JOB SAFETY ANALYSIS
Ref: C5+– JSA- 003
Facility / Site:……………………………………………… Location within Site:…………………….. Permit No:……………………. Permit Type: ……………… Date:…………………….
Task Description: Stringing Pipes on 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. Permitting work Work condition not safe HSE team to assess continuously the PTW system
Procedures and tasks not clear conditions of work in the assigned area Tool Box Talk
Lack of supervisory One person to issue work permits Certificates
Miscommunication Toolbox talks inspection
Not correct PPE worn Competency of personnel and supervisory for
Equipment not inspected and certified the activity
Define hierarchy and reporting flowcharts
Define proper PPE to be used for the work
Check inspection certificates of equipment for
the job
2. Checking equipment Punch point / hand injuries Smart grip / 3 points of contact when climbing First aid kit
Personnel Injury onto machines
Falling from machine Use containment cans/ plastic covers to Emergency
Slipping from ladder prevent spills Response Plan
Diesel / oil spill Adequate equipment and lifting tools ,
Electric shock certified will be used
Breathing dust from filters Competent persons will perform the job
Equipment check list should be made for all
new equipment coming to site
Weekly equipment check list should be made
and kept at engine
Wear proper PPE
Use proper ladders / steps to go on top
3. Stands preparation Back injuries Have right body posture / spinal alignment First aid kit
(wooden edge) Hand puncture / laceration when filling / handling edges
Punch point Wear leather gloves Emergency
Team carrying loads over 25 Kg Response Plan
4. Lifting of pipe Pipe fall Make sure hooks are well placed on the pipe First aid kit
Pipe hitting equipment Check slings before use on daily basis
Pipe hitting ground workers Never pass under suspended pipe Emergency
contact with electric cables and electrocution Watch for truck cabin, proceed carefully Response Plan
Banksman to guide excavator driver
Ground personnel stay away from lifting area
until pipe is spotted on the bags
Keep a safe distance from electrical cables
(5m min)
5. Spotting pipes on stands Pipe hitting stands Control pipe carefully with excavator First aid kit
Pipe hitting ground workers Stay away from suspended pipe until landing
Punch point / hand injury on wood stand Emergency
Response Plan
6. 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
7. Working in ROW Biological hazards such as reptiles Use of proper PPE First aid kit
Personnel missing or lost in the desert Close supervision
Communication means Emergency
Personnel Protests Response Plan
Security accompanying
Terrorist Attack Assess the situation as quick as possible and
announcing the state of the emergency
(Emergency or Alert).
At any security or terrorist threats call first the
ERT leader.
Delegate someone to make sure that the area
is evacuated.
Name Position Date Signed
Prepared By
Checked By
Approved By