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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.

* Required fields.

Logging Contractor

Date: 10/25/2014

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:

*Telephone number:

Subcontractor / Independent contractor Information (if you hire one):

Only report contractors who perform work in risk classification 5001. Landowners are only required to report non-Logger Safety Initiative contractors.

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:

*Logging system and cutting methods being used:

*Estimated number of acres:

*Expected job start date:

*Expected job completion date:

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