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A. <br />Date I /� �� - �z <br />0 <br />Water Checklist #4 <br />Location I� yzti ,3 �,,�-1,,� 6c :,� I Crew Lead I�,�,U�p ,�� �.— <br />Flaggers Names <br />Briefed? <br />'ES or NO <br />Briefed by <br />Flagger Briefing: <br />Job Tasks: Flagger Responsitilities, Emergency Signals, Flagger Radios, Specific work zone hazards, <br />PPE, Night Lighting, Planned Equipment Movement, Emer�ency Escape Plans. <br />C. V�icle Inspection Checkiist: <br />'s Name Equipment tt <br />1—� \cti � •°, <br />D. Checklist 1/4 - Routine P�rt 1 <br />I <br />ri. Make site visit be(ore starting work <br />r2. De(ine activity, scope, and limits <br />3. Review Par[ 1 BMPs <br />• Permit needed <br />' • �quipment maintenance <br />• Disturbed soil <br />• Waste material remcved <br />• Sp�fl kit <br />• Part 2 BMPs needed <br />• Use checklist k3 and routine <br />ehecklist <br />4. Is envirunmentat staff required? <br />NO - continue maintenance <br />YES - contac[ environmental staff for <br />review <br />5�.\�Girmnn.:lmul�di>.4'.cs����l'dl�.�ek:isy tCner.Jra <br />Location <br />�1�/' <br />YES I NO <br />6. <br />Inspection <br />Comments <br />water work <br />Stop work <br />• Contact environmental staff for <br />review <br />• Evalua!e using detailed checklist <br />1, 2, and/or 3 and routine <br />checklist <br />YES I NO <br />