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Job Safety Analysis Sheet: Confined Space Entry
Job Safety Analysis Sheet: Confined Space Entry
Facility:
Permit No.
Date:
PERSONAL PROTECTIVE EQUIPMENT: Hard Hat, Safety Shoes, Hand Gloves, Safety Harness, BA Set / Airline Unit,
Chemical Suit, Gum Boot, Safety Goggles, Multi gas Detector, Lifeline and Full Body Harness.
SEQUENCE
OF BASIC JOB
STEPS
POTENTIAL HAZARDS
Lack of Communication
Non-compliance of KOC
-HSEMS Procedures, F & S
Regulations
Yes /
No
PRECAUTIONS
Energized Equipment
Pre Entry
Pressurized Fluid
Pyrophoric Deposition
Lack of Oxygen
Unauthorized Entry
Re-entry /
Completion
Additional
Hazards
(Other than
indicated above)
JSA Done By
Name:
KOC / ID. No.
Controlling Team:
Signature:
Designation:
Company:
Contract No .(If Applicable):
Date: