Aarti Industries Ltd.

Job Safety Analysis (JSA) - INDEX Sheet

Date: JSA Index No.:
Zone: Division: Plant: Section:
Area Job
Description: Description:

Permits Created and attached details:

Sr. No. Permit No. Permit Type Permit Description

Details of JSA performed and attached (*attach JSA hard copies with this sheet)
Sr. No. JSA No. JSA Code JSA Description

Job Executor Details:

Name:
ID:
Trained for JSA
Sr. No.:
Sign:

Job Supervisor Details:

Name:
ID:
Designation:
AIL / Contractor
Name:
Sign:

JSA Reviewed and Approved by:

Operations / Projects Engineering Safety
(Mandatory) (Mandatory) (Mandatory-Only Class 1 Permits)
Name: Name: Name:
Designation: Designation: Designation:
Sign: Sign: Sign:
 Aarti Industries Ltd.
Job Safety Analysis (JSA) - Continuation Review
Permit No
Date:
(s).:
Zone: Division: Plant: Section:
Area
Job Description:
Description:

This JSA review is as a continuation to JSA defined in sheet JSA Index No.: ________________ of Date:_____________
JSA has been reviewed and all arrangements are found OK to execute the Job
All new Executors (if any) are trained with the attached JSA and names are mentioned below.

Review Conducted and

Contractor's Approved by
Extension Extension for New Executor(s) AIL Supervisor (Name & Sign)
Date Supervisor Remarks
Day No. JSA Codes (Name & Sign) (Name & Sign)
(Name & Sign) Operations/
Engineering
Projects