EP 1110-1-18
24 Apr 00
SAFETY BRIEFING CHECKLIST/SSHP ACCEPTANCE FORM
SITE NAME: ________________________ DATE/TIME__________________
GENERAL INFORMATION
_______ Purpose of Visit
_______ Key Site Personnel/Responsibilities
_______ Training & Medical Requirements
Site-Specific Information
_______ Site Description/Characterization/Past Uses
_______ Previous Studies/History
_______ Contaminant Characterization
_______ Potential Site Hazards/Health Effects
_______ OE Safety Procedures
_______ Site Personal Protective Equipment(PPE) Program
_______ Site SOPs
_______ Site Control Measures, Decontamination and Communications
_______ Emergency Equipment
_______ Emergency Response/Phone Numbers/Nearest Medical Facility
_______ Unanticipated hazardous conditions shall result in ceasing activities and evacuation of
the site in accordance with instructions from the UXOSO.
PLAN ACCEPTANCE
I, the undersigned, have read and have been verbally briefed on the topics noted above and in the
SSHP; I understand the SSHP and agree to comply with all the indicated safety and health
requirements:
PRINTED NAME
ORGANIZATION
SIGNATURE
DATE
Safety Briefing Presenter
Signature
Date
H-13
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