Laserfiche WebLink
BLAINE Daily Tailgate Safety Meeting Checklist & TSIUI <br /> Hazard Mitigation Form <br /> Site Address: pp ff p � <br /> C61-des t—�t j^c�l (/-ei v-501 1 azscJl 7rck c Date: IS/l <br /> Check-in with site representative completed? 7 [1 Yes /q <br /> Is fuel delivery scheduled for today? ❑Yes ❑No N/A <br /> Emergency pump cut-off switch located? ❑Yes BNO <br /> First aid kit located and confirmed ready-to-use? RfYes <br /> Fire extinguisher located and confirmed ready-to-use? rYes <br /> Eye wash located and confirmed ready-to-use? <br /> Emergency Services information located&reviewed? <br /> Hospital map&route located and reviewed? <br /> HASP Special Hazard Notice section reviewed? <br /> Site Status confirmed or amended, dated and initialed?Emergency Response procedures reviewed with all work crew members? <br /> Compliance Roster signed by all work crew members? Yes <br /> Site walk has been performed to locate wells and identify additional hazards? Yes <br /> Job Safety Analysis(JSA)for each task located&reviewed by all work crew members? Yes <br /> Work Area Pians reviewed for suitability and effectiveness given current site conditions? as ❑N/A <br /> Traffic Control Plans reviewed for suitability given current road, traffic&weather conditions?— E]Yes N/A <br /> Stop Work Authority reviewed and understood by all work crew members? Yes <br /> • In the space below,note unaddressed hazards and conditions that might compromise compliance with Approved <br /> Procedures and/or JSA's or impede the safe and proper execution of the Work Plan,Work Area Pian(s)andtor Traffic <br /> Control Plan(s). <br /> • Report unaddressed hazards and adverse conditions to the Project Manager during Pre-Start Call-in and as hazards are <br /> identified or conditions change throughout the workday. <br /> • DO NOT COMMENCE OR RESTART WORK until PM has been notified and mitigation measures approved. <br /> Time Hazard or Adverse Condition Initials Hazard Control Measure <br /> Site representative briefed on planned work activities and Work Area Plans? i2yes ❑N/A <br /> Job Clearance Form completed? es <br /> Pre-Start Call-In completed and approval to start work received from Project Manager? es <br /> Printed Name ,f)c w t-0 4Signature Tim? <br /> i( c TGSMv6 <br />