Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 5 22 of 53 8 Doc u m e n t Identif icat ion F R M 048 P age Nu m b e r 2 of 2 Doc u m e n t C r e ation Dat e F e bru a r y 02 2015 Im p le m e n tat ion Dat e J une 30 2015 Ha z a rdous tools to be use d P owe r e quipm e nt e tc Com pre ssed g a s c y li n de rs De sc ribe Ye s No P e rsona l protec ti ve e quipm e nt nee de d to ent e r w or k a re a Ye s No W ork in c onfine d spa c e s P rogr a m r e view r e qui re d Ye s No C O N T R A C T O R S A FE T Y C H EC K LI ST O R I E N T A T I O N L oc k out ta g out Prog r a m re view re quire d Ye s No W ork a re a a c ti vit ies r e qu iring F a ll P rote c ti on Ye s No He a v y li fting Hois ti n g R igg in g Ye s No W ork o n e lec tric a l s y ste ms e quipm e nt Ye s No R e moval of e x c e ss m a ter ials wa stes ha z a rdous or other wise Ye s No L a dd e r s P latfor mssta g in g L i ft s to be us e d Ye s No W ork e ff e c ti n g fir e de te c ti onsu ppre ssi on e quipm e nt a lar ms sprinkler s fir e pump Ye s No I nte rr upti on of e m e r g e n c y e quipm e nt use a c c e ssi bil it y E y e wa she ss howe rs Ex ha ust venti lation P ho ne se rvic e E g re ss route s Ye s No De sc ribe pot e nti a l i mpac ts a c c omm oda ti ons noise dust odor s e tc a ss oc iate d with t he proje c t wor k Co m m e n ts or o the r r e q u ire m e n ts S IG NA T UR E S The unde rsi g ne d h a ve r e view e d pa rtic ipat e d in t he c ontra c to r sa f e t y c he c kli st and or ienta ti on c on c e rnin g ha z a rds in the fa c il it ies in whic h wor k is t o be pe r for med T he oppo rtunit y to re view S a f e t y Da ta Sh e e ts SDSs f or ha z a rdous m a ter ials i n wor k a re a s ha s be e n pro vided The sc ope a nd sc he dule of se rvic e s to b e pe r for m e d ha ve b e e n r e view e d a nd dis c ussed to mi nim i z e the potential f or a c c idents i njurie s im pa c ts t o the e nv ironme nt and w orkpla c e disrupti ons int e rr upti ons I n d i v i d u a l s b e l o w h a v e r e c e i v e d r e v i e w e d i n f o r m a t i o n r e g a r d i n g t h e l o c a t i o n o f e m e r g e n c y s a f e t y e qu i p m e n t a s w e l l a s t h e p r o c e d u r e s t o f o l l o w i n t h e e v e n t o f a n e m e r g e n c y e v a c u a t i o n Na m e S ign ature E m p loyer