RCMS Occupational Safety

Job Safety Analysis (JSA) Form

SAF_32_JSA FORM_01

SECTION A: JOB DESCRIPTION: Civil Work Construction of ISO Staging (New Access Road),(Road Curb)
LOCATION: AROMA C400 DATE: 1/7/2019
No BASIC JOB STEPS No POTENTIAL HAZARDS No CONTROLS & SAFETY PRECAUTIONS
1 Preparation PTW 1.1 Wrong location / Wrong interpretation 1.1.1 - Site visit with area owner (Aroma) and
project owner (LG 2.0) the area to confirm
the work scope and location.
1.1.2 - Clearly inform in the permit to work the
agreed job scope
1.1.3 - Receiving Authority (RA) to brief the job
scope to the permit issue in detail before
1.1.4 execution
- Permit Receiver to conduct site safety
briefing SSB to all workers before work
execution at work place and make sure
SSB BEEN full fill after briefing
1.2 Working without PTW approval 1.2.1 - Submit all required documents for the
PTW approval with an approved drawing
1.2.2 by BPC.
- PTW register and site inspection to check
1.2.3 the compliance
- PTW, JSA, SSB to be displayed at work
place
1.3 Changes of hazard or jobs scope 1.3.1 - Stop work and revise JSA with the area
owner and LG 2.0.
2 Excavation work using backhoe for 650mm 2.1 Moving machinery 2.1.1 - Competence or certified backhoe driver.
depth (backhoe) 2.1.2 - Make sure working area free from
pedestrian and warning sign display.
2.1.3 - Signalman standby all time and barricade
work area
2.2 Sand Erosion 2.2.1 - Cover excavation area using canvas to
avoid water stacking.
2.2.2 - Excavated land every 20 m must have
excess
2.2.3 - Provision for temporary shoring/strutting.
2.3 Open edges 2.3.1 - Install hard barricade and put warning
signage around the excavate area.
3 Water pump activities during rainy season 3.1 Fire ignition 3.1.1 - Firewatcher must be at full time at work
during excavation period (operation of diesel site during job and must be available till
after 30 minutes of work completion
pump) 3.1.2 - Firewatcher must be approved and trained
by BPC Fire and be endorsed competency
in BPC Safety passport
3.1.3 - Placed fire extinguisher at work site with
valid inspection sticker by BPC. Fire and
Bomba dept
3.1.4 - Fire blanket to further be made as a
habitat to prevent any escaping flame
(surrounding work area)
3.1.5 - Ensure continuous LEL Checking test is
done and result must be 0% all the time
3.1.6 - Ensure no combustible materials are at
work place before and after work
3.2 Oil spillage 3.2.1 - Workers to wear apron and rubber gloves
with basic ppe during diesel top up

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4 Stockpile in within the area of BASF (Tipper
Truck
5 Lay, Spread, Level and Compact using a
backhoe Roller compactor, Paver Machine and
Tandem Roller along with tire
Lay and Spread- (Sand), (Crusher run)
and Spray tack coat/ (Bitumen Sprayer) with a
truck
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3.2.2 - Effective housekeeping is done
3.2.3 - Maintenance with regards to water pump.
Do daily visual checking before or after
work
3.2.4 - Drip tray to be put under the water pump
to avoid spillage and to prepare absorption
3.2.5 pad
- Barricade the work area and put signage
4.1 Collision of other vehicles with the stockpile if it is in 4.1.1 - Have a proper warning, signage, to
the runway indicate the existence of a stock-pile
4.1.2 - Provide a proper planning and scheduling
to the time of the tipper truck is entering
the site for this mobilize stocks to the
stockpiles
4.2 Obstruction excess of way and materials 4.2.1 - Communicate with the owner to where the
location of our stockpile
4.3 Moving Machinery 4.3.1 - Make sure working area free from
pedestrian and warning sign display.
4.3.2 - Traffic controller/signalman must be at site
and control traffic when execution the job
4.3.3 - Make sure machinery/vehicle been
inspected by the owner to get a valid
inspection sticker.
5.1 Moving machinery 5.1.1 - Traffic controller/Flagman with there
respective vest must be at site and control
traffic when execution the job.
5.1.2 - Material and tool is stack and keep at safe
place and proper storage.
5.1.3 - Follow BPC speed limit (30kmperhour)
5.2 Road obstruction by vehicle 5.2.1 - Do not park the vehicle that caused
obstruction/blocking other vehicle, safety
equipment and access way.
5.2.2 - Materials and tools must not be stocked in
a way that could block the road
5.3 Damaged machinery/equipment/tools 5.3.1 - Machines, tools and equipment must all be
inspected and be given valid inspection
sticker by BPC before use and the stickers
must be display on the machines, tools,
equipments
5.3.2 - Modification or alteration with materials
and machineries must only be done with
the consent of area owner
5.3.3 - all damage materials, equipments, tools
must be repaired or be removed from site
if it is unfit
5.4 Spillage 5.4.1 - Maintenance with regards to machinery
5.4.2 - Ubf to do daily visual checking before or
after work
5.4.3 - Inspection by bpc mechanical team and
have a valid inspection sticker
5.4.4 - Prepare a drip tray
5.4.5 - Prepare adequate absorber pad if drip tray
is not avaible
5.5 Spark/Fire ignition/Hot surface 5.5.1 - Firewatcher to be full time must standby
and be after site after 30 mins at work site
during job execution and be certified and
approved by bpc fire and bomba dept and
be endorse competency in BPC Safety
passport.
5.5.2 - Placed fire extinguisher at work site with
valid inspection sticker by BPC. Fire and
Bomba dept
5.5.3 - Spark Arrester should be installed
5.5.4 - LEL must be checked by operations before
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 work start and it must show 0%
5.6 Dust/fumes 5.6.1 - Ensure workers are to be worn a N95 dust
mask
5.7 Heat stress 5.7.1 - Rest in between the work (Follow bpc
fatigue management practice) not exceed 6
day of working
5.7.2 - Rotate workers from long duration of work
5.7.3 - Workers to drink a lot water during hot
weather
5.8 Chemical- Bitumen 5.8.1 - CSDS to be attached with jsa and ptw
5.8.2 - PPE for the specific task i.e face mask
N95?dust mask and glove.
5.8.3 - Proper storage for relating chemicals
5.8.4 - ensure labeling, proper signage
5.8.5 - provide isolation with other chemicals
5.8.6 - Make sure emergency tool kits is nearby
and easy to find when execute the task.
- Make sure to follow SOP and use the
5.8.7 correct procedure when doing the task and
make sure the posture is correct.
6 Do Field Density Test 6.1 Slip, trip and fall 6.1.1 - Housekeeping to be maintained before,
(FDT) test every 6 meters during and after work.
6.1.2 - All personal to wear basic Personal
(manual work) Protective Equipment (PPE)- semi-leather
glove, coverall, safety helmet, safety glass
6.1.3 - Materials and tools are kept safe in a
toolbox to make sure no tools are
obstructing the walkway or the working
space
6.2 Ergonomic 6.2.1 - Manual lifting only for small and light
material not more than 25kg per person.
6.2.2 - Make sure body posture in correct position
6.2.3 - Rotate worker and comply BPC fatigue
management
6.2.4 - Ensure buddy system if the load is heavy to
be transported by one
7 Make road line using thermoplastic machine 7.1 Damaged machinery/equipment/tools 7.1.1 - Machinery/equipment/tools must be
inspected by BPC and must be in good
condition with valid inspection sticke
7.2 Spark/Fire ignition/Hot surface 7.2.1 - Firewatcher to be full time must standby
and be after site after 30 mins at work site
during job execution and be certified and
approved by bpc fire and bomba dept and
be endorse competency in BPC Safety
passport.
7.2.2 - Placed fire extinguisher at work site with
valid inspection sticker by BPC. Fire and
Bomba dept
7.2.3 - Spark Arrester should be installed
7.2.4 - LEL must be checked by operations before
work start and it must show 0%
7.3 Dust/fumes 7.3.1 - Ensure workers are to be worn a N95 dust
mask
7.4 Heat stress 7.4.1 - Rest in between the work (Follow bpc
fatigue management practice) not exceed 6
day of working
7.4.2 - Rotate workers from long duration of work
7.4.3 - Workers to drink a lot water during hot
weather
8 Install road curb along left and right roadside 8.1 Ergonomics 8.1.1 - Rest in between the work (Follow bpc
(manual work) and paint work for the road fatigue management practice) not exceed 6
day of working
curb 8.1.2 - Rotate workers from long duration of work
8.1.3 - Manual lifting only for small and light

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 material not more than 25kg per person
8.1.4 - Use the right body posture to carry loads
8.1.5 - Workers to drink a lot water during hot
weather
8.2 Slip and trip 8.2.1 - Housekeeping to be maintained throughout
work duration and completion of job.
8.2.2 - Materials are all must be kept in the
toolbox and be stored properly
9 9.1 Pinch point 9.1.1 - Use semi-leather gloves
9.1.2 - Make sure the positioning of hands are
correct and not in pinch point location
while working.
9.2 Heat stress 9.2.1 - Rest in between the work (Follow bpc
fatigue management practice) not exceed 6
day of working
9.2.2 - Rotate workers from long duration of work
9.2.3 - Workers to drink a lot water during hot
weather
9.3 Slip and trip 9.3.1 - Housekeeping to be maintained throughout
work duration and completion of job.
9.3.2 - Materials are all must be kept in the
toolbox and be stored properly
9.4 Chemical-paint 9.4.1 - CSDS to be attached with jsa and ptw
9.4.2 - PPE for the specific task i.e face mask
R95?dust mask and glove.
9.4.3 - Provide spill kit/absorber pat
9.4.4 - Proper storage for relating chemicals
10 Housekeeping 10.1 Sharp object/Pinch point 10.1.1 - Wear appropriate PPE i.e leather hand
glove and safety shoes.
10.1.2 - Remove blunt or sharp object from work
area.
10.1.3 - Secure material properly at the temporary
storage area.
10.2 Slip, trip and fall 10.2.1 - Housekeeping to be maintained throughout
work duration and completion of job.
10.2.2 - Materials are all must be kept in the
toolbox and be stored properly
10.3 Ergonomics 10.3.1 - Rest in between the work (Follow bpc
fatigue management practice) not exceed 6
day of working
10.3.2 - Rotate workers from long duration of work
10.3.3 - Manual lifting only for small and light
material not more than 25kg per person
10.3.4 - Use the right body posture to carry loads
10.3.5 - Workers to drink a lot water during hot
weather
11 Close PTW 11.1 PTW not close 11.1.1 - Make sure housekeeping is done before
close PTW
11.1.2 - RA to make sure the work area is cleaned
and tided before closing the PTW
11.1.3 - Return PTW to the area owner With JSA
and Site Safety Briefing Form.
11.1.4 - Inform the job status to LG2.0 team and
area owner (Aroma)

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SECTION B: SAFETY EQUIPMENT REQUIRED FOR THE JOB
Item Yes No Item Yes No Item Yes No Item Yes No
Glove type: general glove Semi √
Safety Helmet √ leather/ leather) √ Warning Signage √ Barricade
Safety Glasses √ Protective Suit type: ______ √ Fire Extinguisher type: ABC √ LEL Detector √
Safety Shoes √ Rain Boot / Plastic Boot √ Ladder √ Continuous CO Monitor √
Face shield √ Safety Harness √ Work Vest √ Trefoil Symbol √
Mono goggle √ Ear Muff / Ear Plug √ Rain Coat √ Lock-Out/Tag-Out √
Respirator type: N95/
JSA Leader (Name/Sign/Date): JSA Members (Name/Sign/Date)
1) 6)
2) 7)
JSA Approver (Name/Sign/Date): 3) 8)
4) 9)
5) 10)
Note: All JSA must be signed by the Team Members, JSA Team Leader and Approved by JSA Approver
SECTION C: Requirement for CONFINED SPACE Activity
1 Name of the equipment / vessel to be worked in
2 Maximum personnel allowed to be in the confined space
3 Associated hazards and mitigations
4 Entry Points
5 Means of ventilation
6 Atmospheric monitoring requirement (frequency)
7 Emergency Response additional requirements (Emergency Response Plan)
8 Means of communications

SECTION D: Requirement for ELECTRICAL HAZARD identification

Types of electrical hazard Yes / No? Control measures
1 Live underground cable
2 Live exposed terminals
3 Live control voltage (110V DC/230V AC)
4 Residual charge
5 Others:

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1 Live underground cable
2 Live exposed terminals
3 Live control voltage (110V DC/230V AC)
4 Residual charge
5 Others:

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