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CERTIFICATION OF CORRECTIVE ACTION WORKSHEET <br />Company Name: Proshot Concrete <br />Inspection Site: N. Third St., Columbus, OH 43215 <br />Issuance Date: 10/01/2009 <br />List the specific method of correction for each item on this citation in this package that does not read <br />Corrected During Inspection" or "Quick Fix Applied" and return this page to: <br />U.S. Department of Labor - Occupational Safety and Health Administration, Federal Office <br />Building - Room 620, 200 North High Street, Columbus, OR 43215-2497. <br />Citation 1 Item 1 --Proper Way to set up road zones <br />Correction -Employee enrolled at ATSSA Traffic Supervisor Grant Course 10/08/09 <br />Citation .1 Item 2 --Proper cleaning station not provided. <br />Correction -Rented portable santation washing stand from Rent -A -John <br />with non -alkaline soap and towels provided <br />Citation 1 Item 3--Unlegible traffic signs. <br />Correction -Arrow signs and lane closed signs have been posted on site <br />in proper places. <br />Citation 1 Item 4 --Extension cord unsafe. <br />Correction --Extension cord missing ground prong removed and <br />replaced with new one. <br />Citation 1 Item 1 --Employees not trained on hazardous chemicals. <br />Correction Employees attend a safety meeting every Monday.. They are <br />informed of all safety issues with visual aid (MSDS SHEETS) <br />presented by the Supervisor. <br />,9M,4 � hx� 0-16-�y <br />NAME OF WANY OFFICIAL DATE <br />SeG - �f eu1 <br />TITLE <br />NOTE: 29 USC 666.(8): Whoever knowingly makes any false statements, representation or certification in any application, record, <br />plan or other documents filed or required to be maintained pursuant to the Act shall, upon conviction, be punished by a fine of not more <br />that $10,000, or by imprisonment for not more than six months or both. <br />POSTING: A copy of the completed Corrective Action Worksheet should be posted for employee review. <br />Page 4 <br />