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SITE MAP FOR SITE SAFETY PLAN (ICS-208-CG SSP-C) Purpose: The Site Map for the Site Safety Plan is required by Title 29 Code of Federal Regulations Part 1910.120. It provides in 1 place a visual description of the site which can help ICS personnel locate hazards, identify evacuation routes and places of refuge. Preparation: The Site Map for the Site Safety Plan can be completed by the Safety Officer, his/her staff or by ICS field personnel (Group Supervisors, Task Force/Strike Team Leaders) working at a site with unique and specific hazards. One or several maps may be developed, depending on the size of the incident and the uniqueness of the hazards. The key is to ensure that the workers using the map(s) can clearly identify the work zones, locations of hazards, evacuation routes and places of refuge. Distribution: This form must be located with the Site Safety Plan (ICS-208-CG SSP-B). It therefore follows the same distribution route. Instructions: Item# Item Title Instructions 1 Incident Name Print the name assigned to the incident. 2 Date/Time Prepared Enter date (month, day, year)prepared. 3 Operational Period Enter the time interval for which the assignment applies. 4 Safety Officer Enter the name of the Safety Officer and means of contact. 5 Supervisor/Leader The Supervisor/Leader who receives this form will enter their name here. 6 Location& size of Enter the geographical location of the site and the approximate square area. site 7 Site Accessibility Check the blocks if the site is accessible by land,water, air, etc. 8 For Emergencies Enter the name and way to contact the individual who handles emergencies. Contact 9 Include Ensure the map includes the listed items provided in this block. 10 Sketch of Site Sketch of site for work. May attach map or chart. 10 Prepared by Enter the name and position of the person completing the worksheet. 11 Date/Time Briefed: Enter the date/time the document was briefed to the appropriate workers and by whom.