JOB SAFETY ANALYSIS (JSA) JSA #:

DEPARTMENT: DIVISION: Operations Date:

UNIT: PLANT/EQUIPMENT:

DESCRIPTION OF JOB / ACTIVITY: Scaffolding Erection, Dismantling, and Modification

JSA DEVELOPED BY :

SAPMT Safety Advisor

SIGN
OPS Day Sup.
SIGN
OE/ CG Member SIGN
BADGE # BADGE # BADGE #

UGP project Eng.

SIGN
BADGE #

REVIEWED BY: UNIT PROCESS ENG REVIEWED BY: OE/ CG LEADER. APPROVED BY: UNIT HEAD.
NAME: ID#: NAME: ID#: NAME ID#:
:
SIGN: DATE: SIGN: DATE: SIGN: DATE:

REFERENCIES (G.I., SAES, EDC.):

1. GI 2.100 Work Permit Systems.
2. GI 8.001 Safety Requirements for Scaffolds
3. CSM I-3 PPE; CSM II-2 Scaffolding; CSM II-5 Fall Protection;
4. SA Safety Handbook
5. OIM 5000 – UGP ERP

Safety Equipment Required for the job

Hard Hat, Safety Shoes, Safety Goggles, Hand Gloves, FRC (Nomex), Full Body Harness, Rattler T 40 (H2S) Monitor,

JOB
STEP NO. JOB SEQUENCE POTENTIAL HAZARDS. MITIGATION
1. Preparation of ground or 1.1 slip, trip 1.1.1 conduct thorough housekeeping prior to
base commence of activities
1.1.2 install barricades around the perimeter of
the working area
1.1.3 identify deviations in level of the base
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 1.1.4 ensure that the base is compacted if
necessary

2.1 structure collapse 2.1.1 ensure that deviations in ground level has
been addressed properly
2.1.2 ensure that base plates are attached at the
bottom of each screw jack
2.1.3 guarantee that supervision is available by
a SA-Certified Scaffold Supervisor
2.1.4 install sole boards with appropriate
dimensions
2.1.5 refrain from utilizing more than 2/3 of the
2. Installation of base lift threaded part of the screwjack

3.1 fall from heights 3.1.1 ensure that scaffold erectors are wearing
PPE appropriate for the task and have taken the
mandatory W@H training
3.1.2 install the SA-approved scaffold tag (RED)
by inserting a scaffold tube through the hole provided
in the scafftag, it shall be placed in the area nearest the
planned access

3.2 ergonomics 3.2.1 avoid overexertion

3.2.2 ensure that heavy scaffolding
components e.g. tubes, planks, beam ladders, etc are
handled safely and ergonomically. Ask for help from
other personnel

3.3.1 secure tools such as spanners with

3.3 falling materials appropriate lanyards attached to the scaffolding
erector

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 3.3.2 tools and other equipment shall be
inspected prior to start of the erection
3. Erecting the scaffold 3.3.3 ensure that the first lift has been
completed before proceeding to erect the succeeding
lifts
3.3.4 raise materials using appropriate drift bins
and the correct type and capacity of gin wheels

3.4.1 install sufficient bracing type as indicated

3.4 structure collapse in the approved scaffold plan

4. Scaffold Inspection and 4.1 structure collapse 4.1.1 conduct scaffold inspection immediately
Tagging after the scaffold has been erected, the Scaffold
Supervisor who was in-charge of the erection shall
inspect his scaffold using the Scaffold Field Safety
Checklist and either tag it with a Yellow or Green
scaffold tag as necessary (The Scaffold Inspector if
required, shall do his inspection afterwards and affix
his signature).

5. Dismantling 5.1 falling materials 5.1.1 erect barricades in the perimeter of the
scaffold subject to dismantling
5.1.2 install Red scaffold tag prior to dismantling
to avoid accidental use of scaffolds
5.1.3 dismantling shall be done level by level,
from top to bottom

5.2 platform failure 5.2.1 braces shall be removed only if danger of

collapse has been eliminated

6. Modification 6.1 personal injuries 6.1.1 during modification, a Red scaffold tag
shall be installed indicating that the structure cannot
be used
6.1.2 work activities shall not be allowed whilst
modifications are being done
6.1.3 the scaffold supervisor (and inspector as

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 applicable) shall inspect and re-tag the scaffold after
modification

7. Special Scaffolds 7.1 plant damage 7.1.1 scaffolds under the criteria of Special
Scaffolds shall be erected by a SA-approved special
scaffold contracting company (GBS)

8. Scaffold erection, 8.1 slip, trip, fall 8.1.1 conduct thorough housekeeping prior to
dismantling, and start of activities
modification inside of
buildings 8.2 eye strain, headaches 8.2.2 sufficient illumination shall be provided

9. Working in adverse weather 9.1 electrocution, fall from heights, 9.1.1 personnel shall suspend activities during but
personal injuries, temperature extremes not limited to, strong rains or sandstorms, lightning,
high winds, and/or high temperatures

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 JSA STOP WORK TRIGGERS

1 Stop work and evacuate the area if the stop work alarm or plant wide siren is initiated.

2 Stop work if there is any LEL or H2S.

3 Stop if you observe any hazardous gases or liquid leakage.

4 Stop work if the fire watch or stand-by man left area.

5 Stop work if the work permit receiver left the area

6 Stop work if you noticed unsafe condition.

7 Stop work if there is oxygen deficiency.

8 Stop work if wind speed is over 20 MPH while lifting activity is performed.

9 Stop work if the weather temperature increased to more than 50 oC

10 Stop work if poor visibility exists in lifting activity.

11 Stop work is the crane engine stop.

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 UTHMANIYAH GAS PLANT DEPARTMENT
OPERATION DIVISION
JSA Acknowledgment

Unit: WP Number: Date: / /

I have read and I fully understand the Job Safety Analysis (JSA).

Discipline Name ID Signature

WP issuer
WP receiver
Gas tester
worker
worker
worker
worker
worker
worker
worker
worker
worker

*This form shall be signed prior to conduct any job that required JSA.

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