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F <br /> Chemic l'Exposures <br /> 1. Remove exposed person to safe area; <br /> 2. If applicable,immediately flush exposed area with water,especially if eyes are affected; <br /> 3. Remove contaminated clothing; <br /> 4. Identify the chemical; <br /> 5. Notify appropriate responders. <br /> 6. Implement injury procedures above if necessary,: <br /> 7. Call project manager,supervisor,and Safety Committee representative <br /> 8. Notify the client <br /> 9. Document the circumstances of the incident in your daily field report and fill out an incident report w/in 24 hours. <br /> i <br /> EMERGENCY MEDICAL FACILITIES, <br /> Hospital name and location: Doctor's Hospital of Manteca—1205 E North Street,Manteca,California <br /> Hospital phone number: (209)823-3111 or 911 <br /> A map to the hospital is attached. <br /> A first aid kit shall be provided by the Site Safety Officer's and available within exclusion zone at all times. <br /> Police Number. 911 Fire Number: 911 <br /> Project Manager: Brandon Wilken Office Number: (510)420 3355 <br /> Client Name: Janet Haikel Contact Number: (650)596-8950 <br /> Emergency medical treatment due to chemical exposure to compounds anticipated to be at the site are presented on the attached <br /> MSDS(or equivalent)forms. <br /> APPLICABLE JOB SAFETY ANALYSIS FORMS AND LOSS PREVENTION ANALYSIS FORMS <br /> Check all JSA forms required for job at hand and ensure that they are on site. <br /> [X] Boring/Well Installation [ ] H202 Injection <br /> [ ] Excavation Observation [ ] Remediation System O&M <br /> [X] Geoprobe/Hydropunch Sampling [ ] Tank Removal Observation <br /> [ ] GWE/SVE Pilot Testing [ ] Well Abandonment <br /> [ ] GWE and/or SVE System Installation [ ] Well Sampling/Gauging <br /> [X] Hand Augering/Jack Hammering [ ] Vacuum Truck Hole Clearing <br /> Other required safety forms <br /> • Incident/Near Miss Form <br /> • Subsurface Clearance Checklist <br /> • Workers Compensation referral form <br /> INCIDENT REPORTING <br /> 1. Report any injury to Human Resources,Cambria Safety Officer(CSO)and the employee supervisor within 8 hours to initiate <br /> LPS'Workers Compensation and client reporting. <br /> 2. All incidents including"near misses"to be reported to assigned Safety Committee representative and supervisor as soon as <br /> possible and no later than 24 hrs after occurrence. <br /> Any injury' sustained while working is covered under Worker's Compensation insurance. Any injured Cambria employee must inform <br /> the medical care facility that this is a Worker's Compensation claim and that our insurance policy is State Fund#092000029404. <br /> Copies of the doctor's report on the injury must be forwarded to our insurance carrier. Cambria employees must notify Cambria's <br /> Human Resources Department and the Company Safety Officer on the same day so that we can properly file this claim. <br /> Any injured sub-contractor or sub-contractor employee will be covered under their employer's policy. <br /> WORKERS'COMPENSATION(applicable to Cambria employees only) <br /> 1. Take or send the injured worker for appropriate medical care. <br /> ❖! For non-emergency care,use facilities in the Kaiser occupational health alliance. <br /> If time allows fill out a referral form,send with employee and call the nearest facility to inform them that someone will be <br /> coming. This makes it easier for the employee to receive care. <br /> ❖ Reference Cambria's workers compensation policy: State Fund#092000029404,valid through 7/1/05 <br /> 2. Within one day,give the employee the Employees Claim for Workers'Compensation Benefits <br /> 3. Report injury as stated before. HR or the CSO will prepare an Employer's Report of Occupational Injury or Illness and track the <br /> claim <br />