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Y M Job Safety JSA Type ®SAR Operations ❑ Transport ❑Office ❑Construction ® New ❑Revised Date 03/30/00 Co Dept Div Org Unit Loc Work Type Environmental Work Activity Hollow Stem Auger Sampling Personal Protective Equtument(PPE) Minimum PPE is Level D including safety glasses or goggles,hard hat steel-toed and shank boots,hearing protection,and gloves(type dependent on Job-specific requirements) Additional PPE may be required in the Health&Safety Plan(HSP) Also refer to the HSP for required traffic control,air momtoring,and emergency procedures. Development Team Position/Title Reviewed By Position/Title Date Field staff must review Job-specific work plan and coordinate with project manager to verify that all up-front logistics are completed prior to starting work including, but not limited to, permitting, access agreements, and notification to required contacts (e g site managers, inspectors, clients, subcontractors, etc) A tailgate safety meeting must be performed and documented at the beginning of each work day Safe Performance Self Assessment(SPSA)procedures must be used during field activities Weather conditions(heat,cold,rain,lightning)must also be considered O Job Steps O Potential Hazard ® Critical Actions Clear drilling locations Traffic hazards,overhead and Reference Borehole Clearance Review form and underground installations,product coordinate with Station Manger(or designee)to minimize releases,property damage,dealer potential conflicts Review proposed locations against inconvenience available construction drawings and known utilities,tanks, product lines,etc Mark out the proposed borehole locations Call underground utility locating service for public line location clearance and get list of utilities being contacted If necessary,coordinate private line locator for _privat__proper Mobilize with proper Vehicle accident Lifting hazards Delay _ Follow safe driving procedures Employ safe lifting equipment/supplies for drilling or improper performance of work due to procedures Make sure sub-contractors are aware of their improper equipment onsite responsibilities for labor,equipment and supplies Review HSP andrmieitt conditions and gather necessary PPE Visually clear proposed drilling Underground and overhead installations Complete Pre-Mobilization section of Borehole Clearance locations _ Review form and add dnllmg locations as necessary ___ Set up necessary traffic control Struck by vehicle during placement Use buddy system for placing traffic control Reference Vehicle accident as a result of improper traffic control plan section of HSP(may include specific traffic control a ui ment placement_ requirements based un Permits) ____ Assist with set up of rig Vehicle accident during ng movement Verify clear pathway to drilling location and clearance for Damage caused by ng while accessing set- raising mast Provide as-needed hand signals and guidance up location Contact with overhead to driver to place ng Visually inspect ng(fire installations Soft terrain Rig movement extinguisher on board,no oil or other fluid leaks,cabling and associated equipment in good condition,pressurized hoses secured with whip-checks or adequate substitute, hacks in good condition9) If necessary,use wooden blocks underlacks to spread Ioad Chock wheels _ Set up exclusion zone(s)and work Struck by vehicle during set up Slip/fall Implement exclusion zone set-up instructions of HSP Set stations(drilling and logging/sample hazards up work stations with clear walking paths to and from ng collection) Clear upper five feet of boring using Back strain,exposure to chemical hazards, Don required PPE and initiate air quality monitoring in post-hole digger or bucket auger hitting an underground utility,repetitive accordance with the HSP Use proper lifting techniques motion and tools Complete the Pre-Drilling section of the Borehole Clearance Review form Contractor