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POTENTIAL HEALTH AND SAFETY HAZARDS <br /> Anticipated physical hazards, Check all that apply: <br /> D Heat(high ambient temperature) D Heavy Equipment <br /> D Cold N Physical Injury/trauma (resulting from moving <br /> machine <br /> 14 Noise D General construction <br /> D Oxygen depletion D Physical injury and trauma <br /> D Asphyxiation D Electrical hazards <br /> D Excavation D Cave-ins <br /> D Falls,trips, slipping D Ignition/Explosive <br /> D Other(specify): <br /> HAZARD EVALUATION <br /> Parameter TLV(ppm) IDLH(ppm) LEL(%)skin eyes Health <br /> Gasoline 300 N/A 1.4 <br /> Diesel 15 N/A N/A <br /> SPECIAL PRECAUTIONS: PID on site to screen soil samples and for air monitoring <br /> PERSONAL PROTECTIVE EQUIPMENT <br /> Check all a plicable items: <br /> E) Hardhat I&Safety glasses / goggles <br /> N Steel-toed /shank shoes or boots R Clothing protection/safety vest <br /> N Hearing protection N Other(specify): <br /> Personal Protection <br /> Level of Protection: D A D B D C 0 D <br /> Modifications: PPE Listed above is to available and worn as appropriate <br /> Surveillance equipment and materials: N/A <br /> Instrument: N/A <br /> Action <br /> Level: N/A <br /> First Aid: First AID kit will be on site. <br /> Revised 4/3/14 <br />