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JOBSITE SAFETY WORKSHEET <br />Date /Z-3-2s <br />Location 5XvIO <br />Lead I <br />Pri Briefing Time 7: 30 <br />Description of Work: nw sr.r�s <br />Safety Incidents & Concerns: <br />YES <br />NIA <br />Tregic Control Plan—AtiacM1 TCP If modified <br />Confined Spew En Hach C rdhned Space Permit <br />Uncontrolled EnsAttach LoC out Ta out <br />Boom Truck Used —Attach Lift plan if needed <br />V <br />O rarM1ead iffino—Insipect helping before each use <br />✓ <br />F ohical Hazards & Controls <br />❑ Dveihead ❑ Underareund ❑ Generator ❑ PermanarnitWiring <br />V <br />Hot Work—Dasaibe <br />HezeNous Materials Used <br />Falls Quarto fee[—COMmlled b <br />Excavation Entry over 3 feet deep <br />Final Depth Width Length <br />❑ Firm Form ❑ Sloping ❑ Trench Box ❑ Builda-Box <br />Y <br />First AldE ul mentlTrelnin IFlm Extinguisher Must ba Current <br />Utilities Located: ❑ Water blue Power(red) Gas lbw ❑ Communication (orange) ❑ other <br />Communication with emergency responders pmmded ❑ Radio Dei ❑ Phone 911 Q City Phone 9-911 <br />Personal Protective E ul menf Hi MVis PrPlead ETEtaa L% Hearin ❑ Whole Body other <br />PreJob Safety Meeting <br />Name <br />Assignment <br />Name <br />Assignment <br />�LO# <br />WST <br />9r.M <br />Nee <br />kdx <br />Ilea <br />/; o� <br />t� <br />ReNsed IVIVIi <br />