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CG ICS SSP: 1910.120 1.Incident Name 2. Date/Time Prepared 3. Operational Period COMPLIANCE CHECKLIST Form B cont 6.a.Cite: 1910.120 6.b.Requirement(sections that duplicate or explain are omitted) 6.c.ICS Form 6.d.Check 6.e. Comments 1910.120 c 6 i Monitoring for ionization conducted? SSP-E ❑ (ii) Monitoring conducted for IDLH conditions? SSP-E ❑ (iii) Personnel looking out for dangers of IDLH environments? N/A ❑ iv Ongoing air monitoring program in lace? SSP-E ❑ (c)(7) Employees informed of potential hazard occurrence? SSP-B ❑ (c)(8) Properties of each chemical made aware to employees? SSP-B ❑ (d)(1) Appropriate site control procedures in lace? IAP,SSP-B ❑ (d)(2) Site control program developed during planning stages? IAP, SSP-B ❑ (d)(3) Site map,work zones,alarms,communications addressed? IAP, SSP-B ❑ (g)(1)(i) Engineering,admin controls considered? SSP-B ❑ (iii) Personnel not rotated to reduce exposures? N/A ❑ 5 i PPE selection criteria part of employer's program? N/A ❑ Responsibility of employer (ii) PPE use and limitations identified? SSP-F ❑ (iii) Work mission duration identified? SSP-F ❑ iv PPE properly maintained and stored? N/A ❑ Responsibility of employer vi Are employees properly trained and fitted with PPE? N/A ❑ Responsibility of employer vii Are donning and doffing procedures identified? SSP-F ❑ viii Are inspection procedures properly identified? SSP-F ❑ ix Is a PPE evaluation program in lace? SSP-F ❑ h 3 Periodic monitoring conducted? SSP-E ❑ k 2 i Have decontamination procedures been established? SSP-G ❑ (ii) Are procedures in place for contamination avoidance? SSP-G ❑ (iii) Is personal clothing properly deconned prior to leaving the SSP-G ❑ site? iv Are decontamination deficiencies identified and corrected? SSP-H ❑ (k)(3) Are decontamination lines in the proper location? SSP-C ❑ (k)(4) Are solutions/equipment used in decon properly disposed or. N/A ❑ (k)(6) Is protective clothing and equipment ro erl secured? N/A ❑ (k)(7) If cleaning facilities are used,are they aware of the hazards? N/A ❑ (k)(8) Have showers and change rooms provided,if necessary? N/A ❑ (I)(1)(iii) Are provisions for reporting emergencies identified? SSP-D ❑ (iv) Are safe distances and places of refuge identified? SSP-B and C ❑ (v) Site security and control addressed in emergencies? SSP-D ❑ (vi) Evacuation routes and procedures identified? SSP-D ❑ (vii) Emergency decontamination procedures developed? SSP-D ❑ (ix) Emergency alerting and response procedures identified? SSP-D ❑ (x) Response teams critiqued and followup performed? SSP-H ❑ (xi) Emergency PPE and equipment available? SSP-D ❑ ICS-208-CG SSP-K (rev 9/06): Page 2. Page of