Sample JSA JSA No.
________
Company name: ABC Company Project name: Big Project
Work description: Geotechnical soils investigation Work location: Area outside north and south of contractor parking
Start date: November 19, 2024 Duration: Approximately 2 weeks
Major equipment: Drill rig Reference material: Soils investigation specification, bore hole location sketch
Trade groups (including subcontractors): Geotechnical Technicians, Labourers, Operating Engineers
Job: To begin (date):
Department: Supervisor in charge:
Prepared by: Approved by: Date approved:
Job steps Hazards Barriers or controls
Spray paint or other chemical marking products Safety data sheet or consumer product labels
1. Establish general Have owner/authorized personnel accompany
locations for Electrical environment Approved electrically resistant footwear
boreholes during Personnel contacting live electrical apparatus Safe limits of approach
initial site walk-about
Reflective safety vest or other clothing
Moving vehicles in vicinity Stay within visible barriers when required
Have owner/authorized personnel accompany
2. Take samples for Electrical environment Approved electrically resistant footwear
contaminants at six
Personnel or equipment contacting live electrical apparatus Safe limits of approach
proposed borehole
locations Reflective safety vest or other clothing
Moving vehicles in vicinity Stay within visible barriers when required
Contact of underground electrical apparatus Excavate by hand only
Personnel wear hard hats and gloves
Pinches, cuts, and strains Safe lifting practices
Possible contaminated fill soils Approved sampling and handling practices
Electrical environment Approved electrically resistant footwear
3. Locate underground
utilities Plans showing underground utility location
False or missing locates due to static or induction Appropriate locate instrumentation
electric fields Documentation of locates
Personnel or equipment contacting live electrical apparatus Safe limits of approach
Reflective safety vest or other clothing
Moving vehicles in vicinity Stay within visible barriers when required
Electrical environment Approved electrically resistant footwear
4. Set up drill rig at
borehole locations Reflective safety vest or other clothing
Moving vehicles in vicinity All work to be carried out within visible barriers
Lane closure and/or door closure permits at boreholes 3,5,6,7, and 8
Pipe rack overhead at borehole 3 Use half-tower on drill rig
Personnel or equipment contacting live electrical apparatus Safe limits of approach
Ground drill rig using two 4/0 portable grounds due to non-
Ground potential rise, induction availability of station grounds (see step 3)
Proximity of borehole to buried services/utilities Hand excavate to expose services
5. Drill boreholes to Electrical environment Approved electrically resistant footwear
required depth Reflective safety vest or other clothing
Moving vehicles in vicinity All work to be carried out within visible barriers
Maintain safe distance away from augers
High-speed rotating augers Wear close-fitting clothing
Recognized drilling practices
High decibel levels during drilling Hearing protection
Flying particles/debris Approved eye protection
Plans showing underground utility location
Contact of underground electrical apparatus by Locate done using appropriate equipment
augers or samplers Drill within defined area
Excavation permits
Personnel or equipment contacting live electrical apparatus Safe limits of approach
Ground potential rise, induction Ground drill rig using two 4/0 portable ground rods
Proximity of borehole to buried services/utilities Hand excavate to expose services
Personnel wear gloves, eye protection
Approved practices per results of chemical analysis
Possible contaminated fills/soils If unknown contaminants encountered, stop work in that area and notify the
owner. Do not resume work until conditions are identified and appropriate
protective measures are taken
Approved handling practices per chemical test results
Possible contaminated soil cuttings or slurry resulting Soils to be contained in drums, if contaminated, for disposal at licensed
from drilling activities facility
Safety data sheet or consumer product labels
Bentonite, cement, and other drilling agents Approved personal protective equipment
Personnel wear hard hats and gloves
Pinches, cuts, and strains Safe lifting practices
6. Move drill rig off Have owner/authorized personnel accompany
Electrical environment Approved electrically resistant footwear
of and between
borehole locations Moving vehicles in vicinity Reflective safety vest or other clothing
Personnel or equipment contacting live electrical apparatus Safe limits of approach
NOTES: 1. Borehole locations shown on attached plan
Introduction 3
