DATE:
JOB SAFETY ANALYSIS
PROJECT: Ras Az Zawr Aluminium Smelter
/ 2011
JSA No.
CONTRACTOR NAME:
ADDRESS:
LOCATION:EPCM Offices
PHONE:
JOB DESCRIPTION:
DEVELOPED BY:
No
Name
Signature
Position
REVIEWED BY:
Certificate
No.
1
2
3
4
5
N
o
Name
Signature
Position
Date.
1
2
3
4
5
APPROVAL BY:
Name:
Signature:
Position
Date
Name:
Signature:
Position
Date
Name:
Signature:
Position
Date
Name:
Signature:
Position
Date
BECHTEL REVIEW BY:
REVIEW: (NOTE: Work SHALL NOT proceed until the JSA is signed and dated by the HSE Manager or nominee)
Name:
Signature:
Position:
Date:
P.P.E REQUIREMENTS
Check
PLANT, EQUIPMENT & TOOLS FOR
JOB
Check
TAGGING & SIGNS
Check
PERMITS/INSTRUCTION
Check
Safety
Harness
Air Purifying
Respirator
Ladder
Excavator
Persons
Working
Above
MSDSs
Static Line
Confined Space
Harness
Hand Tools
Winch
Barrier Mesh
Instruction
Manual
Gloves - PVC
Shovel
Extension
Leads
Flagging
Gloves Hyflex
(Nitrile)
Gloves -Leather
Riggers
Welding
Machine
Backhoe
Personal Locks
Compactor
Power
Source
Drill
Crane
Grinder
EWP
Personal
Danger Tags
Out of Service
Tags
Information
signs
Hearing
Protection
Fire
Extinguishe
r
Fans
Confined
Space
Hard Hat
Fire Blanket
Scissor
Lift
Suspended
Personnel
Platform
Tinted Safety
Glasses
Clear Safety
Glasses
Goggles
Face Shield
Sun Screen
Airline
High Vis Vest
HV Access
Floor/Roof
Opening
Hot Work
Isolation
Excavation
Skills/Competencies/Authorisations
Check
Articulating Boom
Lift
Crane Type and
Capacity:
Scissor Lift
Concrete Placing
Boom
Personnel Hoist
Forklift Type and
Capacity:
Dozer
Grader
Excavator
Scraper
Front End
Loader
Rigger
Backhoe
Scaffolder
Asbestos
Removalist
Heavy Rigid
Vehicle
Articulated
Vehicle
Boat
RISK SCORE CALCULATOR
Use The Risk Score Calculator To Determine The Level Of Risk Of Each Hazard
What would the CONSEQUENCE of an occurrence be?
What is the LIKELIHOOD
of an occurrence?
Catastrophi
c
Multiple
fatalities or
permanent
impairment
Minor
Medium
Medical
treatment
Serious
Lost time
incident
Major
Fatality or
permanent
impairment
Almost Certain
Moderate
High
Critical
Critical
Critical
Likely
Moderate
High
High
Critical
Critical
Possible
Low
Moderate
High
Critical
Critical
Unlikely
Low
Low
Moderate
High
High
Rare
Low
Low
Low
Moderate
High
First aid
treatment
Hierarchy of Controls
Can the hazard be Eliminated or
removed from the work place?
Can the product or process be
Substituted for a less hazardous
alternative?
Can the hazard be Engineered away
with guards or barriers?
Can Administration Controls be
adopted
ie procedures, job rotation etc
Can Personal Protective Equipment &
Clothing be worn to safe guard against
hazards?
JOB STEP
DESCR
IPTION
List the steps
require
STEP
d to
NO.
perform
the task
in the
sequen
ce they
are
carried
out
POTENTIAL HAZARD
List the potential hazards that could
cause injury/damage when the task
step is performed
Risk
Rank
BEFORE
HAZARD CONTROL METHOD
List the control measures required to eliminate or
minimise the risk of injury
Risk
Rank AFTER
RESPONSIBLE
PERSON
JOB STEP
DESCR
IPTION
List the steps
require
STEP
d to
NO.
perform
the task
in the
sequen
ce they
are
carried
out
POTENTIAL HAZARD
List the potential hazards that could
cause injury/damage when the task
step is performed
Risk
Rank
BEFORE
HAZARD CONTROL METHOD
List the control measures required to eliminate or
minimise the risk of injury
Risk
Rank AFTER
RESPONSIBLE
PERSON
JOB STEP
DESCR
IPTION
List the steps
require
STEP
d to
NO.
perform
the task
in the
sequen
ce they
are
carried
out
POTENTIAL HAZARD
List the potential hazards that could
cause injury/damage when the task
step is performed
Risk
Rank
BEFORE
HAZARD CONTROL METHOD
List the control measures required to eliminate or
minimise the risk of injury
Risk
Rank AFTER
RESPONSIBLE
PERSON
JOB STEP
DESCR
IPTION
List the steps
require
STEP
d to
NO.
perform
the task
in the
sequen
ce they
are
carried
out
POTENTIAL HAZARD
List the potential hazards that could
cause injury/damage when the task
step is performed
Risk
Rank
BEFORE
HAZARD CONTROL METHOD
List the control measures required to eliminate or
minimise the risk of injury
Risk
Rank AFTER
RESPONSIBLE
PERSON
