<table>
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<tbody>
<tr class="odd">
<td colspan="17"><h1 id="job-safety-analysis" class="HeadingForm">JOB
SAFETY ANALYSIS</h1></td>
<td colspan="3">Date:      </td>
</tr>
<tr class="even">
<td colspan="5" rowspan="2"><p>Prepared by:</p>
<p>     </p></td>
<td colspan="6" rowspan="2"><p>Project No:</p>
<p>     </p></td>
<td colspan="9">Task Order/Contract No:      </td>
</tr>
<tr class="odd">
<td colspan="9">Area/Bldg:      </td>
</tr>
<tr class="even">
<td colspan="20">Work Scope/Description:      </td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="6">Primary</td>
<td colspan="9">Secondary</td>
</tr>
<tr class="even">
<td colspan="5">Emergency Contact Person(s):</td>
<td colspan="6">     </td>
<td colspan="9">     </td>
</tr>
<tr class="odd">
<td colspan="5">Emergency Radio/Phone No:</td>
<td colspan="6">     </td>
<td colspan="9">     </td>
</tr>
<tr class="even">
<td colspan="20"><p>Specific Work Location(s):      </p>
<p> Various</p></td>
</tr>
<tr class="odd">
<td colspan="3">Prejob Walkthrough Conducted:</td>
<td colspan="4"> Yes</td>
<td colspan="13"> No</td>
</tr>
<tr class="even">
<td colspan="20"><h1 id="known-or-potential-hazards"
class="HeadingForm">KNOWN OR POTENTIAL HAZARDS</h1></td>
</tr>
<tr class="odd">
<td colspan="6"></td>
<td colspan="2">Yes</td>
<td>No</td>
<td>Reference</td>
<td colspan="6"></td>
<td colspan="2">Yes</td>
<td>No</td>
<td>Reference</td>
</tr>
<tr class="even">
<td>1. Radiological Area Work</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>10CFR835; Battelle Radiological Control Program</td>
<td colspan="3">13. Electrical Hazards</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td><p>29CFR1926 Subpart K; WAC 296-155 Part I</p>
<p>NFPA 70E</p></td>
</tr>
<tr class="odd">
<td>2. Hazardous Waste Operations</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1910.120</td>
<td colspan="3">14. Asbestos Work</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926.1101; WAC 296-65</td>
</tr>
<tr class="even">
<td>3. Confined Space</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1910 Subpart J; WAC 296-155 Part C</td>
<td colspan="3">15. Lead Work</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926.62; WAC 296-155 Part B-1</td>
</tr>
<tr class="odd">
<td>4. Hot Work</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subparts F &amp; J; WAC 296-155-260; WAC 296-155 Part
D</td>
<td colspan="3">16. Hazardous Materials</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926.59; WAC 296-155 Part B</td>
</tr>
<tr class="even">
<td>5. Roof Work</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>     </td>
<td colspan="3">17. Respiratory Hazards</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subpart E; WAC 296-155 Part C</td>
</tr>
<tr class="odd">
<td>6. Fall Hazards (&gt;6 ft)</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subpart M; WAC 296-155 Part C-1</td>
<td colspan="3">18. Noise Dose</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1910.95; WAC 296-155 Part B-1</td>
</tr>
<tr class="even">
<td>7. Excavation/Trenching</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subpart P; WAC 296-155 Part N</td>
<td colspan="3">19. Heat Stress</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subpart D</td>
</tr>
<tr class="odd">
<td>8. Scaffolding</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subpart L; WAC 296-155 Part J</td>
<td colspan="3">20. Hoisting &amp; Rigging</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td>Hanford Hoisting &amp; Rigging Manual</td>
</tr>
<tr class="even">
<td>9. Aerial Lifts</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29CFR1926 Subpart N; WAC 296 Part J</td>
<td colspan="10" rowspan="4"><p>= Requires formal/special training</p>
<p>= Requires a permit/form/report</p>
<p>= Requires certification or competent/qualified person
designation</p></td>
</tr>
<tr class="odd">
<td>10. Heavy Equipment</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>29 CFR Subpart O; WAC Part M</td>
</tr>
<tr class="even">
<td>11. Lock and Tag</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>Hanford Lock &amp; Tag Program</td>
</tr>
<tr class="odd">
<td>12. Site/Vehicle Traffic</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="20"><h1
id="specific-hazard-analysis-and-safe-work-requirements"
class="HeadingForm">SPECIFIC HAZARD ANALYSIS AND SAFE WORK
REQUIREMENTS</h1></td>
</tr>
<tr class="odd">
<td colspan="20">A detailed discussion of the unique hazards specific to
the work activity/location, including those noted above, will be
provided on subsequent pages of this JSA. This discussion must include
identification of the work activity, the specific hazards present, and
the safe work requirements/controls (including PPE) to be used to
alleviate/control the hazard(s).</td>
</tr>
<tr class="even">
<td colspan="12"><p>MINIMUM DRESS/PPE REQUIREMENTS:</p>
<p>Substantial Footwear, Long Pants, Shirt with Sleeves</p>
<p>Does further evaluation of the job steps, associated hazards, or
safety measures need to be performed?</p></td>
<td colspan="4"> Yes</td>
<td colspan="4"> No</td>
</tr>
<tr class="odd">
<td colspan="12">Supervision:      </td>
<td colspan="8">Date:      </td>
</tr>
<tr class="even">
<td colspan="12">Job Safety Analysis – Continuation Page</td>
<td colspan="8">Project No: 0</td>
</tr>
<tr class="odd">
<td colspan="12"></td>
<td colspan="8">Task Order/Contract No: 0</td>
</tr>
<tr class="even">
<td colspan="12">ACTIVITY AND SPECIFIC HAZARD</td>
<td colspan="8">SAFE WORK REQUIREMENT/CONTROL</td>
</tr>
<tr class="odd">
<td colspan="12">     </td>
<td colspan="8">     </td>
</tr>
</tbody>
</table>