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Job Safety Analysis <br /> <br /> <br />¹ JOB STEPS ² POTENTIAL HAZARDS ³ CRITICAL ACTIONS TO MITIGATE HAZARDS 4 RESPONSIBLE <br />PERSON(S) <br />Chemical - Respiratory <br />irritation from vapor/gas <br />inhalation. <br />• Keep face clear of preserved sample bottles when filling. Keep <br />face clear of wellhead and work upwind of wellhead, if feasible. <br /> <br />• STOP WORK IMMEDIATELY and contact site supervisor if <br />vapors/gas are noticed in breathing zone or conditions change. <br /> <br />Chemical - Eye irritation <br />from contaminated <br />groundwater or free <br />product splashing on face <br />or body causing. <br />• Locate eye wash prior to conducting work to wash out eyes in <br />case of fluid contact. <br /> <br />• Raise and lower bailer slowly to eliminate splashing liquids. <br /> <br />• Use decanter to transfer media into sampling containers. <br /> <br />• Pour water slowly into containers, stop before overflowing. <br /> <br />Chemical - Dermal <br />irritation from contact <br />with potentially <br />contaminated media. <br />• Do not touch contaminated water with ungloved hands. <br /> <br />• Wear Nitrile gloves over Type II cut-resistant gloves to prevent <br />particulates/liquids from contacting hands and causing irritation. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />¹ Each Job or Operation consists of a set of steps. Be sure to list all the steps in the sequence that they are performed. In Column 2, specify the equipment or <br />other details to set the basis for the associated hazards. <br />² A hazard is a potential danger. What can go wrong? How can someone get hurt? Consider, but do not limit the analysis to the 10 Hazard Classes (Motion, <br />Temperature, Gravity, etc.): Examples are: Motion—victim is struck by or strikes an object; Gravity—victim falls to ground or lower level (Includes slips and <br />trips); Chemical—inhalation/skin exposure hazards to lead and benzene, etc.. Specify the hazards and do not limit the description to a single word such as <br />"Caught." <br />³ Aligning with the first two columns, describe what actions or procedures are necessary to eliminate or minimize the hazards. Be clear, concise, and specific. Use <br />objective, observable, and quantified terms. Avoid subjective general statements such as "Be careful" or "Use as appropriate." 4 Identify the individual(s) by name responsible for ensuring mitigation efforts are implemented. If it is everyone’s responsibility, indicate “Team”. Modify/update in the <br />field to ensure adequate coverage if personnel were yet to be determined during the planning phase. When mitigation action is complete AND before work starts, <br />responsible person should initial next to their name to verify and document completion of action. <br /> <br /> <br /> <br /> <br /> <br /> <br />“I have read this JSA, and I understand the hazards and safe work practices associated with the task. If conditions change or an <br />additional hazard is recognized, I will Stop Work and notify the Site H&S Officer immediately:” <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Seed JSA - Well Gauging and Sampling_020714.docx - 3 -