Laserfiche WebLink
aw Willie MW �A*f "I Weiler <br /> Job Safety Analysis (JSA) Worksheet— Remediation Division <br /> The Proactive Approach to Injury Prevention <br /> Supervisor/Foreman: Brendot�p Wilder Job Site Location: 1444 South Lincoln Street, Stockton, CA 95206 Project: 62403335 Cost Code: 024612 <br /> Date: 1 /30/09 Time: E' :Zo Task: Soil-Vapor Intrusion Survey <br /> Consider the following and check the Items that apply to tha job and then review with the work crew <br /> Permits/Plans ❑ Other: ❑ Warning Signs Q Groundwater Management: <br /> ❑ Required Chemical Contaminant ❑ Grounding <br /> ❑ General ❑ Corrosive ❑ Handrails <br /> 11 Vapor Suppression <br /> ❑ Hot Work <br /> ❑ Confined Space Entry ❑ Flammable Liquid ❑ Overhead Work ❑ Air Monitoring: <br /> ❑ lock-Out/Tag-Out ❑ Poison Q Other Housekeeping keeps Working in Area <br /> ❑ ed at Jobsite•with Permit ❑ Flammable Solid ❑ Ping ❑ Ventilation <br /> west ❑ Fire Protection <br /> (�°f�Silt=SPeI Jo Health&Safety Plan ❑ Acutely Toxic ❑ Traffic Control/Safety <br /> ❑ Water Reactive Liftin <br /> Work Plan/SOP Review ❑ Oxidizer 0F <br /> ❑ Other: El Other ❑ Forklift <br /> 0ment Electrical <br /> ❑ �Jhain fall Demolition <br /> Personal Protective <br /> — / LTJ'Manual Lifting ❑ Utilitles Loca /ShutofflCapped or <br /> PPE QA LIS QC pB� ❑ Locked and Tagged Q Crane(Attach Crane Inspection) Controlled <br /> Normal PPE ❑ Try Start/Stop Switch 0 Rigging: ElAsbestosiXeead Clearance <br /> • Hard Hat ❑ GFCI Test a/Pr'oper Lift Technique Q Other Hkmat Removed/Abated <br /> • Safety Glasses ❑ Other ❑ Equipment Condition ❑ Dem �fleavy Equipment Inspection <br /> • Gloves ❑ N/A Emernenev InfolEouloment Location (Att ch Copy of Daily Inspection) <br /> • Proper Foot Wear Hazards(Chemicals) ❑ W din Cuttin Compressed Gas <br /> • Hearin Protection Plu Muffs ❑ Chemical Bums-Skin/Eyes ❑ MSDS/Loration fat, sues:g p <br /> 9 ❑ Fire Monitors <br /> ❑ Glove Type: ❑ Flammable/Explosive ❑ Fire Extinguishers <br /> ❑ Boot Type: ❑ ,Ingestion <br /> ❑ Addl Foot Protection [1 Inhalation ❑ Other: Site Control/Decontamination <br /> ❑ Protective Coveralls ❑ Skin Contamination ❑ Safety Showers Q CRZ Established: <br /> Type: Wards(Environmental) ❑ Evacuation Route <br /> ❑ Fire Retardant Clothing Terrain: ❑ Emergency Clinic/Hoy ❑ Personnel Decon: <br /> 9 ❑ weather. Id--'Location of Phone fit'!/ x�J <br /> ❑ Addl Eye Protection: <br /> ❑ Fall Protection Wind Direction: LJ Equipment Decors: <br /> ❑ Hand Signals(Review) <br /> Safety Vest: Color. ❑ Temperature: <br /> ❑ <br /> ( iolog'I�aI Harard __r ____�_on ❑ Radio Communication ❑ Other: <br /> R i - n i 5;e ❑ Plant Emergency Signal <br /> ❑ Air ud ed Half ❑Full Access �` - ❑ Exclusion Zone: <br /> R Cartridge Type: ❑ Scaffold(Property Inspected_) G First Aid Klt: h4.• o <br /> ❑ Ladder(Tied Off ) ExcavationlEarfhmovina ❑ Clean Zone: <br /> PAPR Ladder Type: ❑ Utility Clearance/Issues: <br /> Supplied Air:❑SCBA ❑Aidme <br /> Airline Air Source: El Aerial Lift Additional Comments/Concerns: <br /> ❑ Personnel Basket(Inspected and ❑ Corppetent Person: <br /> All Tool <br /> Inspection approved) 11 S�6ring/SlopingBracing <br /> unE] Special Provision lExcavation Acoess/Egress <br /> 54p <br /> ❑ Other: ❑ /Carthmoving Equipment Inspection <br /> 2�Proper Tools for the Job I(Attach Copy of Daily Inspection) <br /> l9'Good Tool Conditions Miscellaneous ❑ `'-Erosion Control <br /> ❑ Qualification Required ❑ Area Isolation: <br /> Hazards Requiring Action if hazard is checked,list control method on back under"Pre-]ob Preparation" <br /> Airbome Particles/Dust 0/inadequate Lighting Fall Potential Electrical Shock <br /> Noise - P' ch Points Heat Stress Poor Access/E rens <br /> 41 S11 -Td Potential ea Objects Poor Housekeeping Hazardous Weather <br /> Hot Cold Surfaces or Materials Sha Objects - Struck B Line of Fire <br /> Other Contractor Hazards Fire Hazard or ExplosionI Li <br /> *Make sure employees have read and understand the reauirements of the JSA and associated Permits <br />