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A§)bo Nfit9v �2� <br /> JSA Type: ® Operations ❑ Transport ❑Office ❑Construction ® New ❑ Revised Date:02/25/00 <br /> Co: Dept: Div: Org Unit: Loc: <br /> Work Type: Monitoring Well Installation Work Activity:Soil Boring/Monitoring Well Installation <br /> Personal Protective ❑ Lifeline/Body Harness ❑ Supplied Respirator ❑ Life Vest <br /> ❑ Equipment (PPE): ❑ Hearing Protection ❑ Air Purifying Respirator ❑ Gloves <br /> ❑ Goggles ❑ Hard Hat ❑ Welding/Pipe Clothing ❑ <br /> ❑ Face Shields ❑ Safety Shoes ❑ Welding Mask/Goggles ❑ Other <br /> Safety Glasses <br /> Other <br /> Development Team Positionrritle Reviewed By Position/Title Date <br /> Berry, Thomas R. Operations Manager N. Scott MacLeod Principal Geologist 6/12/00 <br /> _........_.__....__....-......__.._.._..._..-._-..__._......._.............__............_._..._..._._........_............_._..._................ ......_._.._..._...............................-................_..........._........__.......__........_....._............-.._.._.............................................._........._--..._....__...._...._......._.. - ..__...--------- <br /> Riggi, JohnSr. Staff Geologist Revised by NSM 12/9/03 <br /> ---- - ........_........._...--.... -- --- ._._._..._._._......_..._......_..........__.. .._.... <br /> ..._. _......_.......................-----............_..__....._........._.._...................._._._.._.................._._.......-......_....._._.._...._...----.-..._.._..- — <br /> Milano, Deno Associate Geologist <br /> 0 Job Steps 0 Potential Hazard 0 Critical Actions <br /> .-...--.....--------_ _._...._.....-- .._.__._..._....-----------............_._......................._..__._......_..._.._._.__._........_-----.._...__....._--. ....................--.......-----._..__..........---- ... --.._..__......_.....----....__._._—... —---------- <br /> Obtain necessary permits, Fines,law suits,delays or added work Coordinate with project manager to ensure all approvals obtained <br /> agreements,bonds,coordinate (well,encroachment,access agreements,traffic control plans,etc.) <br /> inspections and subcontractors, and owner,tenant,subcontractors,and agencies notified of start <br /> and notify stakeholders_ date. <br /> Mark out the proposed Traffic hazards,overhead and Review proposed location map in advance of arriving on site. <br /> borehole locations. underground lines&obstructions,dealer Reference Borehole Clearance Review form and coordinate with <br /> inconvenience Station Manger(or designee)to minimize potential conflicts. <br /> ----------....----...__.-.....__.....__._...---- ..._.......---...._...................._.....__..._..__.--_.-._...._.........--._._......__....._..----...--..._--......_..._._._...._......._._....--------......._.. _-.--...._...---------- <br /> Call USA for public line Hitting underground utility(electrocution, Contact USA at least two full working days before drilling/digging. <br /> location clearance. explosion,product release,property Get list of utilities that will be contacted and USA reference# <br /> damage,and interruption of services). (bring with you to site).Visit site before drilling to confirm that all <br /> utilities have been marked. Contact companies that have not <br /> marked utility locations. Do not drill until all utilities are <br /> . accounted for. <br /> . . . . . <br /> ..._.__........._......._.._.....---..._..._.__._._...._... ._.......__._....._..._....._........._._..---..............._..._............_....__......................_......................................._..__..............__._.._......................_.............--........_......._.._.-...... <br /> _...._.._._..- <br /> If necessary,coordinate private Hitting underground utility(electrocution, Review proposed locations against available construction drawings <br /> line locator for private explosion,product release,property and known utilities,tanks,product lines,etc. <br /> pro ert damage,and interruption of services). -.. Where.pgssible,perform preliminary site visit_ _ _ _ <br /> ._..P._....Y..---...._......_.._.. - ............._..._._..._..__._ ... .... ........ .... <br /> Select preferred order for Cross-contamination,adversely impacting Drill from low contamination to higher contamination and try to not <br /> drilling locations. station fuel sales. block dispensers during-peak sales time. <br /> _---..._......_...._.__......_....-..__........._....__............................_.._..........................._.._.._.__..........._......._.._..__..._..........._...._.._................__............_....._..-- .. ....__...._..--..._......__._......__._... -.....-------.-- -- <br /> Mobilize with proper Delay or improper performance of work Make sure sub-contractors are aware of their responsibilities for <br /> equipment/supplies for drilling. due to improper equipment onsite. labor,equipment and supplies. Review Site Safety Plan(SSP)and <br /> permit conditions and gather necessary Personal Protective <br /> ..._Equipment(PPE). <br /> Meet with Station Manger(or Unknown traffic or other work hazards. Explain planned activities. Confirm drilling locations and <br /> designee)on start date before Lack of communication between all schedule. Locate emergency product shut-off switch. <br /> commencing Zwork.------- - ...interestedparties..-- -..........._..._..__.........._... <br /> ....-- ------------- <br /> Perform-PSA&tailgate safety Consider worst case scenario(including Review SSP with co-workers. Highlight aspects identified by <br /> meeting upon arrival at site_- weather conditions). - SPSA and,if necessary,add to SSP. All co-workers sign the SSP_ <br /> ' � <br /> 1 =, �'f <br /> F:\SAFETY\Safety and Health Manual(SHM)\SHM App A-LPS Forms\JSA formsUSA Boring-Well Installation.doc <br />