JOB SAFETY ANALYSIS

Ref: C5+– JSA- 0002

Facility / Site:……………………………………………… Location within Site:…………………….. Permit No:……………………. Permit Type: ……………… Date:…………………….

Task Description: ROW

REQUIRED REFERENCES JSA REVIEW

Have the relevant Procedures, Standards, Guidelines,
or Safe Work Practices been reviewed? Yes N/A
Pending confirmation by the Task Leader of site conditions, I agree that the attached JSA identifies the
significant Task Steps, Hazards, and Controls.

JSA REVIEWER (Supervisor or Designate):

RISK ASSESSMENT
Must existing Procedures or Work Practices be
Yes No Name / Signature: Company:
modified to perform this work?
After mitigation, are there any hazards that continue to WORK SITE VERIFICATION
present a potentially significant risk? (Scenario-Based Yes No
Risk Assessment required)
The Work Team has assessed the worksite conditions and confirms:
 The JSA addresses the applicable hazards and necessary controls.
PPE REQUIRED DURING THIS TASK
 The Team has the appropriate resources (people and equipment) to do the job safely.
HARD HAT SAFETY GLASSES
 Others that could be affected by the work have been informed.
FACE SHIELD TASK LEADER:
SAFETY SHOES / BOOTS
GOGGLES

FALL PROTECTION Name / Signature: Company:

FALL RESTRAINT COMPLETE THE SECTION BELOW IF THIS JSA IS NOT PART OF A PERMIT PACK
GLOVES:

COTTON Work Team Declaration:

LEATHER I acknowledge that I have reviewed the attached JSA, I understand my roles
and responsibilities, and I will comply with the instructions for this task.
IMPACT PROTECTION
Name (print): Name (print):
Dust mask
OTHER (specify):
           
Work clothes
           
           
           
OTHER PPE (specify):            
           
 TASKS/STEPS POTENTIAL HAZARDS HAZARDS CONTROLS HAZARD PORT
(Number) (What could go wrong?) (How can harm be prevented?) MITIGATION STATES
1. Site Preparation • Musculoskeletal – From erecting hoardings, traffic • Adequate PPE for all personnel • Trained First aiders
barriers, barricades and posting safety signage. onsite
• Good lifting practice
• Training regarding good lifting techniques and • Safety signs are
how to recognize your own limitations. posted onsite
• Team work if it looks like two or even three • Emergency response
workers would do the job more effectively and plan (medical
safer than one, then that is probably true. treatment +
ambulance)
• Use adequate body position while lifting or
carrying equipment
• TBT in place
2. Use of grader/backhoe to • Personnel struck by moving machinery • One person to be dedicated to safety watch • Seatbelt On all the
clear right of way • Underground services and have good communications with workers. time driving
• Overhead services (if applicable) • Exposure time to be limited to as low as • Cars equipped with
reasonably practical. first aid kits
• Roll over of machinery
• Banks man is to lead the moving machinery • Fire extinguishers
• Road Crossings
• Competent persons only to perform the job available in cars
• Interfering with other moving vehicles
• CONTRACTOR PTW is in force, personnel to be • Phones and contact
•Soil disturbing list available in all cars
trained on the PTW system
• Careless movement and storage of soils can cause •Emergency response
• Machinery to be daily checked and inspected
serious damage to the structure and future use of the plan (medical
by competent person
soil. treatment +
• Machinery is only to be operated by trained,
• Working in steep slopes and sand dunes ambulance)
experienced and competent personnel
• Project cars to be equipped with IVMS system
At distance control is in place
• Speed limit to be respected all the time
• All Cars are equipped with Roll bars and
necessary first aid kits
• Fertile topsoil is to be kept separately from
mineral soil to allow reinstatement of the ground
to its best advantage for future use.
• Any soil movement or ground disturbing to be
done basing on the Method of statement
• Avoid travel across slopes as much as
 practicable—drive straight up and down slopes.
• Create a level area for the grader /bulldozersto
operate from when working on a steep grade.
3. Use of charger and truck to • Personnel struck by moving machinery • One person to be dedicated to safety watch • Seatbelt On all the
shift big stones from the • Roll over of machinery and have good communications with workers. time driving
right of way • Exposure time to be limited to as low as • Cars equipped with
• Road Crossings
reasonably practical. first aid kits
• Interfering with other moving vehicles
• Banks man is to lead the moving machinery • Fire extinguishers
• Soil disturbing
• Competent persons only to perform the job available in cars
• Careless loading/unloading operation can cause
• CONTRACTOR PTW is in force, personnel to be • Phones and contact
serious personnel and material damage
trained on the PTW system list available in all cars
• Working in steep slopes and sand dunes
• Machinery to be daily checked and inspected • Emergency response
by competent person plan (medical
treatment +
• Machinery is only to be operated by trained,
ambulance)
experienced and competent personnel
• Project cars to be equipped with IVMS system
At distance control is in place
• Speed limit to be respected all the time
• All Cars are equipped with Roll bars and
necessary first aid kits
• Any soil movement or ground disturbing to be
done basing on the Method of statement
• Avoid travel across slopes as much as
practicable—drive straight up and down slopes.
• Create a level area for the grader /bulldozersto
operate from when working on a steep grade.
4. Refuel of Machinery • Contamination of ground and possible • Only trained and competent personnel will • Seatbelt On all the
environmental impact on flora and fauna carry out refueling of machinery on project time driving
• Fire and explosion locations. • Cars equipped with
• All necessary precautions to prevent spills will first aid kits
be taken and any resulting spills will be • Fire extinguishers
immediately cleaned. available in cars
• Any Spill to be reported and contained quickly • Phones and contact
• All needed personnel or equipment to be list available in all cars
mobilized to contain the spill • Emergency response
• Spill report to be issued to CONTRACTOR plan (medical
• All refueling operations to be performed by treatment +
 competent persons
• HSSE supervisors to check after refueling
operation
• Ensure workers understand the hazards and
controls by doing a pre-job tool-box talk.
• Area to be barricaded.
• Electric Pump to be equipped with earthing
system.
• Refueling operation should be performed with
engine OFF.
• Park within 2m of pump.
ambulance)
•Operator/End User must shut the engine of the
Vehicle/Plant & Equipment prior to refuelling
• Ensure that there are No Naked Flames in the
area.
• Refueling must take place in a well-ventilated
area.
• Avoid spilling fuel by protecting the ground
with Fire retardant impermeable blanket & clean
up any fuel run off.
• Full inspection of equipment before to be used.
Smoking is prohibited while fueling engines.

5. Cleaning &Housekeeping • Equipment and tools remain on site • Training for good work practices to be held on Plastic bags
• Slip trip and fall site waste bins
• Trash left in the work place • TBT in place before job, housekeeping issue to
be mentioned in all TBT
• After working day, team leader must ensure
cleaning, inspecting equipment and good
housekeeping.
• Waste management plan is in force during
project
• Waste to be removed in time as per
CONTRACTOR waste management plan

6.  
7. 
 

Name Position Date Signed

Prepared By
Checked By
Approved By