
Environmental Remediation Drilling
Safety Guideline
Page 104 of 132
Attachment 1.B - Example JSA for Clearance Activities
JOB SAFETY ANALYSIS FORM
JOB TITLE/TASK: Pre-Ground Disturbance Clearance Activities
PROJECT ID PROJECT MANAGER:
DATE: REVISION: HEALTH/SAFETY DIRECTOR:
RECOMMENDED PERSONAL PROTECTIVE EQUIPMENT (PPE): _X_ Safety Glasses w/ Sideshields _X_ Steel-toed Boots
_X_
Hard Hat _X_ Nitrile Gloves _X_ Leather Work Gloves _X_ Other _As specified in HASP and JSA Job Step_______
JOB STEP
POTENTIAL
HAZARDS
PREVENTATIVE/CORRECTIVE ACTION
APPLIES TO
PROJECT
(Y/N)
All Pre-
Ground
Disturbance
Clearance
Activities
including Site
Inspection,
Subsurface
Features
Mark-out,
Removal of
Surface Cover
and Ground
Clearance
Slips, Trips, Falls Keep work area free of excess material and debris
Remove all trip hazards by keeping materials/objects organized and
out of walkways
Keep work surfaces dry when possible
Wear appropriate PPE including non-slip rubber boots if working on
wet or slick surfaces
Install rough work surface covers where possible
Stay aware of footing and do not run
Heat/Cold Stress Take breaks if feeling faint or overexerted
Consume adequate food/beverages (water, sports drinks)
If possible, adjust work schedule to avoid temperature extremes
Biological Hazards:
Insects, Snakes,
Wildlife, Vegetation
Inspect work areas when arrive at site to identify hazard(s)
Use insect repellant if observe mosquitoes/gnats
Survey site for presence of biological hazards and maintain safe
distance
Wear appropriate PPE including leather gloves, long sleeves and
pants, and snake chaps as warranted by site conditions
Traffic (including
pedestrian)
Notify attendant or site owner/manager of work activities and location
Use cones, signs, flags or other traffic control devices as outlined in
the Traffic Control Plan
Set up exclusion zone surrounding work area using cones, signs,
flags or other traffic control devices
Wear appropriate PPE including high visibility clothing such as
reflective vest
Inspect area behind vehicle prior to backing and use spotter
Fire/Explosion Post No Smoking signs around work area
Establish designated smoking area away from work area
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