JOB SAFETY & ENVIRONMENTAL ANALYSIS

Stop the job any time anyone is concerned about safety. Stop the job if anyone identif ies a hazard not recorded on the JSEA. Be alert to any changes in personnel, condit ions at the work site, or hazards not covered by the original JSEA. If it is necessary STOP THE JOB, reassess the task and hazards, and amend the JSEA as needed.

Rev. 10/14/08

tDate Completed: Shift: First Person Completing Form:

Ca r l Sn e l l i n g

Project Name & Site Location: Re d R i v e r /3 1 7 & SF D r Job/Task Description:

Cut Turn Radius

Concurrent or Multi-Crew Activity(ies): Yes No Description:

Permits Required None Confined Space Critical Lift Energy Isolation (LOTO) Excavation Hot Work Other Permit(s) Required:

EMERGENCY RESPONSE

Emergency contacts Name(s) & Contact Number(s)

Equipment/Job location GPS coordinates, site location or directions for emergency response Describe Muster Point

Site H&S Manager Bill Thorn

Project Manager Colm McPHearson

Law Enforcement Medical Responders

Fire Department Josh Harris -- 318 -6314

Hazardous Spill Response Janice Goodyear – 318 -9748

Intersection of County Road 31 7 & Sunflower Drive

Lay-down yard

Equipment (crane, forklift, etc.) Model / Serial / ID#: Operator Limitations (e.g., Max. Wind Speed, weight, etc.) Dozer 785769 Ronaldo Jenks None Dump Truck Ford Luis Alverado None Dump Truck Ford Vlad Wosjewski None

JOB HAZARDS - CONVERSATION POINTS Check al l that apply and give details as needed in the Job Sequence / Hazards / Mitigation Section on page 2

Work Area Hazards Energy Isolation – LOTO / Working at Heights (cont’d.) Confined space concerns LOTO training verified Scaffolding shift inspection complete Moving equipment or vehicles Walkthrough & discussion of LOTO Area cordoned off below work Lighting levels too high/low Blocked in & locked out (verification) Rescue personnel & procedures in place Extreme heat or cold Breaker open and locked Other: Severe weather (snow, ice t-storms) Mechanical energy released Hot Work / Welding / Excessive wind Assured grounding Fire extinguisher / equip at job location? Wet, slippery, or muddy ground Trapped dead legs of pressure Fire watch Ignition sources / static / grounding Risk of trapped/non-isolated Energy Combustibles / LEL below work area Other: Other: Fire blanket

Task Hazards Driving / Motorized Equipment / Ground rod for welding machine Ergonomic concerns (bending, lifting, etc.) Seat belts used at all times Ground lead as close to weld as possible Potential for slips trips and falls Condition of road or route Hot work near flammable sources Caught between hazards Spotter / safety watch required Other: Hand tool inspection Unattended operation Excavations/Trenching / Fire hazards Vehicle inspection Utility locate performed Others working overhead / below All loads secured Lines located/ marked/drawings reviewed Other jobs in area / area cordoned off Other: Confined Space concerns Other: Heavy Equipment / Cranes / Approved shoring on hand

Personal Protective Equipment Permit required (critical lift, etc.) Proper sloping Hard hat, safety glasses, safety-toed boots,

hi-visibility clothing/vest Current Operator certification on file Area / Trench roped off (barricades)

Face shield, goggles Equipment Daily Inspections done Proper egress provided Hearing protection Equipment swing radius clear Competent Person review Gloves (rubber/leather/cotton) Positioning and outrigger location addressed Other: Respiratory Protection (SCBA or APR) Overhead power lines, utilities etc. Electrical Safety / Eyewash Station location identified Air horn or other communication Grounding and Bonding required Other: Signal man / spotter GFCI for electric power tools

Emergency and Communication Pinch locations Ensure safe distance is maintained while

performing inspection of energized equipment No cell phones/PDAs/Pagers while driving Soft, hard, muddy, wet, sloped ground Other: Emergency action plan reviewed Area cordoned off Other: Other:

Personnel Concerns Working at Heights /

New employees / Inexperienced workers Man lift inspected Workers Fit For Duty (medications, sleep,

physical limitations, distractions, etc.) Fall protection plan reviewed (competent

person) Language barriers addressed Proper tie-off points identified Other: Full body harness and lanyard / lifeline

Environmental Issues Fall protection equipment inspected Spill mitigation or containment Ladder Safety addressed MSDS review Walking/working surfaces (wet, slippery, icy) Other: Scaffolding weight capacity identified

Co Rd 317 – rough condition, soft shouldersCo Rd 317 – heavy traffic flow

JOB SAFETY & ENVIRONMENTAL ANALYSIS

Stop the job any time anyone is concerned about safety. Stop the job if anyone identif ies a hazard not recorded on the JSEA. Be alert to any changes in personnel, condit ions at the work site, or hazards not covered by the original JSEA. If it is necessary STOP THE JOB, re-assess the task and hazards, and amend the JSEA as needed.

Job Tasks

General Hazard CB – Caught Between FF – Falls From HER – Hazardous Energy Release SB – Struck By O – Other (describe)

Specif ic Hazards (Review the Hazard Conversation Points on pg.1) Specific hazards which apply to every

step in the sequence of this job Preventative and Risk Control

Measures

Person(s) responsible for hazard identif ication and

mitigation

Use additional sheets as necessary

JSEA Approval Individual Name - Company Name Signature Date Site HSM (or designee) Bill Thorn

Crew Supervisor Carl Snelling Carl Snelling Jobsite Supervisor/Foreman Roger Adams

Competent Person

Individual Name Company Signature Individual Name Company Signature Bill Thorn WC Carl Snelling WC Carl Snelling Roger Adams WC Carlos Carvurta WC Carlos Carvurta Renaldo Jenks WC Luis Alverado WC Vlad Wosjewski WC Sylvia Sonnet WC

ALL WORKERS & VISITORS TO

THE JOB/TASK LOCATION

MUST REVIEW,

UNDERSTAND & SIGN THIS

JSEA Jon Kim WC Post Work Follow-up

Did everyone coming into the job location review & sign the JSEA? Y / N Is equipment back in service with all LOTO removed? Y / N Is the job location cleaned up and free of hazards? Y / N Updates for any job plans, procedures, or checklists? Y / N Are tools and equipment cleaned and put away? Y / N Were there any incidents during the job? Y / N Has the Crew Supervisor been notif ied that the job is complete?

Y / N

Work Complete – JSEA Post-Work Review by: Name: Signature:

Date: / /

SB Equipment moving in area; rock dumping; Communicate w/everyone at site. Now where everyone CB cars/trucks driving is t all times. Stay clear of equip. moving; wear proper PPE – ear plugs, hard hat, gloves & Safety glasses.

O Chemicals on skin & on ground Turn off equipment & truck Notify environmental & supervisor; use spill kits to clean & slow chemicals

Working on site

Cleaning chemicals

O - ergonomic Pulled muscles Use proper lifting techniquesRolling fabric

SB Struck by equipment Bring a water truck to remove dust hazard Low visibility, dust periodically

Clean up area properly

Dumping rock

Housekeeping