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1 1 1 U 1 1 Safety Lockout Tagout Pre -Construction Meeting Form Jobsite City & State: Store / Club #: Construction Start Date: I The following is applicable when project work occurs in facilities occupied by Walmart. Walmart Store Management and the General Contractor shall inform each other of the applicable lockout / tagout procedures that will be utilized during the project. Walmart Store Management must provide the General Contractor with a copy of the Store Lockout / Tagout procedures used at the store and available on the WIRE. The General Contractor Superintendent must provide Store Management with copy(s) of the Lockout/Tagout procedure(s) that will be utilized on the project. Discus- sion / explanation of the procedures must take place during the pre -construction meeting. Visual demonstration of the devices that will be used for control of energy (locks and tags) should also occur. It is the responsibility for the General Contractor Superintendents and Store Management to ensure their respective Workers or Associates comply with the restrictions and prohibitions of the various energy control programs. It is most important that construction workers and Walmart Associates recognize the locks and tags used, or any other method used to control other forms of energy, and understand they may not alter remove or in any way try to energize a circuit that has been locked or tagged by another employers associates/workers. Note to Construction Manager and Store Management: Walmart Lockout Tagout Procedures are located on the WIRE at the following location: WIRE>Knowledge Center>Safety>OSHA Programs / Lockout/Tagout. Store Management Signature Date General Contractor Superintendent Signature Date General Contractor must have Field Leadership (foreman) for each trade / subcontractor sign below verifying they understand the Lockout Tagout processes applica- ble to the job site before they begin any work on the site. Company Name and Trade Signature of Field Leadership (Foreman) Date Note: This Form is required by Contract Exhibit Section XXX and Compliance Spec Section XXX. Once the document is signed by both Store Management and the Superintendent a copy should be given to Store Management for their records. The Superintendent should keep the original for documenting the training given to workers and trade foremen. The final copy should be kept as part of the contract docu- ments and must be made available to OSHA or Walmart upon request. 1 0706 - Zephyrhills, Florida - 16592140 February 16, 2017 01351-37