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Investigations 0 ❑ <br /> been followed? (Attach completed Checklist for Subsurface Clearance-Appendix 33-1) <br /> Specify names and phone number of utilities contact: <br /> Name of Underground Service Alert <br /> Contact(s) <br /> Phone Number 1-800-642-2444 <br /> G. SITE CONTROL (1910.120(d)) <br /> Work Zones have been established as shown on:the attached Site Diagram. <br /> Site Security: Security on site will be maintained by: <br /> x Temporary barricades and/or 'warning tape" <br /> Security Fencing <br /> 24 Hour Security <br /> Other (specify) <br /> P <br /> H. PERSONAL PROTECTIVE EQUIPMENT` (1910.120(b)(4)) (LIST EXPOSURES UNDER <br /> WORK ZONE) <br /> Based on evaluation of potential hazards, the` following levels of personal protection have been <br /> designated for the applicable work zones: <br /> Work Zone Level of Protection. Required Protective Equipment (specify exact type <br /> e.g. nitrile gloves) <br /> Exclusion Zone Level D Respirator: NA <br /> Filters/Cartridges: NA <br /> Boots: Steel toe <br /> Inner Gloves: nitrile <br /> Outer Gloves: leather <br /> Protective NA <br /> Coverall: <br /> Hard Hat: yes <br /> Appendix 7-4 (Form HS 003) <br /> Page 5 of 13 <br /> Revised: 3/03 <br />