BARCO Job Safety Analysis

JSA Type: Operations Maintenance ENVIRONMENTAL CONSTRUCTION Contractor: Barco______ Work Type: Responsibility: Personal Protective Equipment (PPE): Goggles Face Shields Safety Glasses w/rigid side shields NOMEX/FRC Tyvek Regular_ _Poly_____ Please list any additional PPE needed based on local weather and conditions: Lifeline/Body Harness Work Activity: Weather: Supplied Air Respirator Air Purifying Respirator Welding/Pipe Clothing Welding Mask/Goggles Safety Vest Life Vest Over water/Boat Gloves: Leather________ Other: __ ____________ Other: Other: Office Construction Other Weather: Date:

Hearing Protection (as needed) Hard Hat Safety Shoes w/steel toe Rubber Steel Toed Boots

NAME

Position/Title

Signature

Date

Job Steps
1. 1.

Potential Hazard
1.

Critical Actions

Additions: 2. 1. 1.

Additions:
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3.

1.

1.

Additions:

4.

1.

1.

Additions:

The above form to consist of typed (pre-written) steps, hazards, and mitigations to be amended by field personnel to perform task on daily basis prior to commencing work activities. List of modifications: 1. The addition of a field to describe the weather conditions 2. The addition of a field for listing additional PPE which may not be listed previous fields 3. Conversion of Development team section to be used as sign off section for those that created JSA on that day as well as others who may review and utilize throughout the day. 4. The addition of rows below each listed step (to be printed) for the hand writing in of additional steps, hazards, and mitigations.

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