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Overhead Job Safety Analysis (JSA)

Date: WO/ Job Number:

Crew Size: Exact Location:

Circuit Clearance Number: Clearance Holder

Energized Equipment: Yes No Conductors Covered: Yes No Path(s) to Ground Covered: Yes No

SWITCHING SEQUENCE
Switching Sequence Required? Yes No Switching Sequence Reviewed? Yes No
Switching Sequence Title -
Is there a planned outage for the job? Yes No If yes, were all customers contacted prior? Yes No

Applicable Safe Work Practice Rule Review-

THINGS TO CONSIDER
(List appears in the order of things you may encounter during a typical day)

− Emergency Information - PPE (FR Clothing, Gloves, Sleeves, Foot, Face/Eye) - Attics/Crawl Spaces
− Walk Job-Identify Hazards - Tool Inspections - Grounding/EPZ
− Traffic Control Set-up - Equipment Inspection/Pre-Flight - Fall Protection
− Poisonous Plants and Wildlife - Emergency Rescue - Excavations
− Multi-Contractor Worksites - Public Safety Precautions - Confined Spaces
− Competent Person(s) - Power Exposures (Overhead, Step, Touch) - Fire/Explosion
− Crew Member Qualifications - Utilities (Marked and Unmarked) - Minimum Approach Distances
− Work Practices/Procedures/Plan - Energy Source Controls - Lasher Obstructions/Branches
− Overexertion/Repetitive Tasks - Stored Energy/Line of Fire - Electrical Power Crew Concerns
− Environmental Issues - Vehicle Ingress and Egress - Material Handling/Rigging

HUMAN ERROR TRAPS (ERROR PROCURSERS)


Task Demands Individual Capabilities Work Environment Human Nature
− Time Pressure − Unfamiliarity with Task − Distractions/interruptions − Stress
− High Workload − Lack of Knowledge − Changes/Departures from − Habit Patterns
− Simultaneous, Multiple Tasks − New Technique Not Used Routine − Assumptions
− Repetitive Actions/Monotony Before − Confusing Displays/Controls − Complacency/Overconfidence
− Unclear Goals, Roles, or − Imprecise Communication − Work-Arounds/ Poor − Mind Set (Intentions)
Responsibilities Habits Instruments − Inaccurate Risk Perceptions
− Lack of, or Unclear Procedures − Lack of − Hidden Systems Responses − Mental Short Cuts or Biases
− Extended Work Hours Proficiency/Inexperience − Unexpected Equipment
− Illness or Fatigue, general Conditions
Health − Personality Conflicts
− Can-Do/Macho Attitude for
Crucial Tasks
JOB SPECIFIC NOTES
Work to be completed (Describe):
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Hazard of Job:

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Work Procedures:

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Special Procedures/Precautions:

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Energy Source Controls:

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Personal Protective Equipment:

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Hospital/Medical Facility: _____________________________________________________________


Location: ___________________________________________________________________
Phone Number: ______________________________________________________________
Person in Charge in foreman’s absence: __________________________________________

Sign Name Print Name Condition/Scope


Change (initials)

CONDITION/SCOPE CHANGE: Yes No


(Change to Work Procedures, People, PPE, Tools/Equipment, Environment shall be described below)

Condition/Scope Change (Give Details)


____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
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I verify that my crew has been given the above information and that they have indicated an understanding of the job description, job task, job hazards and risk
mitigation, their roles and responsibilities, and have all required PPE. Also, I agree to immediately STOP all operations at the first sign of job deterioration, personnel
changes, equipment misapplication or failure, communication issues or any other condition or issue which places my crew, my visitors, the public, or myself at undue
risk.

Person in Charge (Print Name) Person in Charge (Signature)

Post Job Briefing: Yes Any Near Miss or Good Catch Reports? Yes FLS/GF Review: _____________ Date: ________________
(Initial)

Comments
Overhead Job Safety Analysis (JSA)

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