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Task Hazard Assessment AECOM Imagineed DRILLING, GROUTING, MONITORING WELLS 01-01-03-07 Project Name: Client: Date: Permits Required? Work (list): Location: This THA must be fully reviewed with all staff members. All job steps, hazards, work practices, and PPE are clearly understood and have been implemented. All necessary revisions have been written on the THA. Required PPE: ® Hard Hat ®Safety Glasses ® HiVis Vest ®Safety Toe Boots ® Gloves: Leather, nitrile ® Hearing Protection ❑ Other: Tools&Equipment: Cutting tools, Hot Work Permit job/taskREMINDER: Use 4-Sight at the start of, and continuously throughout the Job Steps Potential Hazards Risk Critical Actions To Mitigate Hazards Risk List all steps required to perform How could you be hurt? (initial) List control measures required to eliminate, control or protect against the potential hazards (final) a task in the sequence they What would the injury be? associated with each job step to minimize the risk of are performed injury or environmental impact. Identify any`Stop Work'triggers. 1. Pre-mobilization, Equipment la.Injury from equipment 5 1a.Ensure that PM or person responsible for scheduling rental equipment requests that 4 Inspection. Contact One- malfunction the vendor inspects the equipment prior to site delivery to ensure all appliances are in Call, private utility contractor, 1 b.Failure to have underground working order and fit for use. and/or site personnel to utilities identified could result in 10 1 b.Call public utility locating service prior to initiating work activities. Use private locating locate and mark 4 explosion, electrocution, injury, service to mark out areas on private property. Verify location of utility marks;do not underground utilities. death, property damage. perform intrusive work if utility location marks cannot be found or if marks are destroyed. Preserve utility marks as much as possible. Call to have utilities remarked if unsure as to their location. Complete utility checklist form. On- Site Edits: 2. Setup Drill Rig and work 2a. Struck by vehicle or equipment g 2a. Verify that drilling contractor inspects equipment daily using S3AM-321-FM 1 Daily 4 zone traffic Drilling, Boring&Direct-Push Equipment Inspection or equivalent.Verify that kill switch on rig is tested and operational. Establish work zone using traffic control devices, signs, cones, etc. in advance of initiating monitoring well abandonment activities. Restrict access to observers and passersby. 2b. Sprain or broken bones due to g slip, trip in fall 2b. Maintain required housekeeping in work area, do not carry equipment where visibility 2 of ground is impaired, remove or mark all trip hazards in work area. 2c. Struck-by, crushed-by, caught- 10 2c. Communicate path of movement to all project personnel. Establish and use agreed 4 by drill rig. upon hand signals during spotting activities. Always use a spotter(s)to direct movement of drill rig and watch for vehicle and pedestrian traffic.Additional spotter(s)will be used in DCSA Task Hazard Assessment Form Version 1—October 22,2018 1 of 6