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DAILY FIELD RECORD <br /> Page 1 of <br /> Project and Phase Number: Date: <br /> Project Name: Field Activity: <br /> Location: Weather: <br /> PERSONNEL: Name Company Time Time <br /> In Out <br /> PERSONAL SAFETY CHECKLIST <br /> Hard Hat Safety Goggles Respirator Required? (Y/N) <br /> Gloves (Nitrite, Vinyl) Personal H2S Meter Respirator Inspected? <br /> HEALTH AND SAFETY PLAN REVIEW ( * = include signed HASP tailgate form with this Daily Field Record) <br /> For lone worker, were the HASP and related AHAs reviewed prior to starting field activity? Yes ❑ No ❑ NA ❑ <br /> For multiple workers, was the HASP reviewed and tailgate form signed? Yes* ❑ No ❑ NA ❑ <br /> TIME DESCRIPTION OF WORK PERFORMED <br /> HACOMPANY\Field Protocols\WSP Field Forms\Daily Field Record with HASP.docx <br />