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• 0 Control Number: TSM- SM010309.0000 TSM + project number plus date as follows: xxxxxxxx.xxxx.xxxxx - dd/mm/year 0AARCAD I S e iLt..ft nd TAILGATE HEALTH & SAFETY MEETING FORM Project Name: Project Location: Date: Time: Conducted by: Signature/Title: Issues or concerns from previous day's activities: Task anticipated to be performed today: Additional permits/checklists attached USE TRACK! Evaluate the hazards (h) for the tasks being performed today and rank as Low (L), Medium (M) or High (H). Use relevant JSAs, FHSHB, permit or other work standard to communicate controls (c) to be used to eliminate or mitigate identified hazards. Gravity (i.e., ladder, trips) (L M H) Motion (i.e., traffic, machinery) (L M H) E]Mechanical (i.e., augers, motors) (L M H) h: h: h: c: c: c: Electrical (i.e., utilities) (L M H) Pressure (i.e., gas cyl., wells) (L M H) DEnvironment (i.e., heat, cold) (L M H) h: h: h: c: c: c: Chemical (i.e., fuel, acid, paint) (L M H) 0Biological (i.e., ticks, poison ivy) (L M H) Radiation (i.e., alpha, sun, laser) (L M H) h: h: h: c: c: c: Sound (i.e., machinery) (L M H) OPersonal (i.e. alone, night) (L M H) 0Driving (i.e. car, ATV, boat) (L M H) h: h: h: c: c: c: ❑ Refer to the attached Hazard Analysis Sheet(s) or JSA Comments: Signature and Certification: I have read and understand the project specific HASP for this project. I will STOP the job anytime anyone is concerned or uncertain about health & safety or if anyone identifies • • • a hazard or additional mitigation not recorded in the j site, project, job or task hazard assessment. � � � � • ... • 04I will be alert to any changes in personnel, conditions at the work site or hazards not covered by NPrinted Name/Signature/Company Sign In Time Sign Out the original hazard assessments. If it is necessary to STOP THE JOB, I will perform TRACK; and then amend the hazard assessments or the HASP as needed. I will not assist a subcontractor or other party with their work unless it is absolutely necessary and then only after I have done TRACK and I have thoroughly controlled the hazard. All site staff should arrive fit for work. If not, they should report to the supervisor any restrictions or concerns. In the event of an injury, employees will call WorkCare at 1.888.449-7787 and then notify the field supervisor. Utility strike, motor vehicle accident or 3rd party property damage - field supervisor will immediately notify the Project or Task Manager 'Short Service Employee (SSE) working for Arcadis <1 year.