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DECONTAMINATION (ICS-208-CG SSP-G) <br /> Purpose: The Decontamination form provides information on how workers can avoid contamination and how to get decontaminated. It is a <br /> supplemental form to the Site Safety Plan. <br /> Preparation: The Decontamination Form can be completed by the Site Safety Officer, a member of his/her staff or by the Group/Division <br /> Supervisor, Task Force/Strike Team Leader on the site <br /> Distribution: This form must be located with Site Safety Plan (ICS-208-CG SSP-B). It therefore follows the same distribution route. <br /> Instructions <br /> Item# Item Title Instructions <br /> 1 Incident Name Print the name assigned to the incident. <br /> 2 Date/Time Prepared Enter date (month, day, year)prepared. <br /> 3 Operational Period Enter the time interval for which the assignment applies. <br /> 4 Safety Officer Enter the name of the Safety Officer and means of contact. <br /> 5 Supervisor/Leader The Supervisor/Leader who receives this form will enter their name here. <br /> 6 Location& size of site Enter the geographical location of the site and the approximate square area. <br /> 7 For Emergencies Enter the name and way to contact the individual who handles emergencies. <br /> Contact <br /> 8 Hazard(s) Addressed: Enter the hazards that need to be safeguarded. <br /> 9 Equipment Enter the decontamination equipment needed for the site. If pre-designed Safe Work Practices are used, <br /> indicate here and attach to this form. <br /> 10 References consulted List the references used in making the selection for PPE. <br /> I 1 Contamination Enter procedures for personnel to avoid contamination. If pre-designed Safe Work Practices are used, <br /> Avoidance Practices indicate here and attach to form. <br /> 12 Decon Diagram Draw a diagram for the decontamination operation. If pre-designed Safe Work Practices are used, indicate <br /> here and attach to form. <br /> 13 Decon Steps List the decontamination steps. <br /> 14 Prepared by Enter the name and position of the person completing the worksheet. <br /> 15 Date/Time Briefed: Enter the date/time the document was briefed to the appropriate workers and by whom. <br />