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Name of Project/Site: <br />Site Safety Checklist <br />Page of <br />Instructions: Complete this form immediately prior to project start. <br />Project No: <br />Project/Site Location: <br />Employee Completing Checklist: Date: <br />(Print and Sign): <br />Yes No N/A <br />Written Health and Safety (H&S) Plan is on site? <br />0 Addenda to the H&S Plan are documented on site? <br />0 U H&S Plan information matches conditions/activities at the site? <br />0 U H&S Plan read/signed by all site personnel, including visitors? <br />U U Daily tailgate H&S meetings have been held/documented? <br />0 0 Site personnel have required training and medical? <br />U 1=1 Air monitoring is performed/documented per the H&S Plan? <br />U U Air monitoring equipment has been calibrated daily? <br />1=1 0 El Site zones are set up and observed where appropriate? <br />U U Access to the work area limited to authorized personnel? <br />1=1 0 0 Decontamination procedures followed/match the H&S Plan? <br />1=1 U 0 Decontamination stations (incl. hand/face wash) are set up and used? <br />0 I=1 PPE used matches H&S Plan requirements? <br />0 0 Hearing protection used where appropriate? <br />Yes No N/A <br />1=1 0 1=1 Respirators are available, properly cleaned, and stored? <br />U 1: Overhead utilities do not present a hazard to equipt./personnel? <br />0 0 Traffic control measures have been implemented? <br />0 1=1 Trenches and excavations are safe for entry? <br />0 0 0 Soil Spoils are at least 2 feet from the edge of the excavation? <br />0 U Emergency/FA equipt. is on site as described in the H&S Plan? <br />0 0 Drinking water is readily available? <br />0 0 Phone is readily available for emergency use? <br />0 0 0 Utility locator has cleared subject locations? <br />H=I U U Proper drum and material handling techniques are used? <br />0 1=1 Waste containers/drums are labeled appropriately? <br />I=1 0 U Ext. cords are grounded/protected from water/vehicle traffic? <br />0 0 Tools and equipment are in good working order? <br />U D GFCIs used for portable electrical tools and equipment? <br />Notes <br />(All "no" answers must be addressed and corrected immediately. Note additional health and safety observations here): <br />Distribution. Original — Project File HS-16 REV. 06/2006