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Imaine it. Task Hazard Analysis ALCOM Delgeed. Task Name: Error! Reference source not found. Error! Reference source not found. job/taskREMINDER: Use 4-Sight at the start of, and continuously throughout the additional 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. 3. Oversight of rig inspection 3a. Mechanical failure of 10 3a. Verify that drilling contractor inspects equipment daily using S3AM-321-FM1 4 equipment Daily Drilling, Boring & Direct-Push Equipment Inspection or equivalent. 3b. Emergency shut off disabled 6 3b. Verify that kill switch on rig is tested and operational 3 On- site Edits: 4. Drilling Oversight 4a. Flying debris, caught by/struck g 4a. Keep a safe distance away during rig operation. Do not talk on cell phone or be 4 by injuries distracted by paperwork when in immediate proximity to rig. Wear PPE including 4b.Caught in/by equipment hard hats, steel-toe safety boots, safety glasses, and hearing protection. 10 4b. Keep hands,feet and other body parts shall be kept away from moving parts. Do 4 not approach operator without making eye contact and getting approval. 4c. Exposure to contaminants g 4c. Position yourself upwind of the borehole whenever possible. Perform air 4 monitoring using a PID as described in the HASP. STOP WORK if the action level is exceeded. 4d. Noise-induced hearing loss 5 4d. Setup away from noisy operations. Don't be near the rig when hammering. 3 Wear hearing protection. On- site Edits: 5. 5a. 5a. On- Site Edits: 6. 6a. 6a. On- Site Edits: DCSA Task Hazard Assessment Form Version 1—October 22,2018 2 of 4