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1 t Control No. : JSA Type: ® Operations ❑ Transport ❑Office ❑ M New ❑ Revised Date: 02/25/00 Construction Co: Dept: Div: Org Unit: Loc: Work Type: Monitoring Well Sampling Work Activity: Monitoring Well Sampling/Gauging Personal Protective ❑ Lifeline/Body ❑ Supplied ❑ Life Vest ❑ Equipment (PPE) : ❑ Harness ❑ Respirator ❑ Gloves ❑ Goggles ❑ Hearing ❑ Air Purifying ❑ Face Shields Protection Respirator Other ❑ Safety Glasses ❑ Hard Hat ❑ Welding/Pipe El Safety Shoes Clothing Welding Other Mask/Goggles Development Team Position/Title Reviewed By Position/Title Date Berry, Thomas R. Operations Manager N. Scott MacLeod Principal Geologist 6/12/0 0 Riggi, John Sr. Staff Geologist .................----- ................__.._.__..._....__...---..._._............. ..........-.._..__..._......................._..--.._...._..._......--... - - - --------- -- -----._... Milano, Deno Sr. Project Manager O Job Steps © Potential Hazard © Critical Actions - _ - ---- _ ..._._........ _.......- - --- - ---- --- --- -- Coordinate site access. Delays or added work. Notify Station Manager of schedule. Notify other required personnel if applicable(city,regulators,private property owners,etc.) Mobilize with proper Delay 11 or improper/unsafe performance of Review work plan to determine equipment/supply needs. Make equipment/supplies for sampling. work due to improper equipment onsite. sure all sampling/gauging equipment is decontaminated. Bring Ci oss-containination of wells. ice for sample storage. Review Site Safety Plan(SSP)and gather necessary_Personal Protective Equipment(PPE)_— . ._. Notify other personnel onsite. Unknown traffic or other work hazards. Meet with station attendant or other site personnel and explain Lack of communication between all planned activities. interested parties. __...... -- --- - -- ...--- -- -- -- - --- — ---- --- ------- - - Determine sampling order. Cross-contamination of samples and wells Review prior analytical results and set sampling order from due to incomplete decontamination of lowest to highest concentration wells- sampling equment --.------ -- - ---. .__ ------------------- Perform ---- -.... _ --- -- — y Perform SPSA and tailgate safety Consider worst case scenario(including Review SSP with co-workers- Highlight aspects identified b meeting upon arrival at site. weather conditions). SPSA and,if necessary,add to SSP. Get signature of all co- workers on SSP. - - --- ------------- - Set up any necessary traffic Accident during placement or as a result of Use buddy system for placing traffic control. Reference traffic control. improper traffic control equipment control plan section of SSP(may include specific requirements placement. based on encroachment permit). -- - - -- -... _..__ .._ ...... _.- ....-- ........ ........ ...._.. ... f SSP Set up exclusion zone(s). Injury or exposure to public or other onsite Implement exclusion zone set-up instructions o personnel. Slip and fall hazards to (barricades,caution tape,cones,etc.). Set up work area free of workers. trip hazards:---- ----_- _-- - --- -------- --.. _. _..- -- .—.. - _... -- --- - - — -- Gauge water levels and product Back strain,inhalation or dermal exposure Don any additional PPE and initiate air quality monitoring in thickness(where applicable)in to chemical hazards. accordance with the SSP. Maintain safe distance from well wells. head Bend at knees not waist. ;-S„'`„t A''� �' � c?..r �' 3 '"1 � - ;� '� ANY n E- �.r• PJY•-+.� t- .A�?�'. Ri F '�- � ray r.•-+*�d"'�' xe c'�� zr as'1g 1 1 _ s U t ��- 4s SFr� .z�' `� r.:_ FASAFETY\Safety and Health Manual (SRM)\SRM App A-LPS FOrms\JSA forms\JSA Well Sampling-Gauging.doc