JOB SAFETY ANALYSIS

Ref: C5+– JSA- 004

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

Task Description: Trench preparation & Thrust Boring Activity

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  PTW system
 Procedures and tasks not clear  All necessary permissions and authorization  Tool Box Talk
 Lack of supervisory shall be obtained from the relevant  Certificates
 Miscommunication Authorities concerned before starting any inspection
 Not correct PPE worn work
 Equipment not inspected and certified  HSE team to assess continuously the
conditions of work in the assigned area
 One person to issue work permits
 Toolbox talks
 Competency of personnel and supervisory for
the activity
 Define hierarchy and reporting flowcharts
 Define proper PPE to be used for the work
 Check inspection certificates of equipment for
the job
 Check in/check out system to access to the
excavation (confined space)
2. Checking equipment  Punch point / hand injuries  Wear correct PPE  PPE
 Falling from machines  Smart grip / 3 points of contact when climbing  Ladder
 Diesel / oil spill onto machines  Plastic cover
 Use proper ladders / steps
 Use containment cans/ plastic covers to
prevent spills
3. Use of heavy machines  Equipment structure damaged by heavy machines  Have competent banksman at workplace PPE
 Personnel crushed by excavated materials  Ground personnel to wear high visibility Subterranean plan
Awareness
 Ground personnel hit by heavy machines jackets
 Exposure to dusty environment  Machines operators watch for ground workers
 High noise area  Put a dust mask
 Swing of machines and roll-over  Put ear defenders
 Damage to buried power lines and/or  Do not exceed machines capacity
 pipelines  Respect approved plan of buried power lines
 Risk of fire due to the engine failure and pipelines
 Risk of collision with overhead powerline  Fire extinguisher in place
 Preventive maintenance
 Goal post in place and banksman presence is
mandatory
4. Trench preparation for  Person fall in the trench Install stakes and warning tape around trenches PPE
 Dust goes in respiratory system Ground personnel to wear high visibility jackets First aid kit
boring activity

5. Use of the Boring Machine
6. Cleaning &Housekeeping
 Mishandled or poorly placed material
 Excavated material or other objects falling on
workers
 Personnel hit by excavator, grader or wheel loader
 Mobile equipment incident due to unstable
adjacent structures
 Workers go down in trenches while trenching
 Back injury when working with shovel under bad
posture
 Personnel trip / falling hazards due to excavated
material
 Personnel get bite by snakes or scorpions
 Mechanical hazards (pinch points).
 Working near underground utilities.
 Overhead power lines hazards.
 Collision with moving vehicles.
Entanglement with rotating drum or drive motor.
Drawing in at nip-point between motor and drive mechanism.
Crushing between drum and drum stop when tipping.
Friction or abrasion on contact with moving drum.
Ergonomics and manual-handling injuries during loading.
Health hazard from dust inhalation
Fire Hazards due to the fuel (electricity or petrol).
Dust goes in respiratory system
Mishandled or poorly placed material
Mobile equipment incident due to
unstable adjacent structures
Back injury when working with shovel under bad posture
Personnel trip / falling hazards
Personnel get bite by snakes or scorpions
Injury caused by falling objects, by stepping on sharp objects,
and by impact and collision with sharp or
protruding objects
Dermatitis caused by contact with irritating and allergenic
materials.
Mechanical hazards (pinch points).
Working near underground utilities.
Overhead power lines hazards.
Collision with moving vehicles.
• Equipment and tools remain on site
Remove debris and excavated soil near excavation site Warning tape
Wear respiratory mask if working downwind High visibility jackets
Place excavated material at safe distance from the trench Banksman
Never walk under and beside excavator loader, wheel
loader or front end loader and backhoe
Be aware of nearby vehicles and mobile equipment causing
soil to vibrate
Keep heavy equipment away from trench edges
Do not go down in the trench while excavating the trench
Wear correct safety boots and mind steps / do not rush
Watch for venomous animals and wear safety boots and
leather gloves
Avoid hand and fingers injuries.
Safety signs in place.
Goal posts to avoid collision with overhead power lines.
Banksman permantly presence in mandatory.
Area Underground utilities maps.
Location of the machine on firm, level ground. PPE
Location away from traffic or where traffic is controlled. First aid kit
Fixed guards to motor and drive mechanism. Warning tape
Routine inspection and portable appliance. Awareness
Safe storage of petrol and control of ignition sources for
petrol-powered equipment; avoid use in confined spaces
because of emission of exhaust gases.
Reduction in manual handling or positioning of
cement bags close to the equipment.
Hand protection, respiratory protection, overalls and eye
protection (splash resistant).
Hearing protection to reduce noise exposure.
Fire extinguishers in place.
Install stakes and warning tape around trenches
Ground personnel to wear high visibility jackets
Remove debris and excavated soil near excavation site
Wear respiratory mask if working downwind
Never walk under and beside the boring machine
Be aware of nearby vehicles and mobile equipment causing
soil to vibrate
Wear correct safety boots and mind steps / do not rush
Watch for venomous animals and wear safety boots and
leather gloves.
Avoid hand and fingers injuries.
Safety signs in place.
Goal posts to avoid collision with overhead power lines.
Banksman presence in mandatory.
 Area Underground utilities maps.
• Training for good work practices to be held on Plastic bags
site
 • Slip trip and fall
• Trash left in the work place
• TBT in place before job, housekeeping issue to waste bins
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

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Name Position Date Signed

Prepared By
Checked By
Approved By