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Appendix C <br /> 5 Day Site Safety Checklist <br /> SITE NAME: Fiesta Car Wash/Santa Barbara,CA <br /> SITE NUMBER: UPR-8174-1 <br /> Check if OK, NA if not applicable <br /> DATE: <br /> Pre-mobilization:To be completed before leaving office <br /> Updated health and safety plan <br /> Documentation of e-Railsafe,OSHA-40 hour and 8-hour refresher training <br /> Emergency phone numbers for utilities included <br /> Proper personal protective equipment(PPE)selected&inspected- <br /> Hard hat <br /> Safety glasses(with side shields) <br /> Hearing protection <br /> Reflective Safety vest <br /> Work gloves <br /> Sampling gloves(PM specify type) <br /> Protective coveralls(specify,Tyvek,Nomex,etc.) <br /> Safety boots <br /> Respirator/cartridges(PM identify proper cartridges) <br /> Other protective equipment- <br /> Eye wash(check expiration date) <br /> Fire extinguisher(visually inspected within last 30 days) <br /> First aid kit(inventory and check expiration dates) <br /> Safety cones(or flashing traffic light) <br /> Underground utility hazards identified and addressed <br /> one-call ticket or job number: ) <br /> UV Protection <br /> Protection from biting/stinging insects <br /> Protection from poisonous plants <br /> Cell Phone and Charger <br /> (Sign and date before mobilization to site) <br /> Name: <br /> Signature: Date: <br /> 24 <br />