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Site Name: Subsurface Clearance Client:ERM p Field Process Checklist. ERM Project No.: SSC Exp.Person: Pro'ect Basics Yes No N/A Comments Contact Person requested and identified Subcontractors meet ERM's minimum safety criteria Subcontractors understand their role in the SSC Process SSC Experienced Person with current SSC training assigned Project staff with current SSC training assigned UXO/MEC risks assessed: UXO/MEC IS NOT present General Field Activity&Site Walk Yes No N/A Comments HASP read,understood and signed by project team Site walk Visual Clues /site features below integrated into Site Services Model Identified Visual Clue Yes No Identified Visual Clue Yes No Lights Pipeline markers Signage Fire hydrants Sewer drains/cleanouts Sprinkler systems Cable markers Water meters Utility poles with conduit leading to the ground Natural gas meters Utility boxes UST fill ports and vent pipes Manholes Steam lines Pavement scarring Remote buildings with no visible utilities Comments/Others: Contact Person Approval of Ground Disturbance Locations indicate verbal approval by printing"Verbal"in the signature sace Name Print Company Name Sin Date/Time Pre-Clearance Yes No N/A Comments Public Utility Markout completed Private Utility Markout completed Final Critical Zone determinations made by the SSC Experienced Person Critical Zones Are there any ground ❑ Yes. PIC must approve work within the Critical Zone. The SSC Location Disturbance Permit or equivalent disturbance locations is required for those locations. known or suspected to ❑ No. Physical Clearance will proceed to the deeper of: 0.6m/2 feet below the frost line or 1.2m/4 feet be inside Critical Zones? below ground level,whichever is deeper. Cleararicefor Point Disturbances Yes No N/A Comments Adequate overhead clearance at ground disturbance locations There are disturbance locations known or suspected to be inside Critical Zones Physical Clearance successfully completed at all locations Clearance,fpf Excavations Yes No NIA Comments Adequate overhead clearance at ground disturbance locations Communicate excavation plan and Excavation Buffer locations to subcontractor There are disturbance locations known or suspected to be inside Critical Zones De-energize below ground services prior to beginning excavation SSG.Process C©m`feted 6y SSC Experienced Person Name Print Name Sin Date/Time ERM Health&Safety Page 1 of 1 Last Rev: Sept.2009 English Version