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Ima ine it. Task Hazard Assessment ALCOM Delgeed. Geoprobe Drilling Oversight IDT, 1 01-01-03-01 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 M Gloves: Leather,nitrile ® Hearing Protection ❑ Other: Tools& Equipment: REMINDER: Use 4-Sight at the start of, and continuously throughout the job/task to identify additional and/or hazards to act on! 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. Mobilization 1 a.Striking unidentified 15 1 a.Call public utility locating service prior to initiating work activities. Use private locating 4 underground utilities service to mark out areas on private property.Verify location of utility marks; do not 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. 1 b.Striking overhead utilities 15 1 b. Follow the requirements of S3AM-322-PR1 Overhead Lines. Verify adequate 4 clearance of all drilling locations prior to setting up at drilling location. On- site Edits: 2. Setting up at drilling location 2a. Biological hazards causing 8 2a. Examine ground surface for biological hazards prior to setting up equipment. If 4 bites, stings or other injury biological hazards exist, move equipment to a different area for set up if possible. Machetes, or other fixed open blade tools, are not permitted for clearing vegetation. Use insect repellent and check clothing for ticks periodically when 2b. Struck by traffic applicable. 10 2b. Be alert to other vehicles or pedestrians if work area is in an area with public 4 access. Communicate with any heavy equipment operators in the area to ensure 2c. Unstable Rig platform they know where you and the equipment are located. Don high visibility vest. 10 2c. Verify with contractor that rig is set up level and properly chocked and blocked. 2 On- Site Edits: DCSA Task Hazard Assessment Form Version 1—October 22,2018 1 of 4