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CHECK ALL THAT APPLY. Provide site-specific notes/clarifications above.
<br /> N Soil/groundwater contaminants(historical release) ❑Explosive dust ❑Potential for flammable gas(methane)
<br /> ❑Recent release,known high concentrations ❑Oxygen deficiency ❑Corrosive,acids/caustics,strong irritants
<br /> ❑Former chemical disposal site,landfill N Chlorinated volatile organic compounds(VOCs) ❑Asbestos abatement work
<br /> ❑Urban fill,residual contaminants N BTEX,petroleum derived VOCs N Pesticides,herbicides,fungicides
<br /> N Containerized waste(drums,process equipment) N Fuel oils,petroleum,waste oil,lubricants ❑Sensitizers
<br /> N Buried drums(known or potential) ❑Metals,metal compounds,metal dusts ❑Radioactive contaminants
<br /> ❑Large containers,potential for spills ❑Elemental mercury ❑Controlled substances,drugs
<br /> ❑Contaminated building surfaces ❑Polyaromatic hydrocarbons(PAHs) ❑Wildfire smoke,see HSE SOP 470a
<br /> ❑Unexploded ordnance ❑Potential for flammable vapors Protection from Wildfire Smoke
<br /> Exposure
<br /> ❑Other-describe above
<br /> .......................................................................................................i..............................................................................................................................................................................
<br /> NOTE:For sites with one or more"high-risk contaminants"(below)designated/recognized as a contaminant of concern,or exceeding an environmental reporting
<br /> threshold,or representing a potential exceedance of an action level or exposure limit,the THA must be reviewed by the HSE Dept.before initiating the work:
<br /> ....................................................................................................... ..............................................................................................................................................................................
<br /> ❑Asbestos ❑Chromium VI(hexavalent chromium) ❑Lead
<br /> ❑Arsenic/arsenic compounds ! ❑Crystalline Silica(airborne) ! ❑Methylene chloride
<br /> ❑Benzene ! ❑Dioxins ! ❑Polychlorinated biphenyls(PCBs)
<br /> ❑ Beryllium ! ❑Mercury ! ❑Vinyl chloride
<br /> ❑Cadmium ! ❑Hydrogen Cyanide(HCN)
<br /> FOR WORK CONSISTING OF CLEANUP OPERATIONS,CORRECTIVE ACTIONS,PRELIMINARY INVESTIGATIONS at an"UNCONTROLLED HAZ.WASTE SITE"
<br /> (per HAZWOPER,29 CFR 1910.120 or equivalent),delineate procedures in"Site-Specific Notes and Clarifications"(or attachments)addressing the
<br /> following,as applicable to the work:
<br /> — Workers attend pre-work orientation on hazards,risks,onsite safety measures,emergency contingencies.
<br /> — Implement site control plan-delineate Exclusion Zone(s),Contaminant Reduction Zone(s),Support Zone(aka EZ,CRZ,SZ).
<br /> — Include site map/figure depicting work locations and other relevant site-specific information.
<br /> — Site workers in EZ or CRZ shall have 40-hour HAZWOPER training,current 8-hour refresher,3 days supervised field experience.
<br /> — Site supervisor(s)shall have 8-hour Supervisor training.
<br /> — Site workers in EZ or CRZ shall participate in medical monitoring program,as applicable.
<br /> — Implement site-specific procedures for worker protection via engineering controls,work practices,personal protective equipment(PPE),air
<br /> monitoring,decontamination procedures,spill containment,emergency preparedness and response.
<br /> — Conduct air monitoring,as appropriate;see Part E,"Air Monitoring,Worker Exposure Monitoring."
<br /> — PPE program:Specify Levels of Protection and specific PPE to be used for applicable tasks;
<br /> o Level D:No respirator,no chemical protective clothing,standard work clothes,basic PPE;(COVID-19 face covers allowed)
<br /> o Modified Level D:No respirator,chemical protective clothing as appropriate;(COVID-19 face covers allowed)
<br /> o Level C:Air-purifying respirator,chemical protective clothing as appropriate;consult with Corp.HSE Dept.required.
<br /> o Level B:Air-supplied respirator,chemical protective clothing/suit as appropriate;consult with Corp.HSE Dept.required.
<br /> o Level A:Fully encapsulating suit,self-contained breathing apparatus(SCBA);Level A prohibited for Geosyntec personnel.
<br /> ® FOR SITE WITH CHEMICAL CONTAMINANTS OR WASTE BUT NOT REGULATED BY HAZWOPER
<br /> — Workers shall be knowledgeable/aware of chemical hazards thru safety training/orientation and availability of hazard information.
<br /> — Implement controls to minimize worker exposure through engineering controls,work practices,PPE,decon,as appropriate.
<br /> — Evaluate worker exposure via air monitoring/sampling,as applicable;see Part E,"Air Monitoring,Worker Exposure Monitoring."
<br /> ® STORAGE/TRANSPORT OF IDW* N Describe site-specific procedures above for spill containment,container handling,as applicable.
<br /> Spill/Release Risk: ! ❑For liquids,provide secondary containment during storage.
<br /> N Risk of incidental spill/release ! N Segregate incompatible chemicals during storage.
<br /> ❑Risk of emergency spill/release ! ❑Locate emergency gear(eyewash,fire extinguisher,spill kit,safety signage)near storage area,as applicable.
<br /> ❑For incidental spills;spill kit on-site for low-hazard releases(low-flammability/toxicity/quantity/volatility)
<br /> *Investigation-Derived Waste ❑For emergency spills:describe spill/release hazard and response plan/procedure above,and indicate
<br /> Emergency response contact in Part B,"Emergency Response and First Aid."
<br /> ❑DOT/TDG/IATA-Regulated transport:see D.17."Hazmat/Dangerous Goods Shipping/Transportation."
<br /> OFF-SITE MIGRATION OF AIRBORNE ❑Implement controls to minimize hazard migration(dust suppression,covers,foam,etc.).
<br /> CONTAMINANTS ! ❑Community/perimeter air monitoring will be conducted per perimeter air monitoring plan;see E.3"Fence
<br /> Line/Perimeter Air Monitoring."
<br /> HSE Program Documents:HSE STD-120:Occupational Medical Management Program,HSE STD-125:Personal Protective Equipment Program,
<br /> HSE STD-130:Respiratory Protection Program,HSE STD-145:Safety Training Program,HSE STD-150:Globally Harmonized System for Hazard Communication, HSE
<br /> SOP-301a:Contaminated Site Investigation&Remediation(US-only),HSE SOP-460:Field Site Exposure Monitoring,
<br /> HSE SOP-634:Drum Sampling,HSE SOP-636:Handling of Uncharacterized Hazardous Waste Containers,HSE SOP 470a Protection from Wildfire Smoke Exposure
<br /> RADIATION HAZARDS(Other than Sunlight) ❑ Applicable ® Not Applicable, Not Anticipated
<br /> Co eosyntec Project/Task Name: Well Maintenance THA ver.
<br /> consultants THA Date:4/17/25 Page 15
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