Cal. Code Regs. Tit. 19, div. 2, ch. 2, subch. 2, form ICS 208 HM
Current through Register 2024 Notice Reg. No. 49, December 6, 2024
INSTRUCTIONS FOR COMPLETING THE SITE SAFETY AND CONTROL PLAN
ICS 208 HM
A Site Safety and Control Plan must be completed by the Hazardous Materials Group Supervisor and reviewed by all within the Hazardous Materials Group prior to operations commencing within the Exclusion Zone.
| Iem Number | Item Title | Instructions |
| 1. | Incident Name/Number | Print name and/or incident number. |
| 2. | Date and Time | Enter date and time prepared. |
| 3. | Operational Period | Enter the time interval for which the form applies. |
| 4. | Incident Location | Enter the address and or map coordinates of the incident. |
| 5-16. | Organization | Enter names of all individuals assigned to ICS positions. (Entries 5 & 8 mandatory). Use Boxes 15 and 16 for other functions: i.e. Medical Monitoring. |
| 17-18. | Entry Team/Decon Element | Enter names and level of PPE of Entry & Decon personnel. (Entries 1 - 4 mandatory buddy system and back-up.) |
| 19. | Material | Enter names and pertinent information of all known chemical products. Enter "UNK" if material is not known. Include any which apply to chemical properties. (Definitions: ph = Potential for Hydrogen (Corrosivity), IDLH = Immediately Dangerous to Life and Health, F.P. = Flash Point, I.T. = Ignition Temperature, V.P. = Vapor Pressure, V.D. = Vapor Density, S.G. = Specific Gravity, LEL = Lower Explosive Limit, UEL = Upper Explosive Limit) |
| 20-23. | Hazard Monitoring | List the instruments which will be used to monitor for chemical. |
| 24. | Decontamination Procedures | Check "NO" if modifications are made to standard decontamination procedures and make appropriate Comments including type of solutions. |
| 25-27. | Site Communications | Enter the radio frequency(ies) which apply. |
| 28-29. | Medical Assistance | Enter comments if "NO" is checked. |
| 30. | Site Map | Sketch or attach a site map which defines all locations and layouts of operational zones. (Check boxes are mandatory to be identified.) |
| 31. | Entry Objectives | List all objectives to be performed by the Entry Team in the Exclusion Zone and any parameters which will alter or stop entry operations. |
| 32-33. | SOP's, Safe Work Practices, and Emergency Procedures | List in Comments if any modifications to SOP's and any emergency procedures which will be affected if an emergency occurs while personnel are within the Exclusion Zone. |
| 34-36. | Safety Briefing | Have the appropriate individual place their signature in the box once the Site Safety and Control Plan is reviewed. |
| Note the time in box 34 when the safety briefing has been completed. |
Cal. Code Regs. Tit. 19, div. 2, ch. 2, subch. 2, form ICS 208 HM