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r <br /> SITE PERSONNEL AND CERTIFICATION STATUS <br /> Subcontractor's Health and Safety Program Evaluation <br /> Name of Subcontractor: <br /> Address: 2_36,5 fir• <br /> Activities to Be Conducted by Subcontractor: Q <br /> Evaluation Criteria <br /> r Medical program meets O&4A/WESTON cataria <br /> Personal Proteahre equipment avadab4 <br /> Onsite morteonng egtppntent awiiable,calitXated and <br /> Acceotable operated pro" <br /> ❑Unaceeotabit ❑ <br /> Comments: oUnacceoLawe ❑Unaccep,apy A �/ ` <br /> commons /v <br /> r <br /> safe wwwng procaduros clearly sPed»d <br /> 7rarnrr1 r.wts OSHA/WESTON Accraena <br /> ceptable <br /> E^—ge^ry procedures <br /> r <br /> ❑Unacceptable ❑ <br /> UrtAaeaceotacaotabk 2AccePtable <br /> Comments: ❑Unacceptable <br /> Comments: <br /> Comments: <br /> Decontamination <br /> Procedures/ General he&4th and safety program evalualrprt <br /> Addswnal eommems: <br /> ` Acceptable rL J`�1• / <br /> Accetxatye <br /> ❑Unacceptable <br /> r ❑UnsuePLable Subcomracta has agreed to and mil conform wMh <br /> Comments: the WESTON HASP for this protect. <br /> Comnenti <br /> ,*al/ ❑Subcontractor wdt wont under his own HASP wt,,h <br /> ..+ has been at:ceoted by CorporM&HeMh and <br /> Evaluation Conducted by EC ,*/- safety. <br /> Date: ( �7 <br /> Subcontractor �+ <br /> Name: Si�C C i- w Iter <br /> Title: Name: w��- � <br /> 5C rt N(r <br /> Task(s): Title: <br /> Certification Level or Description: Task(s): <br /> C3 Medical Current Certification Level or Description: <br /> ❑Trarrung Current <br /> ❑Medical eunem <br /> 11FitTest Current fOutl. 11 Training Currerrt <br /> .,r ) ❑Fit lest Currem lOuant) ❑Fit Ttst Current(Dual.) <br /> Name: ❑Fa Test Current(Ouant.) <br /> Title: Name: <br /> Task(s): Title: <br /> Certification Level or Description: Task(s): <br /> ❑ <br /> Medical Current ❑Training Current Certification Level or Description: <br /> ❑McOrcal Currant <br /> ❑Fri Test Curtem(Oual.l 13 ❑Training Current <br /> Fit lest Current 10uant.) <br /> Name: ❑Fit Test Current fOual.) ❑Fit Test Current(Ouam.) <br /> Title: Name: <br /> Task(s): Title: <br /> Certification Level or Description: Task(s): <br /> 13 Certification Level or Description: <br /> MedKal Current <br /> ❑Training Current <br /> ❑Medical Current <br /> 0 Tramrng Current <br /> r <br /> 1:1FA lest Current;Dual.! <br /> 13Fit'est Current fOwnt.) ❑Fit Test <br /> Current(Oual.) <br /> F'Tess Current IOuartt.l <br />