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2900 - Site Mitigation Program
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PR0527590
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Entry Properties
Last modified
3/4/2020 1:36:52 PM
Creation date
3/4/2020 1:28:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
WORK PLANS
RECORD_ID
PR0527590
PE
2950
FACILITY_ID
FA0018694
FACILITY_NAME
ASSIEH DEVELOPMENT CORP
STREET_NUMBER
2403
Direction
W
STREET_NAME
LOUISE
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
19811002
CURRENT_STATUS
01
SITE_LOCATION
2403 W LOUISE AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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Bradburn, Briller&Johnson,# • Health&Safety Plan <br /> HEALTH AND SAFETY SUMMARY REPORT <br /> To be completed by Field Safety Coordinator(after completion offwm work) <br /> Project No.: R1005160 HSP Log No.: 10-700-2 <br /> Client Name: Project Name/Location:Manteca,CA Phase 11 ESA <br /> Field Safety Coordinator(FSC):Genevieve de la Torre Dates of Field Work: <br /> 1. Were there any violations of the HSP by BB&J Personnel? YES_or NO <br /> If Yes, Explain: <br /> 2. Were there any violations of the HSP by subcontractors? YES_or NO <br /> If Yes,Explain: <br /> 3. Was there any obvious,significant exposure to COCs? YES_or NO— <br /> If <br /> O_If Yes, Explain: <br /> 4. Were there any OSHA reportable accidents or injuries? YES_or NO— <br /> If <br /> O_If Yes,Explain: <br /> If Yes was answered in any of the aforementioned questions, provide a detailed explanation of the <br /> situation, including circumstances, personnel involved, causes,type of contamination (if applicable), and <br /> corrective action taken(i.e.,first aid or medical assistance required). <br /> Signature Date <br /> Field Safety Coordinator <br /> ** RETURN A COPY TO HEALTH AND SAFETY OFFICER UPON COMPLETION OF WORK <br /> To be completed by Health &Safety Officer <br /> Was an audit conducted? YES or NO <br /> Signature Date <br /> Health&Safety Officer <br /> Bradburn, Briller&Johnson,LLC <br />
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