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TABLE A- EMERGEN�Y tNFORMAT10t� SHEET <br />11�fORK S�TE INFOR�VIATION <br />Work Site �oca�ion: �MEleage, Subdivision) �Address, Number and Street} <br />Con�rac�or' Superv'rsor: �Name� (Tit�e} <br />Site Te�ephone: <br />Emergency Site Access Route: (Prov�de sketch - S�aW��� <br />access roads, physical <br />landmar(cs to guide EMS to <br />focation� <br />Nearest Town: <br />Cer���ied Firs� Aid Attendant: <br />Locatian of First Aid Sup�i'res at Site: <br />Location af FEre Exfinguishin� Equ�prnent: <br />EMERCENCY CONTAC7 INFORMATfON <br />EMERGENCY CONTACTS <br />RaiCway Traf�ic Con�rolrer: <br />Firef�ghtere <br />Pa�ice: <br />Am�u[ance: <br />HospitaE: <br />Physicran: <br />Aircraft Service, (if appf�cable}: <br />Wa�erc�aft Serv�ce, (ff app[Ecab�e}. <br />�tre�cher lacation at site: <br />Loca�ton of WHIMS data sheets: <br />Type and �acat�on of ret�ieva[ systems a� b��dges, (if applicable}: <br />Type and �acatior� of emerge�cy equipme�� for work near or aver <br />water, (if applieable} : <br />Emptoyee(s} responsib[e for rescue operat�ons, (ifi app�icable}: <br />Desfgr�ated Evac�at�on Vehicie: <br />�mergency Evacuation Route, (Prov�de sketc�}: <br />. � <br />(} <br />() <br />f� <br />�) <br />L�CATION <br />UTILI�'IES INFORMAT�ON <br />UTILtTIES CONTACT <br />Natura� Gas: <br />E�e�tricat : <br />Fibre Opt�c �ine: <br />Water & Sewer. <br />Tei�phone: <br />Gab�e Sys�em: <br />C�ua�if�ed er���oyee(s) in: <br />Confined Space Entry, (if app�icable}: <br />Equipment requiremen�s far Confined S�ace En�ry, (if applicable): <br />PHONE <br />() <br />t� <br />LOCATION <br />C} <br />(} <br />(} <br />�} <br />f� <br />�� <br />/nitialed by: � <br />