Total Safety Task Instruction – Job Safety Analysis
TSTI-JSA is a safety communication, task planning and risk management system.
(Complete each box before proceeding to the next box.)
(Box 1&2 by FLS) Task Planning
Permit / Work Order # __________ Contractor ___________ Craft ____________ Date __/ __ / __ (1)
Task Description ________________________________________________________________________
Administrative
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Recognized Hazards _____________________________________________________________________
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Unit/Area Specific Training:________________________________: ___ Client Required ___ KBR Required
Emergency Action Plan (Risk Management) (2)
Area / Unit ___________ Alarm Code ______________________________________________________
Plant Emergency # ____________ Evacuation Route _________________________________________
_____________________________________________________________________________________
Nearest Safety Shelter Location ___________________________________________________________
Assembly Area __________________________________ Safety Showers / Eye Washers Located
Yes
Communication - Task Planning - Risk Management (JSA)
Task Steps (3) Potential Hazards (4) Eliminate / Control Hazards (5)
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Hazard Recognition / Considerations (Risk Management)
Physical (6) Physical (continued) (6) Health (7)
___ Arcing / Sparking Equip. ___ Pinching & Crushing ___ Airborne Particles (work created)
___ Dust (weather created) ___ Pressurized Systems & ___ Chemical – Liquid / Vapor
___ Electricity-Close Proximity Equipment ___ Contaminated Soil or Water
___ Electricity, loss of ___ Radiation – X-ray ___ Fatigue
___ Engulfment ___ Sharp / Jagged Objects ___ Fumes
___ Entanglement ___ Slips / Tripping Potential ___ Noise (excessive)
___ Falling Objects ___ Structural-Surface ___ Oxygen Deficient Atmosphere
___ Fall Potential Openings ___ Temperature-Extreme Heat / Cold
___ Fire / Explosion ___ Tight/Close Work Quarters ___ UV Rays – Eyes / Skin
___ Flying Debris ___ Vibration (excessive) ___ Other _______________________
___ Heavy Bulky Material ___ Water-Drowning /
___ High Voltage-5KV + Hypothermia Environmental – Air-Soil-Water (8)
___ Hot & Cold Surfaces Other ___________________ ___ Chemical Spills / Releases
___ Lighting – Inadequate ________________________ ___ Waste Water
___ Moving Hazards Other _________________________
Task Planning
Standard Equip. Requirements(9) Special Equipment / Tools (10) Support Craft-Third Party (11)
________________________ ____________________________ _________________________
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____________________________ _________________________
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____________________________ _________________________
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____________________________ _________________________
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____________________________ _________________________
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_____________________________ ____________________________ _________________________
____________________________ _________________________
________________________ Example: Radios-Special Testing Meters Example: Equipment Vendor-Laborers
Example: Back Hoe-Cherry Picker Special Tools-Bead Blaster-SCBA
Compressor-Crane-Fork Lift-Tractor Trailer Special Hole Drilling - Testing Co.
Risk Management
Safe Work Practices (12) Basic Safeguards (13) PPE Required (14)
___ Asbestos Abatement ___ Arc Shields ___ Arc Suit
___ Confined Space Entry ___ Barricades ___ Chem. Resistant Clothing
___ Crane Lift Study ___ Crane Suspended Work Platform ___ Eye Protection
___ Electrical-Close Proximity ___ Fire Extinguishers Located ___ Fall Protection
___ Excavations & Shoring ___ Fire Watch ___ Foot Wear
___ Hot Taps ___ Hole Covers ___ Hand Protection
___ Lead Abatement ___ Hole Watch ___ Head Protection
___ Line Breaking/Equipment Opening ___ Housekeeping ___ Hearing Protection
___ Lock-Out / Tag-Out ___ Lighting - Additional ___ Respirator
___ MSDS & Labeling ___ Post Warning Signs ___ Weather Resistant Clothing
___ Other______________________ ___ Scaffolding ___ Other ________________
______________________________ ___ Tools/Equip in good condition ________________________
___ Ventilation/Exhaust Systems
Communication
Stop Work Conditions (Reminders) (15)
Adjacent Work Hazards Chemical Spills-Releases Excessive Noise Fires & Explosions
Change in Conditions Evacuation Alarm Extreme Weather Unusual Odors
FLS, Employee Comments / Changes in conditions__________________________________________ (16)
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I acknowledge receiving and understanding these instructions, I will fully comply with the assigned task (17)
requirements.
Signature Badge Signature Badge
___________________________ __________ ___________________________ ____________
___________________________ __________ ___________________________ ____________
___________________________ __________ ___________________________ ____________
___________________________ __________ ___________________________ ____________
___________________________ __________ ___________________________ ____________
FLS / Supervisor (Signature) __________________________ (Print) ___________________________
(FLS will ensure completed TSTI-JSA forms are forwarded to the appropriate General Foreman or Up-line Management)
08-14-04
