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Imaine it. Task Hazard Assessment aLCOM Delgeed. Groundwater Sampling — Bailer 01-01-05-12 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 (final) a task in the sequence they What would the injury be? potential hazards associated with each job step to minimize the risk of are performed injury or environmental impact. Identify any`Stop Work'triggers. inhalation hazards or illness 2d.Slowly lift the well cover away from person and look for insects underneath the well. 2d.Biologic hazards; insects, 6 Use long handle tool to remove or kill any insects(i.e. screwdriver). 4 poisonous plants, and animals On- Site Edits: 3. Lowering bailer into well 3a.Cuts/lacerations/crushing, 6 3a.Avoid touching sharp material/edges. Keep face, hands,fingers feet clear when 2 bruises cutting tubing and setting up equipment. Wear cut resistant ANSI 2 gloves with disposable nitrile over gloves On- Site Edits: 4. Removing bailer from well 4a.Exposure to chemical hazards 4 4a.Stay upwind to avoid vapor exposure 2 in groundwater resulting in inhalation hazard or illness 4b.Cuts/lacerations/bruises to 4 4b.Don knee pads and inspect ground before kneeling down and take frequent breaks to 2 knee(flush mount) stand and stretch On- Site Edits: 5. Closing well casings/flush 5a.Cuts/lacerations/crushing, 4 5a.Avoid touching sharp material/edges.Wear cut resistant ANSI 2 gloves. Keep face, 2 mount covers bruises hands,fingers feet clear when closing well cover. Don knee pads and inspect ground before kneeling down. 5b.Back strain from 4 5b.Keep back straight. Take regular rest/stretch breaks. Change position regularly. heavy/awkward material handling On- Site Edits: DCSA Task Hazard Assessment Form Version 1—October 22,2018 2 of 4