite? Is JSA onsite? <br /> Authorization Sig tare: <br /> Re.isionepo.orK o7.o7,m <br /> i _ <br />