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Site Safety Plan Form <br />Date - Enter the date the work will be performed and the time you started the Hazard Analysis process. <br />Emergency Communication - Enter the phone number(s) for reporting emergencies at that location <br />Site Name — Enter the name of site where work will be performed. <br />Location - Enter the city/state where the work will be performed. <br />Tech. Team Leader - Enter the name of the immediate foreman or supervisor. <br />Support Technicians - Clearly print the name(s) of each person that will be working on the job. This may include <br />employees not associated with C & E Excavating, Inc., such as other contractors or client personnel working with <br />you. <br />Yes, No, N/A Questions - Each one of these questions requires an answer. Carefully consider each question and <br />how it will affect or apply to the work being performed. If the question doesn't apply to the job, mark it "N/A" <br />(Not applicable). Each question is important. <br />Departure Time —Time the crew completed work on site. <br />Arrival Time —Time the crew arrived on site. <br />Site Contact - Enter the name of the client contact person for that job. <br />Tech. Team Leader Si nature - Now that you have filled in the blanks and answered the questions, review the <br />Site Safety form with all crewmembers and any other contractor client personnel working on the job. Tech. <br />Team Leader will sign form ONLY after all technicians have reviewed the site safety form. <br />Additional Special instructions Comments — Include any additional special instructions or comments <br />Now you can start the job! Remember, the form is complete, but the process continues. Always remain <br />alert for changing conditions. The Site Safety Plan must be modified/updated if conditions change or new <br />hazards are found. Any modifications must be communicated with all crewmembers. *Remember to review the <br />Site Safety Plan with any new crewmembers that are added while the job is in progress. Their name(s) must <br />also be added to the Hazard Analysis form. Post all completed forms in a conspicuous and readily available <br />location. <br />29 <br />