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I, Attachment C—Site Safety & Health Plan Safety Plan implementation Checklist Project Name Project Location(aty and state) Date Name or Site Safety Officer Weather Conditions Project Number BC Staff Present Nasne Office Indicate the status of each of the following 1. Is a copy of the Site Safety and Health Plan(SSHP)on site? ❑ YES ❑ NO Q N/A 2. Is the personal protective equipment required by the SSHP available and being ❑ YES ❑ NO ❑ NIA used correctly? 3 Have the work zones been delineated? ❑ YES ❑ NO ❑ N/A 4. Has a decontamination station been set up as required by the SSHP? ❑ YES ❑ NO ❑ N/A S. Are the decontamination procedures being followed? ❑ YES ❑ NO ❑ N/A 6. Is access to the exclusion zone being controlled? ❑ YES ❑ NO ❑ N/A 7. Has the site activities bnefing and tailgate safety meeting been provided? ❑ YES ❑ NO ❑ N/A e. Is the list of emergency telephone numbers posted at the support zone? ❑ YES ❑ NO ❑ N/A 9. Are directions to nearest emergency medical assistance posted at tits support zone? Q YES ❑ NO ❑ N/A 10. Is emergency equipment available and functional,as required by the SSHP? ❑ YES ❑ NO ❑ N/A 11. Has the nearest toilet facility been identified or a portable facility been set up? ❑ YES ❑ NO ❑ N/A 12. Has an adequate supply of drinking water been provided? ❑ YES ❑ NO ❑ N/A 13. Has water for decontamination been provided? ❑ YES ❑ NO ❑ N/A 14. Have the instruments for environmental and exposure monitoring been calibrated ❑ YES ❑ NO Q N/A and set up as required by the SSHR 1S. Are the instruments being used properly and penodically checked dunng the ❑ YES ❑ NO ❑ NIA shift for battery charge status? 16. Have trenches and excavations been clearly marked? ❑ YES ❑ NO ❑ N/A 17. Have trenches and excavations been shored or sloped as required by soil ❑ YES ❑ NO ❑ N/A type and work activities? 18. Are dust suppression measures being used? ❑ YES ❑ NO ❑ N/A 19. Is food and tobacco consumption being restricted to the support zone? ❑ YES ❑ NO -- ❑ N/A 20. Has a confined space been identified as part of this project? ❑ YES ❑ NO ❑ N/A 21. Are the confined space entry procedures being correctly implemented? ❑ YES ❑ NO ❑ N/A 22. Has the work/rest cycle for the shift been established? ❑ YES ❑ NO ❑ N/A TIME ON (minutes): TIME OFF (minutest 23. Has a shaded rest area been set up in the support zone? ❑ YES ❑ NO ❑ N/A BRowN.nd cw<owEu Place compieled form m project file. Hs-eaiffl pzv 1y91