JOB SAFETY ANALYSIS

Ref: C5+– JSA- 003

Facility / Site:……………………………………………… Location within Site:…………………….. Permit No:……………………. Permit Type: ……………… Date:…………………….

Task Description: Stringing Pipes on ROW

REQUIRED REFERENCES JSA REVIEW

Have the relevant Procedures, Standards, Guidelines,
or Safe Work Practices been reviewed? Yes N/A
Pending confirmation by the Task Leader of site conditions, I agree that the attached JSA identifies the
significant Task Steps, Hazards, and Controls.

JSA REVIEWER (Supervisor or Designate):

RISK ASSESSMENT
Must existing Procedures or Work Practices be
Yes No Name / Signature: Company:
modified to perform this work?
After mitigation, are there any hazards that continue to WORK SITE VERIFICATION
present a potentially significant risk? (Scenario-Based Yes No
Risk Assessment required)
The Work Team has assessed the worksite conditions and confirms:
 The JSA addresses the applicable hazards and necessary controls.
PPE REQUIRED DURING THIS TASK
 The Team has the appropriate resources (people and equipment) to do the job safely.
HARD HAT SAFETY GLASSES
 Others that could be affected by the work have been informed.
FACE SHIELD TASK LEADER:
SAFETY SHOES / BOOTS
GOGGLES

FALL PROTECTION Name / Signature: Company:

FALL RESTRAINT COMPLETE THE SECTION BELOW IF THIS JSA IS NOT PART OF A PERMIT PACK
GLOVES:

COTTON Work Team Declaration:

LEATHER I acknowledge that I have reviewed the attached JSA, I understand my roles
and responsibilities, and I will comply with the instructions for this task.
IMPACT PROTECTION
Name (print): Name (print):
Dust mask
OTHER (specify):
           
Work clothes
           
           
           
OTHER PPE (specify):            
           
 TASKS/STEPS POTENTIAL HAZARDS HAZARDS CONTROLS HAZARD PORT
(Number) (What could go wrong?) (How can harm be prevented?) MITIGATION STATES
1. Permitting work  Work condition not safe  HSE team to assess continuously the  PTW system
 Procedures and tasks not clear conditions of work in the assigned area  Tool Box Talk
 Lack of supervisory  One person to issue work permits  Certificates
 Miscommunication  Toolbox talks inspection
 Not correct PPE worn  Competency of personnel and supervisory for
 Equipment not inspected and certified the activity
 Define hierarchy and reporting flowcharts
 Define proper PPE to be used for the work
 Check inspection certificates of equipment for
the job
2. Checking equipment  Punch point / hand injuries  Smart grip / 3 points of contact when climbing  First aid kit
 Personnel Injury onto machines
 Falling from machine  Use containment cans/ plastic covers to  Emergency
 Slipping from ladder prevent spills Response Plan
 Diesel / oil spill  Adequate equipment and lifting tools ,
 Electric shock certified will be used
 Breathing dust from filters  Competent persons will perform the job
 Equipment check list should be made for all
new equipment coming to site
 Weekly equipment check list should be made
and kept at engine
 Wear proper PPE
 Use proper ladders / steps to go on top
3. Stands preparation  Back injuries  Have right body posture / spinal alignment  First aid kit
(wooden edge)  Hand puncture / laceration when filling / handling edges
 Punch point  Wear leather gloves  Emergency
 Team carrying loads over 25 Kg Response Plan

4. Lifting of pipe  Pipe fall  Make sure hooks are well placed on the pipe  First aid kit
 Pipe hitting equipment  Check slings before use on daily basis
 Pipe hitting ground workers  Never pass under suspended pipe  Emergency
 contact with electric cables and electrocution  Watch for truck cabin, proceed carefully Response Plan
 Banksman to guide excavator driver
 Ground personnel stay away from lifting area
until pipe is spotted on the bags
 Keep a safe distance from electrical cables
(5m min)
5. Spotting pipes on stands  Pipe hitting stands  Control pipe carefully with excavator  First aid kit
 Pipe hitting ground workers  Stay away from suspended pipe until landing
 Punch point / hand injury on wood stand  Emergency
Response Plan

6. Cleaning &Housekeeping
• Equipment and tools remain on site
• Slip trip and fall
• Trash left in the work place
• Training for good work practices to be held on Plastic bags
site waste bins
• TBT in place before job, housekeeping issue to
be mentioned in all TBT
• After working day, team leader must ensure
cleaning, inspecting equipment and good
housekeeping.
• Waste management plan is in force during
project
• Waste to be removed in time as per
CONTRACTOR waste management plan

7. Working in ROW
 Biological hazards such as reptiles  Use of proper PPE  First aid kit
 Personnel missing or lost in the desert  Close supervision
 Communication means  Emergency
 Personnel Protests Response Plan
 Security accompanying
 Terrorist Attack  Assess the situation as quick as possible and
announcing the state of the emergency
(Emergency or Alert).
 At any security or terrorist threats call first the
ERT leader.
 Delegate someone to make sure that the area
is evacuated.

Name Position Date Signed

Prepared By
Checked By
Approved By