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SITE INSOCTION LOGMASP SIGNAT&E PAGE <br /> PROJECT NAME:Payless Shoes Source LOCATION:434 Dr.MLK Jr.Blvd,Stockton,CA 95204 <br /> PROJECT NUMBER:17-191672.4 DATE:9/25/17 <br /> PROJECT MANAGER:.Ioe Mangine COMPLETED BY:Nate Maroon <br /> SITE DESCRIPTION AND NATURE OF WORK: <br /> HAZARD COMMUNICATION EXCAVATIONS and TRENCHES <br /> [X] Chemical hazards identified [X]All personnel and storage at least 2 feet from top edge of <br /> [NA]All containers properly labeled excavation <br /> [NA]MSDS/workplace notebook on-site [NA]Ladder in place <br /> [X] Site safety briefing completed and documented [X] Guarding/barriers in place <br /> ACCIDENTS/EMERGENCY INFO VEHICULAR TRAFFIC <br /> [X]First aid personnel identified [X]All vehicular traffic routes which could impact worker <br /> [X]Hospital location identified safety identified and communicated <br /> [X]Police/fire/ambulance phone numbers available [X]Barriers or other methods established to prevent injury from <br /> [NA]Fire extinguisher present moving vehicles <br /> STORAGE PEDESTRIAN TRAFFIC/SITE CONTROL <br /> [X]Tools/drill equipment/supplies safely stacked to prevent [NA]All walkways which could be impacted by site activities <br /> rolling or collapse identified and communicated <br /> [X]Work areas and passage ways kept clear [X]Barriers or other methods established to prevent pedestrian <br /> injury from site activities <br /> UNDERGROUND HAZARDS <br /> [X]All underground hazards identified and communicated to AIR MONITORING <br /> workers on-site [X]PID on-site for air monitoring of work breathing space <br /> [X]Utility/USA clearance confirmed [X]PID calibrated daily and recorded in log book <br /> [X]Clearance dates: [X]Operational action levels communicated and PPE present <br /> [X]Clearance ID#: for use,if required <br /> OVERHEAD HAZARDS COMMENTS/OTHER HAZARDS <br /> [X] 15-foot minimum clearance maintained <br /> [X]All sources of falling objects/swinging loads/ <br /> rotating equipment identified <br /> [X]Barriers or other methods in place to prevent injury due to <br /> overhead hazards <br /> x=OK NA =Not Applicable <br /> Partner Site-Specific Health and Safety Plan Page 12 <br /> Version 1.02 September 25,2017 <br />