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SR0083445 (2)
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2900 - Site Mitigation Program
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SR0083445 (2)
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Last modified
10/28/2022 4:26:51 PM
Creation date
10/28/2022 4:07:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
WORK PLANS
RECORD_ID
SR0083445
PE
2903
FACILITY_ID
FA0026288
FACILITY_NAME
VENETIAN SQUARE
STREET_NUMBER
4555
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017001
ENTERED_DATE
3/23/2021 12:00:00 AM
SITE_LOCATION
4555 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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Project Hazard Identification, Risk Assessment and Control (HIRAC) Form <br />35 <br />7.3 Job Safety Analysis <br />Any work tasks conducted or hazards identified that are not addressed on the developed Project HIRAC <br />form shall be discussed and documented by field project personnel using SLR’s Job Safety Analysis (JSA) <br />Form (provided in Appendix A of this plan). <br />The SSO is responsible for ensuring that the Project HIRAC form and/or JSA adequately address all <br />potential hazards to project personnel and that they are properly mitigated and documented. <br />Some project sites may require a documented JSA to be developed and discussed with the work crew on <br />a daily basis. If this is the case the SLR JSA form will be utilized for this purpose unless directed otherwise <br />by the client site. Recommend referencing the information in the Project HIRAC form on the JSA form as <br />applicable. <br />Documented JSAs shall be forwarded to the SLR HSE Manager for review and potential revision of the HSE <br />Plan to meet the identified hazards / mitigation methods. <br />8.0 HSE Forms / References to be included in the Field: <br />Included in the HASP: <br />☒ Tailgate Safety Meeting Form <br />☒ Vehicle Inspection Form (Attachment 21J) <br />☒ Safety Observation/Conversation Form (Attachment 5A) <br />☒ Incident/Near Miss/Hazard Identification Report Form (Attachment 5B) <br />☒ Utility Clearance Mark-out Log (Attachment 10A) <br />☒ Ground Disturbance Checklist (Attachment 10B) <br />☒ Job Safety Analysis Form (Attachment 9C) <br />☒ Vehicle Accident Reporting Form (Attachment 16C) <br />☒ Witness Statement Form (Attachment 17C) <br />☒ Project Site Checklist <br />Optional (Dependent upon work scope, copies to be added to this document or kept in field binder.) <br />☐ Traction Device Selection and Use (Attachment 13H) <br />☒ Journey Management Plan Form (Attachment 20A) <br />☐ Contact Schedule Form (Attachment 20B) <br />☒ Vehicle Operations Guidelines (Attachment 20C) <br />☐ All-Terrain Vehicles – Off Road Vehicle Operation Guidelines (Attachment 20D) <br />☐ Snowmobile Operation Guidelines (Attachment 20E) <br />☐ Helicopter Use Guidelines (Attachment 20F) <br />☐ Small Aircraft Use Guidelines (Attachment 20G)
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