PROPERTY DAMAGE:CAUSE,. What were you doing when incident --------------------------------COMMENT. :NAME OF OFFICIAL FILLING OUT THIS FORMSIGNATURETITLEDATE4

Merritt Properties2066 Lord Baltimore DriveBaltimore, MD 21244Office: 410.298.2600 Fax: 410.298.9644EMPLOYEE'SFIRST REPORT OF INJURY(to be completed by the employee)Employee's Nome: -:-- ---: - --:- ::: -----'Sex:--LastFirstMiddleHome Telephone#:Dote ofBirth: --,I --,I - . . . . .Social Security No: How lonK employed Iu!re:.Home Address: eM sYkaUon:Bi-Weekly Soltl1y:Location ofAccident: ,.-. !"'-- -------Name ofBuildingiArea (bathroom, etc.)Dateo!Accident:Time:When did you report the occident to your sllpervisor?D cribe fUUyhow occident occurred:5

Describe bodily injury sustained (be specific about location):Name ofSuperviso,,:. Title:Name of Witness(es): "'""7'T- --'l""W """' (Attach wiiliCSS(es) report(s»Signature of Employee: .:.-lJate:6

IV1 rritt Prope2066 Lord Baltimore DriveBaltimore, MD 21244Office: 410.298.2600 Fax: 410.298.9644ACCIDENT INVESTIGATION FORMPlace of Accident (Job):,.Date of Accident: . .Time:. . . a.m./p.m.PERSONAL INJURYIHLNESSName ofEmployee:.Occupation:Describe Injury:Expected Date ofReturn to Work: .PROPERTY DAMAGEWhat was Damaged:Estimated Cost:- - - - -DescribeDamage:6

CAUSEWhat Happened?What were you doing when the accident occurred?- -------------.,-- -,-- -------------- PREVENTIONSuggestions to Avoid Repetition:---- -------- nesses:Names:NAME OF OFFICIAL COMPLETING FORMTITLESIGNATUREDATE7

HOT WORK PERMIT' -".Gt.od this day only: From: am/lnu To: am/pmPermit is regujred prior to startjo& BOy wddiUI. bumiUI. soJderiu&. or other Oamelspark procedure.PERMIT REQUESTED BY:Com yNmne:Name ofperson requesting Pennit:Work to be done:ooooWeldingSoldering or bra7jngTorch cutting or burningOtiter (describe)Location ofwod:I haye personally inspected the loc1tion of work. All required precmtions for safe welding. burning. soldering or otherflame/spark procedures hme been taken. AU work will be performed with the HOT Work Policy printed Oil the back of this form.Subcontractor SupcrintcndentIForeman: :-:-(Signature)Welch & Rushc Project Safety Direc{ol"( S iguature ),-"".FIRE WATCH ASSIGNMENTName of work assign to Fire Watch: : ". ----------------(Print Nmue)I have properly been instmcted in my duties as Fire Watch:( Signature)FIRE WATCH CERTIFICATIONActual ,york :;tart tilllc: ,am/pm Actual wort completion timc: am/pm Fire Watch Comp1etc alll/pmI haye monitored all areas e -posed to flame. sparks. slag. etc. for 30 minutes after the woeli: has been completed.Signed: Date:PRECAUTION CHECK llST:Sprinkler System:In sen-ice Out of Sen-icc Not ApplicableDOUBLE check these itemsArea swept clean'! (wet down if needed)All combustibles mmed at least 20" from operations or protected with;ll proycd material'!All floor openings, wall opcumgs. floor dmins adequately protected')Additional Fire Watch men assigned in-areas abowtbelow bot workoperaHons'!Fire Protection in pl lce-cxtiu uisbers!WtUcr hoses?Electrical circuits hlmed off and locked out')YESNON/A

Merritt Pro erties lockoutITa out ChecklistNameSuperintendentJobDateToI PurposeIf you have any doubt about the procedures, ask your supervisor. Do notproceed without adequate information and proper authorization.The six steps for accomplishing the safety requirements of the programare: (INITIAL REQUIRED)1. Prepare For Shut downKnow and identify all energy sources., b. Notify appropriate personnel of intentions; andc. Have supervisor approve and assist.2. Shutdowna. Deactivate all operating controls.3. Locate All Energy Control Devicesa. Use them to isolate the equipment; andb. Disconnect the main and auxiliary power sources.4. Apply Lock-outlTag-out Devices,a.lockalldtag all disconnects, valves and otherenergya.,.,. .'.,isoufces . .5. Control of Energya. Test all equipment with. appropriate test equipment before work in begun.6. Verify Isolation of Equipment.a. Push aU start buttons and controls to verify that the equipmenfwill not start;b. Check all disconnects, valves and other sources of energy to make certainthat they cannot be operated.4

Merritt Properties LockoutlTagout ChecklistJob NameDateSuperintendentEquipment designationSchedule time for shut-downSchedule time for re-startEmployee applying lock-tagOwner rep notified (sign)Secondary trades tageRotation ABC orBACIDENTIFY CONTROL DEVICESMETHOD OFCONTROLLOCATIONSOURCE OF PWRACTION TAKEN(Lock-Tag, icChemicalThermalOther5

TEST SYSTEMPush ButtonVoltmeter TestDischarge CapacitorOtherLOCKITAG REMOVAL PROCESSINITIAL1. Notify owner representative2. Notify secondary trades3. Visual inspection of area4. Account for all personnel & tools5. Remove lock/tag & restore Power6. Verify rotation ABCIBAC7. Verify proper operationSignedBy:ElectricianSuperintendentOwner's RepresentativeTime & Date6

erritt PropertiesJOB INSPECTION/SAFElY CHECK LISTJob Identification: - - - - -Date:------------------Job Location: -----Check ToiletsBuilding Condition: Guarded Openings-floors, stairs,walls, elevatorsScaffolds-bracing, planks, handrails, wheel locksLaddersElectrical assured grounding- testing/tapingPersonal Protective Equipment-eye protection, respirators, hardhats, safety belts, etc.Tool and equipment conditionFire Protection-extinguishers, safe use and storage offlammablematerialsCompressed gas cylinders-stored upright, secured, caps or gaugesattachedFirst Aid KitWarning signs-OSHA materials postedMaterial storageTool and equipment useMSDS for hazardous materials on the job siteUnsafe