25d_NCS000250_NCDOT_Appendix A_HASP for Metals Sampling (Example)_DRAFT

mM I TETRA TECH
Research Triangle Park Office
Health &Safety Plan (HASP)
for
NCDOT Hydraulic Unit NPDES
Support: Task Order 07 Metals
Sampling
July 28, 2017

NCDOT.- Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
1 Introduction
1.1 PURPOSE OF THE HEALTH & SAFETY PLAN
The purpose of the Health & Safety Plan is to guide appropriate actions while conducting
stormwater runoff monitoring of NCDOT field sites assessments in the field for the NCDOT
Hydraulic Unit NPDES Support Task Order 07: Metals Sampling, Data Analysis, and
Programmatic Updates Project (100-RTP-T336943-07). The following are sites for which
stormwater runoff samples will be collected in accordance with the project sampling plan:
• NCSU SECREF site at Lake Wheeler Field Research Labs: controlled bioswale
monitoring site.
• NC-50/NC-98 Interchange retrofit bioswale(s)
• I-40/I-95 Interchange retrofit bioswale(s)
1.2 ASSIGNMENT OF RESPONSIBILITY
There is a definite hierarchy of responsibility in the event an incident occurs. All incident reports
should be given to the RTP office Health & Safety representative (Wendy Wilkins) and in the
event she is not present, the IWM Mid -Atlantic Regional Manager (Trevor Clements), and
Kimberli Cordoba at 703-385-1713. In the event Kimberli is not available, contact WEI's Health
& Safety Coordinator, Angela McElyea, in Denver, CO (303-775-9515) or Christina
Papadopulos, Corporate Risk Management Coordinator, in Pasadena, CA at [phone]. In
the event of an incident, the appropriate forms are located at O:\Administration\Health & Safety.
1.3 EMPLOYEE RESPONSIBILITY
It is the responsibility of each Tetra Tech employee participating in the field reconnaissance to
implement and familiarize yourself with the contents of this document to keep yourself safe in the
field and to know which procedures to follow and forms to Ell out if necessary.
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NCDOT.- Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
2 Preparation for Field Work
2.1 HEALTH AND SAFETY EXPECTATIONS
Each employee is expected to include health and safety considerations as a part of their
preparation for field work. Important items include:
Always bring a first aid kit (including CPR mask and vinyl or latex gloves) and
safety vests. Be sure to bring a hard hat if you will be in a construction zone.
2. Have a plan in place in case someone is injured (i.e., cell phone available, locations
of nearest hospital and/or urgent care center).
Work in pairs if at all possible or with communication devices.
4. Hold and document daily tailgate safety meetings before commencing work each
day.
Be sure there is a record of where you are headed in the field and who is in the field.
Employees are encouraged to take Red Cross CPR and First Aid Courses
periodically.
Review Tetra Tech Health & Safety Manual, Vol. Three, General Safe Work
Practices (pages 1 and 2). This can be found on the my.tetratech.com intranet site.
Applicable Safe Work Practices (EMPLOYEES MUST BE FAMILIAR WITH
and/or Take to the Field. Documents can be found in the Health & Safety Manual.
Select only those that apply to your specific job).
Personal Protective Equipment Program
DCN: 2-07
Heat Illness Prevention and Monitoring
SWP 05-15
Prevention of Sun Exposure
SWP 05-26
Review and comply with NCDOT Highway Stormwater Program Quality Assurance
Project Plan, Field Safety requirements ( Section 4.2)
2.2 FORMS
Forms are attached to this plan for:
➢ Field Audit Checklist (complete prior to trip) — Attachment 1
➢ Daily Tailgate Safety Meeting Forms (complete in field) — Attachment 2
2.3 HOSPITAL INFORMATION
The nearest hospitals/urgent care centers to our field work are (see Attachment 3 with directions):
NCSU SECREF at Lake Wheeler Field Labs
1. Med Mar Primary & Urgent Care hours of operation 8:00am-7:00pm (M-F)
4450 Fayetteville Rd.
Raleigh, NC 27603
Phone: [phone]
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NCDOT.- Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
NCDOT Retrofit Monitoring Site at US-50/US 98 Intersection
1. Rex Urgent Care of Wakefield hours of operation 8:00am-4:30 pm (M-F)
14501 Falls of Neuse Rd
Raleigh, NC 27614
Phone: [phone]
NCDOT Retrofit Monitoring Site at I-40/I-95 Interchange
1. Med Fast Urgent and Primary Care hours of operation 9:00am-2:00pm (TH, SA)
Cumberland St. 9:00am-6:00pm (M-W, F)
Dunn, NC 28334 1:00pm-4:00pm (Su)
Phone: [phone]
2.4 EMERGENCY CONTACT INFORMATION
1. For Jesse Phillips (Cell number: 919-630-8418)
a. Primary
i. Jenna Schreiber (Spouse) — 513-503-8595
b. Secondary:
i. Gary Phillips (Father) — 919-444-1075
2. For Jared Hodes (Cell number: 914-310-5316)
a. Primary
i. Trisha Dupnock (Girlfriend) — 607-765-5880
b. Secondary:
i. Marilyn Hodes (Mother) — 914-282-6526
3. For Hillary Nicholas (Cell number: 919-609-0291)
a. Primary
i. Tristan Yonce (Fianc6) — 336-302-2186
b. Secondary:
i. Dianne Nicholas (Mother) — 919-467-4406
4. For Michelle Schmidt (Cell number: 989-506-0849)
a. Primary
i. Mike Schmidt (Spouse) — 989-621-0556
b. Secondary:
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NCDOT.- Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
i. Linda Frasco (Mother) — 989-506-6041
5. For Jenn Lenart (Cell number: 630-301-4972)
a. Primary
i. Brad Minrovic (Boyfriend) 330-697-1451
b. Secondary:
i. Paula Lenart (Mother) — 331-201-5677
RTP Office Number: [phone], Wendy Wilkins, H&S Officer, 919-485-2074
Trevor Clements: (office) 919-485-2058, (cell) 919-328-0175
FFX Office Number: [phone], Kimberli Cordoba
Angela McElyea, M.P.A., ASP, MSP - Director, Health & Safety (DIV-WTR,
IER, IMR, INE, IWR) [phone] [e-mail]
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NCDOT.- Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
3 Reporting Procedure for Injurieslillnesses
Due to Field Work
3.1 INCIDENTS WHICH MUST BE REPORTED
The following procedure should be followed in all instances of injury or illness due to fieldwork,
with the exception of those instances requiring only first aid.
It is necessary for the RTP office administration to record all work related injuries and illness that
result in:
➢ Death
➢ Loss of consciousness
➢ Days away from work
➢ Restricted work activity or job transfer or
➢ Medication treatment beyond first aid (OSHA, 2002).
The RTP office must also record work -related injuries and illnesses that are significant and are
diagnosed by a physician or other licensed health care professional. The office must record any
work -related case involving cancer, chronic irreversible disease, a fractured or cracked bone, or a
punctured eardrum (OSHA, 2002).
It is not necessary to report:
➢ Visits to a doctor or health care professional solely for observation or counseling
➢ Diagnostic procedures, including administering prescription medications that are used
solely for diagnostic purposes
➢ Any procedure that can be labeled first aid
First aid is considered:
➢ Using non-prescription medications at non-prescription strength
➢ Administering tetanus immunizations
➢ Cleaning, flushing, or soaking wounds on the skin surface
➢ Using wound coverings, such as bandages, gauze pads, etc., or using SteriStripsTM or
butterfly bandages
➢ Using hot or cold therapy
➢ Using any totally non -rigid means of support, such as elastic bandages, wraps, non -rigid
back belts, etc.
➢ Using temporary immobilization devices while transporting an accident victim (splints,
slings, neck collars, or back boards)
➢ Drilling a fingernail or toenail to relieve pressure, or draining fluids from blisters
➢ Using eye patches
➢ Using simple irrigation or a cotton swab to remove foreign bodies not embedded in or
adhered to the eye
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NCDOT: Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
➢ Using irrigation, tweezers, cotton swab or other simple means to remove splinters or
foreign material from areas other than the eye
➢ Using finger guards
➢ Using massages
➢ Drinking fluids to relieve heat stress (OSHA, 2002)
3.2 REPORTING OF INCIDENTS
If an accident or illness occurs due to fieldwork (per the criteria above), it is necessary for the
employee or supervisor to report the incident to the office Health & Safety Representative as soon
as possible. In the event the on-the-job accident requires three or more employees to be
hospitalized or causes a fatality, Tetra Tech must report it to Angela McElyea, Chris McClain,
and the NC Department of Labor, Division of Occupational Safety and Health (OSHNC) within
eight hours of its occurrence (preferably much sooner than that). To report an accident, call 1-
800-LABORNC or [phone].
3.3 FORMS
To report an accident or illness which occurs on-the-job, the employee or supervisor should use
the appropriate form, which is found online at O:\Administration\Health & Safety. (i.e., when
back in the office)
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NCDOT.- Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
ATTACHMENT 1— Field Audit Checklist
Project Name: NCDOT: Metals Sampling, Data Analysis, and Programmatic Updates
Project No.: 100-RTP-T36943-07
Field Location: Various in Triangle Region of NC
Project Manager: Jonathan Smith
Site Safety Coordinator: Jared Hodes
General Items in Compliance?
Health and Safety Plan Requirements
Yes
No
NA
1 Approved health and safety plan (HASP) on site or available
2 Names of on -site personnel recorded in field logbook or daily log
3 Designated site safety coordinator present
4 Daily tailgate safety meetings conducted and documented
5 Emergency telephone numbers posted
6 Emergency route to hospital posted
7 First aid provider and supplies available
Project Manager's / Site Safety Coordinator's Signature
Date
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NCDOT Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
ATTACHMENT 2 — Daily H&S Meeting Logs
March 12, 2017
Project Name: NCDOT: Metals Sampling, Data Analysis, and Programmatic Updates
Project No.: 100-RTP-T36943-07
Field Location: Various in Triangle Region of NC
Project Manager: Jonathan Smith
Site Safety Coordinator: Jared Hodes
Site Activities Planned for Today: Stormwater Runoff Sampling of NCDOT sites
Safety Topics Discussed:
Protective clothing and equipment:
Physical hazards:
Environmental hazards:
Equipment hazards:
Review of emergency procedures:
Other:
Signatures:
Jared Hodes
Date
Jonathan Smith Date
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NCDOT Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
ATTACHMENT 3 — Maps of Nearby Urgent Care Facilities
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NCDOT: Metals Sampling, Data analysis, and Programmatic Updates. July 28, 2017
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