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Universal Health & Safety Plan For use on all high-risk,industrial and HAZWOPER projects Department of Toxic Substances Control 9 sites . Attachment C: THA Forms, and Tailgate Safety Meeting Form Required Task Name Permit(s) Primary Task Performed By Coronavirus Precautions—Field, Office&Travel THA ❑ Yes Z No ❑x ❑x ❑ Driving To and From the Site ❑ Yes Z No ❑x ❑x ❑ Site Visit and Phase I ❑ Yes Z No ❑x ❑ ❑ Utility Clearance ❑ Yes Z No ❑ ❑x ❑ Direct Push drilling ❑x Yes ❑ No ❑ ❑x ❑ Soil Sampling ❑ Yes Z No ❑x ❑ ❑ Groundwater monitoring well installation ❑ Yes Z No ❑ ❑x ❑ Water Sampling ❑ Yes Z No ❑x ❑ ❑ Soil gas probes installation ❑ Yes Z No ❑ ❑x ❑ Soil gas sampling ❑ Yes Z No ❑x ❑ ❑ Waste Transportation and Disposal ❑ Yes Z No ❑ ❑x ❑ Well Surveying ❑ Yes Z No ❑ ❑x ❑ HazardTask Assessment Instructions: V Each unique task or work group should have their own THAs. If workers have a THA for their task(s)in hand,they should simply review it and document the site-specific edits in the appropriate section. If workers do not have a THA for all tasks to be performed, a THA must be obtained or drafted prior to starting work on that task. Use additional pages as needed. ■ Identify the basic steps of the task that must be performed in order and their associated hazards. Identify controls or barriers to mitigate each identified hazard. ■ Clearly identify any STOP WORK triggers. ■ Document stop work and change management if conditions/scope changes. ■ Use 4-Sight to identify and mitigate site-specific hazards throughout the day. Modify the THA as needed. Contact site supervisors or the PM for any significant scope changes or changes of expected conditions. ■ All THAs shall be 3 pages(maximum)or less(preferred). If they are longer,the task is too broad. ■ All hazards will use standardized nomenclature(Hazard Wheel), should be specific, detail how someone could be hurt and what the outcome could be. ■ All actions to mitigate hazards must be specific, clearly aligned with its respective hazard and not generic.Avoid words such as"proper", "correct', or"appropriate"). Use specifics and numerical values(i.e.,wear disposable nitrile gloves, stand back 6 feet/1.8 meters,take a 10-minute break every hour). ■ PPE cannot be the only line of defense- PPE is always the last line of defense,so think through what other controls(engineering, administrative, etc.)could mitigate hazards. ©AECOM Restricted Universal Heath and Safety Plan Template(S4(DSC)AM-209-FM-C) B-1 Revision 12 September 9,2021 PRINTED COPIES ARE UNCONTROLLED.CONTROLLED COPY IS AVAILABLE ON COMPANY INTRANET.