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�UJ _J Control <br /> No. : <br /> JSA Type: ® Operations <br /> ❑ Transport ❑Office <br /> ❑ Construction ® New ❑ Revised Date: 3/23/04 <br /> Cc: <br /> Org Unit: Dept: <br /> Loc: Div: <br /> Work Type: Jackhammer/hand auger Work Activity: Jackhammer/hand auger <br /> ® Personal Protective ❑ Lifeline/Body ❑ Supplied ❑ Life vest <br /> Equipment (PPE) : Harness Respirator ❑ Gloves <br /> ❑ Goggles ® Hearing ❑ Air Purifying <br /> ® Face Shields Protection Respirator ❑ other <br /> ® Safety Glasses ® Hard Hat ❑ Welding/Pipe — <br /> ® Wrist guard ® Safety Shoes Clothing ❑ other <br /> ❑ Welding <br /> Mask/Goggles — <br /> Development Team Position/Title Reviewed By <br /> Position/Title Date <br /> Albert Simmons CTX Safety Manager Aubrey Cool Company Safety Officer 4/16/04 <br /> ® Job Steps ® Potential Hazard ® Critical Actions <br /> mate with project manager to ensure all approvals obtained <br /> obtain necessary permits, Fines,law suits,delays or added work Coor p J <br /> agreements,bonds,coordinate (well,encroachment,access agreements,traffic control plans,etc.) <br /> and owner,tenant,subcontractors,and agencies notified of start <br /> inspections and subcontractors, <br /> date <br /> and notify stakeholders_-- _._.__---.._.._.............._..............-.___....._.__...._...._.._..............__..........._._..._.................___......_.. <br /> ............... ..........................._..........._........_.....-----.................__..._...............__..__...__.._.__.........._..__...----- <br /> Traffic hazards,overhead and Review proposed location map in advance of arriving on site <br /> Mark site for proposed borehole . <br /> locations. underground lines&obstructions,dealer Reference Borehole Clearance Review form and coordinate with <br /> inconvenience Station M_ anger(or designee)to minimize potential conflicts. <br /> - — -....__........_......_..._.._.__. --........._..._..............._......__........................................................_._.............................._.................. .-._.._...._.Contact USA at least two full working days before drilling/digging. <br /> Call USA for line location Hitting underground utility <br /> clearance. (electrocution,explosion,product Get list of utilities that will be contacted and USA reference# <br /> release,property damage,and (bring with you to site).Visit site before drilling to confirm that all <br /> interruption of services). utilities have been marked. Contact companies that have not <br /> marked utility locations. Do not drill until all utilities are <br /> accounted for. _ <br /> _..._._........._......._..........._.._—...__—_..._...__--_ "-Reviewproposed locations against available construction drawings <br /> If necessary,coordinate private Hitting underground utility <br /> g <br /> line locator for private property. (electrocution,explosion,product and known utilities,tanks,product lines,etc. <br /> Where possible,perform preliminary site visit. <br /> release,property damage,and <br /> ----------—--- -interruption of_services):....._.._....._._._.._.___..__._.._.....__...--__.----.--..._......_.........._......._..---.._.-._..........__..................._......._ --....... <br /> ._....__.._._._...__......__._._._._..__..._.__.___... —_-._... <br /> Mobilize with proper Delay or improper performance of work Make sure sub-contractors are aware of their responsibilities for <br /> ew Site Safety <br /> ev <br /> equipment/supplies for drilling. due to improper equipment onsite. permiequipment <br /> cond tions and gather nee scary Personal Protective P)and <br /> Equipment(PPE). <br /> — -.._..- — - - ---....__.....-...........--- ..—..............-...---.._..............._......._.._.........--.........................__........_................................_._....._.._........_.._._...._...__�._._......._._..._.__.._____.._.locatio --o ed and —.. <br /> Meet with Station Manger(or Unknown traffic or other work hazards. Explain planned activities.Confirm locations to be cleared and <br /> designee)on start date before Lack of communication between all schedule. Locate emergency product shut-off switch. <br /> commencing work...._.....__.._.._._.__......_._........._interested parties:..._.....__... -....._..__.._.__... —-----._............ <br /> __..........__..__.---.._.._.. <br /> d by SPSA <br /> ..... <br /> Perform SPSA and tailgate Consider worst case scenario(includingReview fnecesary,add to SSP. Hwith co-workers. �ave�all co workeght aspects rs sign the SSP. <br /> safety meeting upon arrival at weather conditions). <br /> site. _....._.....-------..._------------...__..------- <br /> 71 <br /> o ° " <br /> F:\SAFETY\Safety and Health Manual (SHM)\SHM App A-LPS FormsUSA formsUSA Hand auger-jackhammer.doc <br />