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Attachment C <br />Field Checklist for Implementation <br />Fill in blanks and circle yes or no as appropriate for each. if an item does not apply, write N/A after <br />question. <br />Site Safety Officer <br />Project <br />Job No. <br />Date <br />Location <br />(City) (State) <br />Weather Conditions <br />1. <br />Is a copy of the site safety and health plan (SSHP) on site? <br />YES <br />NO <br />2. <br />Is the personal protective equipment required by the SSHP available <br />and being used correctly? <br />YES <br />NO <br />3. <br />Have the work zones been delineated? <br />-YES <br />NO <br />4. <br />Has a decontamination station been set up as required by the SSHP? <br />YES <br />NO <br />5. <br />Are the decontamination procedures being followed? <br />YES <br />NO <br />6. <br />Is access to the exclusion zone being controlled? <br />YES <br />NO <br />7. <br />Has the site activities' briefing and tailgate safety meeting been <br />provided? <br />YES <br />NO <br />8. <br />Is the list of emergency telephone numbers posted at the support zone? <br />YES <br />NO <br />9. <br />Are the directions to the nearest emergency medical assistance posted <br />at the support zone? <br />YES <br />NO <br />M <br />Is emergency equipment, as identified in the SSHP, readily available <br />and functional? <br />YES <br />NO <br />11. <br />Has the nearest toilet facility been ideentified or a portable facility <br />been set up? <br />YES <br />NO <br />