JOB SAFETY & ENVIRONMENTAL ANALYSIS

tDate Completed: Jun 10, 2009

Person Completing Form:

R e d R i v e r /3 1 7 & SF D r

Project Name & Site Location:

Concurrent or Multi-Crew Activity(ies):

Permits Required

First

Shift:

Yes

Ca r l Sn e l l i n g

Job/Task Description:

Cut Turn Radius

No Description:

None

Confined Space

Hot Work

Other Permit(s) Required:

Critical Lift

Energy Isolation (LOTO)

Excavation

EMERGENCY RESPONSE
Emergency contacts
Site H&S Manager
Project Manager
Law Enforcement
Medical Responders
Fire Department
Hazardous Spill Response

Name(s) & Contact Number(s)

Bill Thorn

Colm McPHearson

Intersection of County
Road 31 7 & Sunflower
Drive

Describe Muster Point

Lay-down yard

Josh Harris -- 318 -6314

Janice Goodyear

Equipment (crane, forklift, etc.)

Dozer
Dump Truck
Dump Truck

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

318 -9748

Model / Serial / ID#:

785769
Ford
Ford

Operator

Ronaldo Jenks
Luis Alverado
Vlad Wosjewski

Limitations (e.g., Max. Wind Speed, weight, etc.)

None
None
None

JOB HAZARDS - CONVERSATION POINTS

Check all that apply and give details as needed in the J ob Sequence / Hazards / Mitigation Section on page 2
Energy Isolation LOTO
/
Work Area Hazards
Working at Heights (contd.)
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:
Hot Work / Welding
/
Severe weather (snow, ice t-storms)
Mechanical energy released
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
Driving / Motorized Equipment
/
Ground rod for welding machine
Task Hazards
Ergonomic concerns (bending, lifting, etc.)
Seat belts used at all times
Ground lead as close to weld as possible
Hot work near flammable sources
Potential for slips trips and falls
Condition of road or route
Caught between hazards
Spotter / safety watch required
Other:
Excavations/Trenching
/
Hand tool inspection
Unattended operation
Vehicle inspection
Utility locate performed
Fire hazards
Others working overhead / below
All loads secured
Lines located/ marked/drawings reviewed
Other jobs in area / area cordoned off
Other:
Confined Space concerns
Heavy Equipment / Cranes
/
Other:
Approved shoring on hand
Permit required (critical lift, etc.)
Proper sloping
Personal Protective Equipment
Area / Trench roped off (barricades)
Hard hat, safety glasses, safety-toed boots,
Current Operator certification on file
hi-visibility clothing/vest
Equipment Daily Inspections done
Face shield, goggles
Proper egress provided
Competent Person review
Hearing protection
Equipment swing radius clear
Gloves (rubber/leather/cotton)
Positioning and outrigger location addressed
Other:
Electrical Safety
/
Overhead power lines, utilities etc.
Respiratory Protection (SCBA or APR)
Eyewash Station location identified
Air horn or other communication
Grounding and Bonding required
Other:
Signal man / spotter
GFCI for electric power tools
Pinch locations
Ensure safe distance is maintained while
performing inspection of energized equipment
Emergency and Communication
No cell phones/PDAs/Pagers while driving
Soft, hard, muddy, wet, sloped ground
Other:
Emergency action plan reviewed
Area cordoned off
Other:
Other:
Co Rd 317 rough condition,
Working at Heights
/
Personnel Concerns
soft shoulders
New employees / Inexperienced workers
Workers Fit For Duty (medications, sleep,
physical limitations, distractions, etc.)
Language barriers addressed
Other:
Environmental Issues
Spill mitigation or containment
MSDS review
Other:

Man lift inspected

Fall protection plan reviewed (competent
person)
Proper tie-off points identified
Full body harness and lanyard / lifeline
Fall protection equipment inspected
Ladder Safety addressed
Walking/working surfaces (wet, slippery, icy)
Scaffolding weight capacity identified

Co Rd 317 heavy traffic flow

Stop the job any time anyone is concerned about safety. Stop the job if anyone identifies a hazard not recorded on the
JSEA. Be alert to any changes in personnel, conditions 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

General Hazard

JOB SAFETY & ENVIRONMENTAL ANALYSIS

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

Specific Hazards

(Review the Hazard Conversation Points on pg.1)

Preventative and Risk Control

Measures

Person(s) responsible for

hazard identification and
mitigation

CB

Specific hazards which apply to every

step in the sequence of this job
Equipment moving in area; rock dumping;
cars/trucks driving

is t all times. Stay clear of equip. moving; wear proper

Cleaning chemicals

Chemicals on skin & on ground

Turn off equipment & truck Notify environmental

Rolling fabric

O - ergonomic

Pulled muscles

& supervisor; use spill kits to clean & slow chemicals

Use proper lifting techniques

SB

Struck by equipment

Bring a water truck to remove dust hazard

Job Tasks
Working on site

Dumping rock

SB

Low visibility, dust

Communicate w/everyone at site. Now where everyone

PPE ear plugs, hard hat, gloves & Safety glasses.

periodically

Housekeeping

Clean up area properly

JSEA Approval
Site HSM (or designee)
Crew Supervisor
Jobsite Supervisor/Foreman

Use additional sheets as necessary

Individual Name - Company Name
Bill Thorn
Carl Snelling

Signature

Date

Carl Snelling

Roger Adams

Jun 10, 2009

Jun 10, 2009
Jun 10, 2009

Competent Person

ALL
WORKERS &
VISITORS TO
THE
JOB/TASK
LOCATION
MUST
REVIEW,
UNDERSTAND
& SIGN THIS
JSEA

Individual Name

Company

Bill Thorn
WC
Carl Snelling
WC
Carl
Roger Adams
WC
Carlos Carvurta
WC
Renaldo Jenks
WC
Luis Alverado
WC
Vlad Wosjewski
WC
Sylvia Sonnet
WC
Jon Kim
WC
Post Work Follow-up
Did everyone coming into the job location review & sign the JSEA?
Is the job location cleaned up and free of hazards?
Are tools and equipment cleaned and put away?
Has the Crew Supervisor been notified that the job is
complete?
Work Complete JSEA Post-Work Review
by:
Name:

Signature

Individual Name

Company

Signature

Snelling

Carlos Carvurta

Y
Y
Y
Y

/
/
/
/

N
N
N
N

Is equipment back in service with all LOTO removed?

Updates for any job plans, procedures, or checklists?
Were there any incidents during the job?

Signature:

Y / N
Y / N
Y / N
Date
:

Stop the job any time anyone is concerned about safety. Stop the job if anyone identifies a hazard not recorded on the JSEA. Be alert to any changes in personnel,
conditions 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.