RADIATION USER QUARTERLY SURVEY FORM - DOC by O8Ne5w

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									                                                      SITE SAFETY MEETING



Job #:                      Date:

                                                        Job Description
      Lab Pack                                                        Chemical Move
      Chemical Consolidation                                          Onsite Services
      Area / Equipment Decontamination                                Other (describe)

          Chemical / Biological Hazards                                             Physical Hazards
      Corrosive           Highly Toxic                                Heavy Lifting           Elevated Surfaces
      Flammable           Carcinogen                                  Loud Noise              Hot/Cold Conditions
      Reactive            Infectious Materials                        Trip Hazards            Sharp Objects
      Toxic               Other (describe)                            Heavy Machinery         Other (describe)

                                                        PPE Required
Eye Protection             Hand Protection (Gloves)       Body Protection                Respiratory Protection (cartridges)
     Safety Glasses             Nitrile                       Tyvek L.C.                      Organic Vapor / Acid Gas
     Goggles                    Latex                         Tyvek C.O.                      HEPA
     Face Shield                Leather                       Poly Tyvek C.O.                 Ammonia / Methyl Amine
     Other                      Other                         Steel Toed Shoes                Other
                                                              Other


Medical Information
Nearest Medical Facility
(include address and
map):


    Emergency Phone
          911


Fire Extinguishers:                 In Truck   Location of nearest:

First Aid Kits:                     In Truck   Location of nearest:

Safety Shower Location (must be within 100’ or 10 seconds):

Emergency Eyewash Location (must be within 100’ or 10 seconds):

                                               Employee Verification Signature

								
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