Laserfiche WebLink
PART F-APPROVALS, ACKNOWLEDGEMENTS <br /> F.1.THA PREPARATION, REVIEW/APPROVAL SIGNATURES A THA is typically prepared by project staff,often with input from an HSC,with <br /> review/approval,at a minimum,by PM and/or Field Lead.Corporate HSE staff must be consulted as required or otherwise deemed appropriate*. <br /> Printed Name Signature Date <br /> PREPARERS) Adam Schneider S'c/7l7eldej'' 6/26/2025 <br /> Ir <br /> THA Printed Name Signature Date <br /> REVIEWED/ Annie Lee 6/27/2025 <br /> APPROVED BY: <br /> (Project Manager or PM- <br /> ** Dean Zapishny � 7-15-2025 <br /> Designee,at a minimum) <br /> *At a minimum,Corp.HSE must review/approve the THA review when Geosyntec staff will encounter"high hazards/high risks,"or perform critical tasks,such as(but not limited to): <br /> Work at heights>10',use personal fall apparatus Implement lockout/tagout controls Wear a respirator <br /> Work at height near overhead electrical utility lines Enter a trench/excavation>5'deep Presence of"high-risk"contaminant(s) <br /> Operate a UTV/ATV,aerial lift or fork-lift Function as a construction"Competent Person" Sustained exposure to wildfire smoke AQIPM 2.5>150 <br /> Tow a trailer on roadway Operate a pneumatic or powder-actuated tool Exposure to radioactive isotopes(a,p,y) <br /> Oversee a hot-work permit system "Qualified"Electrical testing&maintenance>50 V High-risk exposure to:non-ionizing(microwave,EMF,UV, <br /> Enter a hazardous confined/enclosed space High risk,non-typical infecfious/pathogenic hazard IR)or ionizing(radio-isotope,x-ray)radiation. <br /> Use of unmanned aerial vehicle(drone) Derive action levels for VOCs or toxic dusts Onsite risk of emergency chemical spill <br /> High-risk ergonomic/musculoskeletal hazard Instrument monitoring for critical exposure risks Applicability of Chemical Anti-Terrorism Standards <br /> Corporate HSE must also be consulted when Geosyntec subcontractors(under Geosyntec's oversight)perform high hazard/high risk work(such as demolition,blasting,crane critical <br /> lifts, confined space entry, testing/maintenance of electrical systems, Iockout/tagout, HAZWOPER cleanup activities). Consultation with Corp. HSE is encouraged for all <br /> questions/concems regarding worker safety,regulatory compliance,risk/liability aspects,or project-specific safety requirements. <br /> **It is recommended that THAs be approved/signed by both the PM and Field Lead(or alternate PM designee),unless due to small scope/scale or routine nature of task,or staff <br /> unavailability,only one approval is deemed sufficient by PM.Additional review and approval will be performed by Corp.HSE for high-hazard/high-risk tasks,or as otherwise requested. <br /> HSE Program Documents:Formore information,see"HSE STD-105.Proiect Safety Management Handbook" <br /> F.2. GEOSYNTEC FIELD CREW ACKNOWLEDGEMENTS <br /> Please sign below to acknowledge you reviewed and understand this THA,participated in project safety briefing and had an opportunity to ask questions about the information herein. <br /> Printed Name Signature Employee No. Date <br /> F.3. SUBCONTRACTOR'S FIELD CREW ACKNOWLEDGEMENTS ® Applicable ❑ Not Applicable <br /> Please sign Mow to acknowledge this THA was made available to you,and you had an opportunity to ask questions about the information herein. <br /> Printed Name Signature Company Name Date <br /> Geosyntec')' Task/Project Name: THA ver.4.0 <br /> THA Date: Page 19 <br /> consultants <br />