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Task Hazard Assessment AECOM Imagineed DRILLING, GROUTING, MONITORING WELLS 01-01-03-07 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. On- Site Edits: 4. Inspect grout mixer/pump 4a.Personnel, property, and/or 6 4a. Read start-up and shutdown procedures shown on grout mixer/pump or read 2 equipment damage due to operating manual that accompanies unit. Check all fluid levels if equipped with gas failure to inspect mixer/pump engine. Be familiar with how to shut off mixer/pump in case of an emergency. Check that properly unit has adequate amount of fuel in the tank. Check all hydraulic hoses and fittings for leaks,wear, and proper connection. Ensure all guards are in place. 4b.Skin irritations or labored 3 breathing due to contact with 4b. Never overfill tank due to fuels expanding when heated. Make certain that fuel cap is with fuel fastened tight.Wear nitrile gloves underneath leather gloves during inspection On- Site Edits: 5. Grouting, Installing Well Pad 5a.Exposure to cement dust and 6 5a. Wear a dust mask to protect against airborne particles.Wear leather gloves when 2 mixed cement, skin, eye, and adding materials to mixing tank. Open bags of dry materials in a controlled manner to inhalation minimize dust. Try to stay upwind from grout mixing. 5b.Injury from entanglement in 5b. Do not reach into the mixing tank during operation. Do not wear loose clothing or use 2 drive shaft or mixing paddles 6 tools that could become entangled in drive shaft or mixing paddles.Turn the unit off before attempting to service the mixer or clear debris. 4 5c.Wear face shield to guard against splashes.Add water or other liquid additives in a 1 5c.Splashes and spills controlled manner to avoid splashes. Do not exceed the capacity of the mixing tank 9 5d. Stage bags of dry materials as close to mixer as possible. Use a buddy to help move 3 5d.Muscle strain heavy bags. If possible, lower the height of mixer to minimize lifting. 5e.Hand injury from opening bags 5e. Wear leather gloves when placing bags of dry materials onto bag breakers. Do not 2 on breakers. Pinch points. 6 place hands between heavy bags and the bag breakers. DCSA Task Hazard Assessment Form Version 1—October 22,2018 3 of 6