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BLAINE Daily Tailgate Safety Meeting Checklist & <br /> rErnsErroa:c Hazard Mitigation Form TGSM <br /> Site Address: <br /> Date: <br /> Check-in with site representative completed? ❑Yes N/A <br /> Is fuel delivery scheduled for today? ❑Yes []No ylA <br /> Emergency pump cut-off switch located? -TY—es————UZA <br /> First aid kit located and confirmed ready-to-use? Yes <br /> Fire extinguisher located and confirmed ready-to-use? Yes <br /> Eye wash located and confirmed ready-to-use? Yes <br /> Emergency Services information located&reviewed? Q 6 <br /> Hospital map& route located and reviewed? es <br /> HASP Special Hazard Notice section reviewed? [J as <br /> Site Status confirmed or amended, dated and initiated? es <br /> Emergency Response procedures reviewed with all work crew members? Yes <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 /> .lob 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? ❑Yes El N/A <br /> Trafflc Control Plans reviewed for suitability given current road,traffic&weather conditions? ❑Yes �/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 JSxs or impede the safe and proper execution of the Work Plan,Work Area Plan(s)anrllor 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? ❑Yes /A <br /> Job Clearance Form completed? Yes <br /> Pre-Start Cali-in completed and approval to start work received from Project Manager? I ayes <br /> Printed Nam n Signature�� Timery <br /> TGSM v6 <br />