Logging Safety Initiative Jobsite Notification Form

Within 48 hours, to the extent possible, of work beginning at a new logging/cutting site, notify the department and provide the following details for non-mechanized (risk classification 5001) work. Printable version also available (F417-249-000).

* Required fields.

Date: 7/3/2015

Forest Practices Application/Notification Number:

LSI Participant:

*Note If your company is not listed, please contact the LSI Program Office at 360-902-5008 or loggersafety@lni.wa.gov. You must be a registered LSI participant to use this form.

*Contact Name for jobsite:

*Telephone number:

Contractor/Subcontractor/Independent Contractor Contact Information:

Only report contractors who perform work in risk classification 5001.

Name:

Address:

Phone number:

Name:

Address:

Phone number:

Name:

Address:

Phone number:

Name:

Address:

Phone number:

Site location from Emergency Medical Plan:

*Township, range, and section numbers or latitude and longitude or UMS Grid System coordinates:

*Directions by road to site (include County):

*Logging system and cutting methods being used:

*Estimated number of acres:

*Expected job start date:

*Expected job completion date:

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