GAS OPERATIONS AND EXCAVATION JOB BRIEF

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Work Location
  Address

• DDS Division

  Select

General

• Nearest Intersection/Landmark

• Nearest Hospital (Optional):

• Work Tasks

• Operator Qualifications Verified for Work Tasks

  Yes

  No

  N/A

• Comments:

Required PPE / Safety Equipment

• Select applicable

  Select Hard Hat, Safety Glasses, Work Boots Safety Vest / Class 3 Hi-Vis Clothing Dust Mask Hearing Protection FR Coverall / 100% Cotton Undergarment Air Respirator/ FR Balaclava / FR Glove Liners Electric Hazard Rated Rubber Gloves Fire Extinguisher Other

  • Hard Hat, Safety Glasses, Work Boots
  • Safety Vest / Class 3 Hi-Vis Clothing
  • Dust Mask
  • Hearing Protection
  • FR Coverall / 100% Cotton Undergarment
  • Air Respirator/ FR Balaclava / FR Glove Liners
  • Electric Hazard Rated Rubber Gloves
  • Fire Extinguisher
  • Other

• Specify

Pre-Work Assessment

• Valid Work Permit:

  Yes

  No

  N/A

• Emergency Permit in Process

  Yes

  No

  N/A

• Approved SOP:

  Yes

  No

  N/A

• Within 200' of Reg Station:

  Yes

  No

  N/A

• If "Yes" contact Gas Control

• Valid Dig Safe/One Call Ticket:

  Yes

  No

• Dig Safe Pre-Marks Present:

  Yes

  No

• CAT Used Identify UG Electric:

  Yes

  No

• CGI Calibrated:

  Yes

  No

• Cell Phone Coverage:

  Yes

  No

Hazard Categories and Preventative Measures

• Pipeline Safety Over-Pressurization, Gas Leak / Damage, CI Main Break, Undermine, Poor Pressure, Water in Gas Facility, Deep Gas Facility

  Select Establish "Safety Perimeter" Close Roadways / Sidewalks Excavate Remote Openings Request Environmental Support Utilize Air Respirators Evacuate Buildings Install / Monitor Gauges Take Gas Readings Davit Retrieval System Contact Gas Control Utilize Shoring Other

  • Establish "Safety Perimeter"
  • Close Roadways / Sidewalks
  • Excavate Remote Openings
  • Request Environmental Support
  • Utilize Air Respirators
  • Evacuate Buildings
  • Install / Monitor Gauges
  • Take Gas Readings
  • Davit Retrieval System
  • Contact Gas Control
  • Utilize Shoring
  • Other

• Specify

• Weather Conditions Rain, Sleet, Snow, Wind, Fog, Thunderstorms, High Temp, Low Temp, Flooding, Mud

  Select Slip Resistant Footwear/Spikes Slippery Surface Walking Techniques Sand / Salt Work Zone Water Pumps Proper Hydration Tent Periodic Work Breaks Other:

  • Slip Resistant Footwear/Spikes
  • Slippery Surface Walking Techniques
  • Sand / Salt Work Zone
  • Water Pumps
  • Proper Hydration
  • Tent
  • Periodic Work Breaks
  • Other:

• Specify

• Traffic Hazards Heavy Vehicular Traffic, High Speed Vehicles, Commercial Vehicles, Pedestrian Volume, Proximity to School / Businesses

  Select Signage Cones & Barricades Vehicle as Barrier Pedestrian Walkway Flag Person(s) Police Detail Radar Speed Sign LED Road Flares Arrow Board Jobsite Lighting Other: Kids going to bus stop, local traffic in and out of driveways

  • Signage
  • Cones & Barricades
  • Vehicle as Barrier
  • Pedestrian Walkway
  • Flag Person(s)
  • Police Detail
  • Radar Speed Sign
  • LED Road Flares
  • Arrow Board
  • Jobsite Lighting
  • Other: Kids going to bus stop, local traffic in and out of driveways

• Specify

• Jobsite Hazards Fire, Water Main Break, Undermine, Active Construction, Tripping Hazards, Traffic Plates, Material Storage, Debris, Environmental Concerns, Noisy, Dark

  Select Establish Incident Command with FD/PD Identify / Eliminate Tripping Hazards Hazardous Atmosphere Testing A Traffic Plates Stored / Handled Properly Close Roads/Sidewalk Fall Protection Equipment, Tools & Material Stored Properly Hearing Protection Jobsite Lighting Other:

  • Establish Incident Command with FD/PD
  • Identify / Eliminate Tripping Hazards
  • Hazardous Atmosphere Testing
  • A Traffic Plates Stored / Handled Properly
  • Close Roads/Sidewalk
  • Fall Protection
  • Equipment, Tools & Material Stored Properly
  • Hearing Protection
  • Jobsite Lighting
  • Other:

• Specify

• Other Utility Assets OH/UG Electric, Cable, Telephone, Water, Sewer, Cesspool, Sprinklers

  Select Hand Excavate within Tolerance Zone Utilize CAT to locate UG Electric Insulating Blankets Verify Markout Request De-energization Rubber Gloves Other: Overhead lines

  • Hand Excavate within Tolerance Zone
  • Utilize CAT to locate UG Electric
  • Insulating Blankets
  • Verify Markout
  • Request De-energization
  • Rubber Gloves
  • Other:
  • Overhead lines

• Specify

• Heavy Equip / Tools / Rigging Backhoe, Loader, Trencher, Skid Steer, Dig-It, Crane, Dump Truck, HDD, Road Saw, Pneumatic Equip.

  Select Backup Alarm Functional Swing Radius Review Utilize Spotter Blind Spot Awareness Hand Signals Confirmed Inspect Rigging Equipment Verify Sufficient Load Capacity of Lifting Equipment Stabilizers Up When Moving Establish Drop Zone Other:

  • Backup Alarm Functional
  • Swing Radius Review
  • Utilize Spotter
  • Blind Spot Awareness
  • Hand Signals Confirmed
  • Inspect Rigging Equipment
  • Verify Sufficient Load Capacity of Lifting Equipment
  • Stabilizers Up When Moving
  • Establish Drop Zone
  • Other:

• Specify

• Vehicle Backing, Damage by Public Vehicles, Vehicle Security, Entering / Exiting Risks

  Select Spotter for Backing & Tight Maneuvers Lock Vehicles Outside Work Zone Parking Brake Utilize 3 Points of Contact Safe Parking Locations Monitor Vehicle Within Work Zone Wheel Chocks Remove Keys Other:

  • Spotter for Backing & Tight Maneuvers
  • Lock Vehicles Outside Work Zone
  • Parking Brake
  • Utilize 3 Points of Contact
  • Safe Parking Locations
  • Monitor Vehicle Within Work Zone
  • Wheel Chocks
  • Remove Keys
  • Other:

• Specify

• Soft Tissue Injury Prevention Sprain, Strain, Contusion, Laceration, Abrasion

  Select Co-worker/Mechanical Lift Assist Stretch & Flex Identify Pinch Points/Sharp Edges 3 points of contact Proper Body Position Other:

  • Co-worker/Mechanical Lift Assist
  • Stretch & Flex
  • Identify Pinch Points/Sharp Edges
  • 3 points of contact
  • Proper Body Position
  • Other:

• Specify

• Other Hazards & Risks Complacency, Distraction, Fatigue Time Constraints, Personal Safety / Security, Animals, Insects, etc.

  Select Maintain Situational Awareness First Aid Kit Available Effective Communication Burn Kit Available Safety Stop / Time Out Other

  • Maintain Situational Awareness
  • First Aid Kit Available
  • Effective Communication
  • Burn Kit Available
  • Safety Stop / Time Out
  • Other

• Specify

Excavation

• All excavations are to be evaluated by a the competent person at least once per day, prior to entry, and as needed throughout the shift

• Competent Person

• Comments

Excavation

• Dimensions

• Length___FT___IN

• Width___FT___IN

• Depth___FT___IN

• Soil Classification

  Stable Rock

  Type A

  Type B

  Type C

• Protective System Required

  No

  Yes

• Supervisor Notified at

  Date

• Select

  Timber Shoring

  Shoring Box (Modular)

  Sloping

  Other

• Specify

• Notes

  Select Surface Water present Excavation exposed to vibration Previously disturbed soils Excavation contains layered soils Adjacent Structures Excavation Access / Egress Compliance-Ladders / Steps / Ramps Design of protective system available at jobsite

  • Surface Water present
  • Excavation exposed to vibration
  • Previously disturbed soils
  • Excavation contains layered soils
  • Adjacent Structures
  • Excavation Access / Egress Compliance-Ladders / Steps / Ramps
  • Design of protective system available at jobsite

• Estimate depth based on prints & update prior to entry if needed The excavation depth must be measured from the deepest point. Excavations 5 feet or greater require a protective system unless within stable rock.

• Soil classifications: Each soil and rock deposit shall be classified by a competent person as Stable Rock, Type A, Type B, or Type C using OSHA approved visual and manual tests. If after classifying a deposit, the properties, factors, or conditions affecting its classification change in any way, the changes shall be evaluated by a competent person. The deposit shall be reclassified as necessary to reflect the changed circumstances.
  
  Means of Egress: Ladders or other safe means of egress shall be provided in excavations 4' or greater and (1) per 25' lateral travel for employees. Ladders used in excavations secured and extended 3' above landing or grade level.
  
  Soil Setback: Soil and materials must be maintained 24" from the edge of the excavation.

Job Brief Participation

Participant

• Name and Signature

• Position

  Crew Leader

  Crew Member

  Visitor

• Time initial job brief completed

  Date

• Crew Leader's signature

  Sign

• Job Brief reviewed with other crews if present

  Yes

  No

  N/A

Job Brief Re-assessment

• Must be completed lunch/significant delay or when job tasks/jobsite conditions/hazards have changed

• Re-assessment conducted by

  Sign

• Changes to hazards or required preventive measures

• Supervisor Review

  Sign