JOB SAFETY ANALYSIS (JSA) FORM

Job Location/Site: Task/Activity: Work Area: Check applicable anticipated or Activities:

Welding, cutting, grinding Scaffolding Coating/Painting

JSA NO: JOB NO: Permit No: Date

CRITICAL PROCEDURES: Where work involves any of the following
hazards, applicable critical procedures must be incorporated into the JSA

Work at heights above 1.5 m (5 ft- includes excavations) Confined Space Entry (includes tank cleaning) Electrical/Mechanical Lockout (live, isolation, lock out/tag out) Heavy Equipment Lifting (cranes, boom trucks, excavators) Sub-surface Clearance (pre drill/borehole/excavation protocol) Entry into excavations > 1.2 m (4 ft) deep Hot Work (in a potentially explosive atmosphere)

Emergency situation /Evacuation

Gas Leak / Fire /Any Emergency: In case of emergency, all works must be stopped, equipment must be switched off
and left in safe condition. All personnel shall reach the nearest muster point considering the wind direction (upward or cross-ward)

Personal Protective Equipment: (Minimum requirement: safety shoes / hard hat / coveralls/dust mask / gloves used as required)
Additional PPE:

Eye Protection (specify) Other (e.g. fire retardant coveralls, breathing apparatus, etc.) Hearing Protection __________________________________________________ Fall Protection __________________________________________________ Rubber footwear and gloves if in damp area __________________________________________________
POSITION: _______________ POSITION:________________ SIGNED ______________ SIGNED ______________ SIGNED ______________ DATE:_____________ DATE__________________ DATE__________________

PREPARED BY:________________________
REVIEWED AND APPROVED BY ________________________

APPROVED

BY JOB OFFICER__________________________REF-INDICATOR____________

JSA-0-REV-0

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JOB SAFETY ANALYSIS (JSA) FORM

SL.N O ACTIVITY STEPS HAZARDS INVOLVED WHO IS AT RISK CONTROL MEASURES

Morning Meeting People Not Understanding What The And JHA Plan Or Hazards Are; People Afraid Discussion To Ask Questions Presence Of H2S gas and Toxic gas In Work Areas Presence of chemical or flammable items Work Permit Unauthorized commencement of works May result in exposing people and/or potential to harm or danger.

People Equipment Facility Environment

Make Sure Everyone Is Involved With The JSA/JHA Discussion And Understands; Encourage Everyone To Ask Questions And Participate. Don't Make Anyone Feel For Speaking Up Or Questioning Try To Identify These Types Of things In Your Work Areas Before Starting the work; Clear Carefully Work Areas By gas testing and daily site inspection Authorized work permit holders shall ensure obtaining and maintaining valid work permits. The supervisor responsible for this activity has to check the PPE of his staff to ensure that all required items are available and properly used. Inform all people regarding permit conditions before work starts. Supervisors must conduct daily toolbox talk about nature of work and associated potential hazards and their essential precautionary measures. Carryout gas test by QP Authorized gas tester time to time. All groups working in different area shall have H2S personal gas monitor All operatives shall be Trained for proper handling of tools. Appropriate tools only has to be used and its requirements shall be comply with site regulations All operatives shall wear their PPEs without fail. Keep Extra or Unused tools In Storage Container. Keep Tools In Tool Trailer - Do Not Store In Building. Keep only required amount of tools at site. All tools shall be kept clean for easy use.

People Equipment Facility Environment

Gas test

Using of hand tools

May found toxic gas or H2S gas leak near by existing facilities or extreme oxygen limit in air Tripping hazards Body pain / injuries or property damage Missed use by other contractor persons Slippery Handmade tools Defective tools Incorrect tools Unsafe method Not wear proper PPE Not proper clean tools Slips trips and falls due to poor housekeeping

People Environment People Equipment Facility Environment

Housekeeping Clean up worksite

People Environment Facility Equipment

Remove tools equipment and rubbish from worksite and maintain a clean work environment. Arrange housekeeping on daily and every shift bases Supervisor shall conduct tool box meeting in this regards Page 2 of 2

JSA-0-REV-0