Employer Doc. No.

NSRP Contractor Doc. No.

Complex Project Nghi Son Refinery and Petrochemical S-000-1654-0100V
Limited Liability Company Rev. 0 Page 1 of 28
Nghi Son, Vietnam

Employer Contract No. Contractor JOB Code: 0-6495-20 Date: 18/JUL/2014

JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD

STATEMENT(SWMS)

Unit No.: Not Applicable

Document Class: X

Issue Purpose For Construction

Rev Date Page Description Prep'd Chk'd App'd

0 18/JUL/2014 - Format updating/For Construction J.F L.W T.H

A 11/JUN/2013 All First issue J.F M.K Y.O

Operation Centre JOB Code: Operation Centre Doc. No.:

Responsible Company Prepared by Checked by Approved by

JVD J.Furumoto L.Wratten T.Hayashi

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 2 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

CONTENTS

1 GENERAL .............................................................................................................................................4
2 REFERENCE DOCUMENTS ................................................................................................................4
3 DEFINITIONS AND PROJECT IDENTIFICATION ...............................................................................4
3.1 Abbreviations: ......................................................................................................................................4
4 SCOPE& PURPOSE .............................................................................................................................5
4.1 SCOPE ..................................................................................................................................................5
4.2 PURPOSE .............................................................................................................................................5
5 RESPONSIBILITIES .............................................................................................................................5
5.1 CONTRACTOR Site Manager ..............................................................................................................5
5.2 CONTRACTOR Site HSSE Manager ...................................................................................................6
5.3 Contractor Superintendent and/or Supervisor .................................................................................6
5.4 Contractor HSE Supervisor ................................................................................................................6
5.5 Sub-contractor Superintendent or Field Supervisor .......................................................................7
6 SAFE WORK SYSTEM .........................................................................................................................8
6.1 General Construction Method Statement & Hazid workshop of Subcontractor ...........................8
6.2 Safe Work Method Statement Preparation ........................................................................................8
7 SWMS & JSA DOCUMENT FLOW ......................................................................................................9
8 SAFE WORK METHOD STATEMENT (SWMS) ................................................................................10
8.1 Preparation of the SWMS..................................................................................................................10
8.2 What should go into the Safe Work Method Statement .................................................................11
9 JOB SAFETY ANALYSIS (JSA) ........................................................................................................12
9.1 Concepts/ definitions ........................................................................................................................12
9.2 Multiple JSAs for 1 Safe Work Method Statement .........................................................................12
9.3 JSA Sequence ....................................................................................................................................13
9.4 Identify Steps .....................................................................................................................................13
10 SWMS &JSA MEETING......................................................................................................................18
10.1 The example list of Questions at the SWMS & JSA meeting ........................................................18
11 START MEETING ...............................................................................................................................20
12 APPENDIX ..........................................................................................................................................20
APPENDIX 1: SAMPLE JSA FORM ...............................................................................................................21
APPENDIX 2: EXAMPLE COMPLETED JSA FORM .....................................................................................22
APPENDIX 3: CONTRACTORS JSA FORMAT .............................................................................................23
APPENDIX 4: JSA CHECKLISTS ...................................................................................................................24

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 3 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

APPENDIX 5: SWMS/JSA MEETING FORM..................................................................................................26

APPENDIX 6: SAMPLE OF SAFE WORK METHOD STATEMENT FORMAT .............................................27

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 4 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

1 GENERAL
This procedure covers the HEALTH, SAFETY, SECURITY AND ENVIRONMENTS (HSSE)
REQUIREMENTS) on Job Safety Analysis (JSA) & Safe Work Method Statement (SWMS)
Procedure for the NSRP Complex Project.
Safe Work Systems on a construction site are fundamental to a safe work site. This process
includes as Permit to Work (PTW) requirements, Safe Work Method Statement (SWMS), Job
Safety Analysis (JSA), START meeting ‘safe work briefing’ for the work crew before work
starts.When site conditions change, and as required, risk assessments applicable to the severity
of the work task.
This procedure addresses both the aspects of the SWMS and JSA.
A written SWMS and JSA are documents that identify the work process, the hazardss to which the
workforce or the environment might be exposed and the control measures to be adopted to reduce
the risk of harm to “as low as reasonably practical” (ALARP) level. The process shall incorporate
line management ownership, support and responsibility from the top down.

2 REFERENCE DOCUMENTS
Following documentation will be used together with this specification.
S-000-1654-0001V Worker’s Occupational Health and Safety Management Plan
S-000-1654-0004V HSSE&S Management System
3 DEFINITIONS AND PROJECT IDENTIFICATION
Project Title :Nghi Son Refinery and Petrochemical Complex Project

CONTRACTOR’s Job Codes :0-6495-20

Employer :Nghi Son Refinery and Pertochemical Limited Liability
Company
CONTRACTOR :JGC/CHIYODA/GS/SK/Technip Joint Venture
3.1 Abbreviations:
ALARP : As Low As Reasonably Practicable
JSA : Job Safety Analysis
MSDS : Material Safety Data Sheet
HSSE : Health, Safety, Security and Environment
PPE : Personal Protective Equipment
PTW : Permit To Work
SCBA : Self-Contained Breathing Apparatus
START : Safety Task Analysis Risk Talk
SWMS : Safe Work Method Statement
TBT : Tool box Talks
V : Volts

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 5 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

4 SCOPE& PURPOSE
4.1 SCOPE
This SWMS and JSA Procedure were developed for all CONTRACTOR and its Subccontractors
activities performed during the Employer Project. The prevention of incidents is a cornerstone of
the CONTRACTOR HSSE Policies and Procedures. The Job Safety Analysis shall be used as one
of the Safe Work System Tools to prevent potential incident during routine and non-routine
activities. Prior to the start of a job, JSA will be prepared covering all steps within a job which may
expose employees to physical, biological or chemical Safety. JSA shall be produced for critical
tasks. The JSA Procedure will also provide a method for supervisors to involve employees in
conducting a safety analysis of jobs and to provide supervisors with a document for training
employees. The Job Safety Analysis and Safe Work Method Statement (SWMS) serves as the
attachment of the Permit to Work System.
Typically, SWMS and JSA cover only one construction activity or operation.

4.2 PURPOSE
The purpose of the SWMS is to plan for work activities that present an increased risk of injury
and/or ill health and to prevent damage to existing facilities. A SWMS outlines
The Safety and risks associated with a particular task or activity
The control measures to be implemented to minimise the evaluated risks.
The method on how the work is to be managed safely

5 RESPONSIBILITIES
5.1 CONTRACTOR Site Manager
Site Manager will hold the ultimate responsibility for ensuring that this JSA and SWMS procedures
are developed, effectively implemented, and regularly updated and maintained, to ensure that it is
applied to relevant activities performed throughout the construction and commissioning phases.
The responsibilities of the Site Manager include, but are not limited to, the following:
 Provide necessary resources to facilitate the effective implementation of this Procedure.
 Ensure that the responsibilities of key participants under this procedure are communicated to
those personnel under his direction.
 Ensuring that the personnel appointed under this procedure are competent to carry out the
tasks for which they are assigned.
 Segregating areas and assigning the responsibility for control in those areas to the Section
Managers.
 Ensuring that Line management are competent in the risk assessment process
 Ensuring that the JSA and SWMS are subject to active assurance, and that a self-regulatory
review and/or audit of the JSA and SWMS implementation are carried out on a regular basis.
 Site Manager shall also act upon all recommendations and proposed improvements.

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 6 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

5.2 CONTRACTOR Site HSSE Manager

CONTRACTOR Site HSSE Manager, assisted by site HSSE department staff, will oversee the
development, implementation, update and maintenance of this JSA and SWMS procedure.
Specific responsibilities of HSSE Manager include, but are not limited to, the following:
 Ensure JSA and SWMS are performed and that all hazards are identified, and control
measures/contingency plan sections are completed adequately and each job has a current
assessment of the occupational safety and health hazards and risks.
 Assist Site Manager and Section Managers to conduct their responsibilities in relation to the
implementation of this procedure
 Review and approved JSA to ensure that all hazards and risks associated with all non-routine,
high risk and hazardous construction activities have been identified. Upon review, HSSE
Manager shall (Note: Contractor HSSE Manager shall request a higher level of risk assessment
should he consider that risks have not been fully addressed).
 Implementing training to familiarize Contractor and Subcontractor employees with the JSA and
SWMS procedure
 Implementing specific JSA and SWMS training for all Field Supervisors to ensure they are fully
aware of their direct responsibilities
 Reviewing this procedure through regular audit and inspection, and making recommendations
to update or amend the procedure to ensure that it remains current and effective

5.3 Contractor Superintendent and/or Supervisor

 Responsible for assuring that a JSA has been performed and shall review and approve each
SWMS.
 Assist Subcontractor in preparation, development and implementation of JSA and SWMS for
critical, all non-routine, high risk and hazardous construction activities

5.4 Contractor HSE Supervisor

Responsibilities of the HSE Supervisor will include, but not be limited to, the following:
 Assist HSSE Manager by ensuring that the JSA and SWMS procedures are observed and
effectively implemented by all Contractor personnel and Subcontractor employees, throughout
the construction and commissioning phase.
 Assist HSSE Manager to conduct training to familiarize Contractor and Subcontractor
employees with the JSA and SWMS procedure.
 Assisting the HSSE Manager to conduct audits and inspections in order to ascertain the
effectiveness of the JSA and SWMS.
 Ensuring that all potential hazards and risks relating to non-routine, high risk and hazardous
construction activities are identified, addressed and effectively communicated to the workforce
involved, prior to commencement.
 Review the SWMS and JSA and all other relevant documentation given by the performing
parties before critical work starts.
 Conduct field verification of the JSA and SWMS and provide feedback to Management.

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 7 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

 Attending START to ensure that the contents of SWMS and JSA’s are fully disclosed to, and
understood by the workforce.

5.5 Sub-contractor Superintendent or Field Supervisor

 Responsible for the preparation, development and implementation of Job Safety Analysis (JSA)
and SWMS outlining the job scope in detail.
 Shall thoroughly discuss the job scope with his working team before carrying out the job and list
the control measures that are in place and/or required to be put in place to ensure the risk level
is acceptable.
 Ensure that JSA and SWMS have been reviewed and approved by both Contractor HSSE
Manager and Superintendent in charge of the area or work activity.
 Participate in specific JSA and SWMS training sponsored and provided by Contractor
 Conduct specific JSA and SWMS training to workers under his direct supervision
 Conduct tool box talk along with workers under his direct supervision to discuss JSA and SWMS
implementation prior to starting any work activity.

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 8 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

6 SAFE WORK SYSTEM

6.1 General Construction Method Statement & Hazid workshop of Subcontractor
The Construction Method Statement of the scope of work will be prepared before that activity
starting by Subcontractor or the Method Statement would be prepared at the bidding stage as a
technical proposal to CONTRACTOR. These Method statements would include HSE plan or risk
assessment or JSA.
This document is called as ”General Construction Method Statement”.
Normally, these general construction method statements cannot cover enough the actual site
information or specific condition of work requirements.
The general method statement shall be revised taking into account of Hazid workshop results of
each Subcontractor’s Hazard identification work shop at the initial mobilization time. The General
Construction Method Statement shall be finalized including the result of CONTRACTOR’s Hazcon
workshop results.
The meeting SWMS & JSA meeting can be regarded as the Hazid workshop ,in case the
Subcontractor’s scope of work is limited.

6.2 Safe Work Method Statement Preparation

The final General Construction Method statement of Subcontractor consists of Risk Assessment of
the respective works.
However the controlling and ensuring the work at site and distributing the requirements of the
activity to the actual work team members properly, it is still too general and ambiguous to
implement and it would not be understandable enough for work team.
If the Subcontractor’s scope is the limited one or the Subcontractor is the specialized company
such as Soil investigation or Survey work, the final General Construction Method Statement would
be possible to apply as the Safe Work Method Statement depending on the contents of the
document.
Basically the detail Safe work method statement shall be prepared separately focussing on the
specific work and the SWMS will be the attachment of PTW.

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 9 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

7 SWMS & JSA DOCUMENT FLOW

Construction Activity Work Method Statement

selection / Identifying /HAZID Work shop

Incl. Work Sequence

Safe Work Method Drawings (Plan/section)
Statement Preparation Sketches

Describing each steps of the

work and countermeasures for
Draft JSA the risk assessment shall be
Preparation described.

↑Subcontractor / Work team draft preparation

Work Team Based on the draft JSA,

JSA Meeting Depending on the importance of the
activity ,Subcontractor shall inform the
(Based on JSA & SWMS) necessary person of CONTRACTOR
JSA
to attend this meeting.
Meeting ◆Subcontractor Construction Manager
Form ◆Subcontractor HSE Manager
JSA,SWMS ◆Work team leader
◆The workers person who is the key
(Final) personnel of the activity.
◆CONTRACTOR psn in charge.
◆Construciton Supervisor
◆HSE supervisor
PTW
↑Subcontractor finalization
Not
Enough
CONTRACTOR
PTW Procedure
S-000-1654-0200V
Review

PTW
↑Before the actual work at site

Confirming the countermeasures of

START Meeting JSA.
Person in charge confirmation for the
START Meeting key personnel of the activity.
Form /Procedure
S-000-1654-0110V

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 10 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

8 SAFE WORK METHOD STATEMENT (SWMS)

A site and activity SWMS must be developed prior to commencement of any work activity on site
where required by CONTRACTOR, in conjunction with its Subcontractors will review General
Construction Method Statement. When working conditions are not thoroughly addressed within
the General Construction Method Statement document, the SWMS will be revised to address the
specific work activity information associated with working conditions.
“SWMS” will then have been created to reflect the way the job will actually be performed. The
“SWMS” and the necessary JSAs prepared following section 9 process , will be discussed by the
respective persons related to the activity such as the Supervisor(s) in charge of the work, and
employee(s) doing the work.
Especially, the critical and sensitive activity work procedures shall be confirmed with the
responsible person such as Construction Manager shall confirm the work contents and safety
countermeasures.

The SWMS and JSA will detail the HSE requirements to be followed and will serve as a record to
demonstrate compliance with HSE legislative and contractual requirements. CONTRACTOR’s and
Subcontractor employees performing the work shall be responsible for implementing the actions
identified in the SWMS and JSA which shall be consistent with the scope of work.
The sample of contents of SWMS shall be referred to the appendix 6.

8.1 Preparation of the SWMS

The safe work method statement must be specific for the defined activity, and take into account all
the local conditions that could also have an impact on the task.
When required, special studies or trials shall be conducted to confirm the proposed methodology.
The information of such studies or plans shall be included in the preparation of the method
statement
The safe work method statement must be prepared by a competent engineer who has a detailed
understanding of the defined work scope.
The safe work method statement must be reviewed and finalized through the person who has
substantial experience on the subject matter/activity covered by the method statement.
All safe work method statements produced by CONTRACTOR’s Subcontractors and its specialist
subcontractors shall be independently reviewed by CONTRACTOR to ensure items listed in
Section 9 are all covered by the way of PTW reviewing process.
The safe work method statement would be submitted to Employer for confirmation through PTW
as the attachments, in case it is required.
Safe Work Method statements that would have an impact on the facilities and personnel of
external third parties shall be reported to the Employer. Depending on the necessity of the
communication to the local authorities or third parties. The notification and explanation shall be
done in the support of NSRP.

The method statement is compiled taking into account any risk assessment that has been carried
out for the specific task or activity. Key elements of the method statement shall include:

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 11 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

8.2 What should go into the Safe Work Method Statement

The CONTRACTOR Safe Work Method Statement follows a standard constructionindustry format
and, therefore, the following aspects are to be identified:
8.2.1 General Information
 Activity/Task Description
 Location
 Schedule, Timeframe and work shift information
 The work volume, respective quantities
 Procedures to ensure compliance with legal requirements
8.2.2 Work information
Plan drawings or sketches to understands the work sequence
Section drawings or sketches to understand the work sequence.
8.2.3 Vicinity information
 Methods for safeguarding existing structures
 Waste identification and methods to prevent local pollution
 Arrangements for protecting the safety of members of the public
8.2.4 Resource
 Plant ,equipment tools to be used.
 Manpower information and required certificates information.Key personnel involved.

8.2.5 General Safe Countermeasure

 Health protection arrangements, such as the use of local exhaust ventilation and respiratory
protection where Hazardous dusts and fumes could be created
 Arrangements for access, e.g. to roofs, into trenches, confined spaces, etc
 Segregation of specific areas
 Structural stability precautions, e.g. temporary shoring arrangements
 Activity Breakdown and Work sequencing (Step by Step)

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 12 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

9 JOB SAFETY ANALYSIS (JSA)

CONTRACTOR will use JSA as the tool to implement safe controlling. The JSA identifies the tasks
required to complete an activity, assesses the Safety associated with each task and offers a plan
to eliminate or minimize the identified risks. This JSA procedure shall be treated as a living
document and shall be consistent with site condition changes.
JSAs facilitate effective pre-job planning, Safety identification and worker involvement. JSAs will
be developed for all significant jobs including not only PTW related works ,critical works, routine
works ,but also non-routine works.
CONTRACTOR will identify those jobs and tasks that require JSAs prior to commencement of the
work.
JSA initially developed for a specific task may be filed and re-used for subsequent occasions of
conducting the identical task, but the following steps shall occur to the JSA:
 Must be fully reviewed with all involved personnel
 Adjusted to account for the existing conditions of the current task to which the original JSA is
being applied.
 Follow the original approval process.
 The JSA shall be specific with PTW / site changes / special conditions as required and
referenced accordingly.
Each step should begin with an action word such as remove, lift, weld, carry, place etc. Record the
breakdown of job steps on the JSA Form found in Appendix-1,2.
9.1 Concepts/ definitions
A Job Safety Analysis (JSA) is a process to list up all detail, any moves, everthing someone does,
one’s every moves and actions required to complete a job task, identify the Safety related to the
tasks, assess the uncontrolled risk as low, medium or high and determine control measures
required to lower the risk to ALARP taking into account the complexity of the work.
JSA provides a methodology for a worker to do a specific job in a safe way and prevent the real
and / or perceived Safety from causing an injury or illness or a loss of any kind (e.g. unplanned
environmental release). The JSA also includes Critical Tasks Analysis for the purpose of this
Procedure. The JSA is job-related part of an overall Risk Assessment which includes risks from:
Job / work activities
Inherent / existing workplace Safety
Interaction between the job and the workplace (a job is defined as a sequence of steps that
accomplishess a work task).
The JSA document number shall be consistent with the SWMS reference numbers.
A copy of a blank JSA is at APPENDIX 1 to this document.
An example of a JSA form is at APPENDIX 2 to this document

9.2 Multiple JSAs for 1 Safe Work Method Statement

If JSA appears to be lengthy or complex, it may be due to the inherent nature of the job. It is
recommendable to break down a big job into multiple smaller ones. For example, the disassembly

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 13 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

of a control valve is, in reality, a sequence of steps involving removal of a number of

sub-assemblies. Each one of the steps involves different sets of tools and fixtures to complete and
therefore each can be the subjected to its own Safety Analysis to aid the overall JSA.
Write JSA as if you are trying to explain the job to someone who has never done it before. Do not
assume that everyone reading it will understand acronyms or craft specific jargon. One of the key
uses of JSA can be to teach tasks to people who, in fact, may have never done them before.
Keep in mind that JSA can be, and in fact should be, revised when new information, tools or
techniques become available that can make the job safer. In addition, whenever an injury or illness
occurs where there is JSA in place, a revision of the JSA should be done if the JSA did not
anticipate the Safety that caused the incident.
When a job involves the use of toxic or hazardous chemical substances, attach the MSDS or
CHRA for these substances to the JSA.
Approved JSAs should be used at START, attached to the Permit to Work.
For highly critical jobs, all members of the team undertaking the pre-job site meeting separately
START meeting con confirm the JSA requirements.

9.3 JSA Sequence

9.3.1 Identify and Select the Job
Consider the following when identifying the job:
Accident / Incident Frequency – Select jobs that have repeatedly produced accidents/adverse
incidents.
Severity of Accidents/Incidents – Select every job that has produced a disabling injury or a very
severe loss to the environment.
Risk Potential - Some jobs may not have a history of accidents/incidents, but may have the
potential for it. Initially, select a job with the highest perceived risks and one that is most frequently
performed. Then perform the JSA on it to determine which of the associated steps have the
highest potential for adverse incident rates.
Similarly, new jobs created by changes in equipment, in processes and / or local conditions
obviously have no history of accidents, but their accident potential may be high.
Complicated jobs involving multi-parties (Foremen from all parties feed JSA formulation)
Tasks which have high consequence of failures
Repetitive tasks
Tasks normally not carried out and outside normal job scope.

9.4 Identify Steps

The Site Supervisor will organize the job into a sequence of logical steps with each step describing
completely what is being done. A person who is experienced with the type of work should help with
the job break down. Determine the basic job steps by asking, "What step starts the job?" Then,
"What is the next basic step?" and so on.
Attachments 3 & 4 give guidance on completing JSA.

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 14 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

9.4.1 Select the Employee and Observe Job Steps

For the job being performed, select a worker who is experienced in the associated tasks
(same/similar/new job);
Choose the worker preferably with teamwork attitude and willingness to share experience and
ideas while being observed under a work task;
Communicate to the workersthat they were selected on the basis of experience and capability;
Explain to the worker that the job (work task) rather than the worker is being evaluated;
Communicate to the observed worker that the goal of the analysis is to make the job safer.
9.4.2 Identify Safety’s and Risks
The Site Supervisor shall manage and be responsible for the worker performing the job. Identify all
real and potential environmental and occupational Safety. These may include (but not limited to)
various physical, biological and chemical Safety such as:

9.4.3 Hazards
Dropping an object from height
Being struck by an object or making harmful contact with an object
Getting caught on, in or between objects (e.g. line of fire)
Pressure releases/loss of containment
Hazardous materials
Toxicity
Being exposed to various airborne contaminants, such as biological species, gases, mists, fumes,
dust etc.

 Stepping on / Striking objects

 Body / body parts placed in the line of fire
 Manual Handling
 Excavations
 Falls
 Falling Materials
 Electricity
 Overhead Power Lines
 Underground Services
 Noise
 Hazardous Chemicals and Materials
 Fire
 Dust

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 15 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

 Vibration
 Temperature
 Driving / Vehicles

9.4.4 Work Condition

Working at height
Restricted/confined access
Poor lighting
Poor housekeeping
Fire/explosion Safety
Underground Safety, overhead Safety, weather Safety

9.4.5 Equipment and facilities

Hand tool Safety’s

Mechanical integrity
Equipment malfunctioning
Electrical Safety
Lock-out/tag-out

 Test Equipment
 Cable Detectors
 Gas Detectors
 Self Contained Breathing Apparatus (SCBA) and Breathing Apparatus on supply hoses
including air compressor
 Rescue Equipment
 Lifting Slings, Shackles, Chains and Gear
 Explosives
 Spill Response Kits

 Ladders
 Fixed and Mobile Scaffolds
 Lifting Equipment / Cranes / fork lifts
 Hoists / Mobile Elevated Platforms
 Shoring Systems

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 16 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

 Task Lighting
 Portable / Mechanical Hand Tools
 Welding Machines
 Excavators, compaction rollers, graders, bulldozers, front end loaders
 Tipper trucks
 Delivery / transport vehicles
 Passenger vehicles (e.g., buses, pick-up trucks, passenger vehicles)

9.4.6 Communication
Communication, signalling and notification problems
Lack of coordination between the jobs in the same geographical area or the interrelated systems
including controls
9.4.7 Moving and Handling
Moving equipment Safety’s
Slipping or falling from one level to another
9.4.8 Health
Causing a strain due to pushing, pulling, bending, twisting or lifting
Coming in contact with chemicals
Health Safety
Night shift work
Extended work days
Worker fatigue
Being exposed to environmental Safety, e.g. heat, cold, noise, ionising or solar radiation.
9.4.9 Environment
Likely to cause environmental pollution/ problem
Lack of disposal of Hazardous waste
Handling situations of violence, traffic and security
Vehicle Safety

9.4.10 Develop Solutions

The Site Supervisor in coordination with the site HSSE team shall determine the environmental &
occupational risks of a job and develop solutions for controlling the Safety. The principal means of
control are:
 Elimination
Elimination of the risk
Substitution of an activity to eliminate the risk

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 17 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

Engineering solution to eliminate the risk

 Clear & Safe Access
 Lock Out / Tag Out
 Barriers

 Mitigation
Changing the job’s working procedure/finding a new way to do the job to eliminate Safety
Changing the physical conditions that create the Safety
Questioning the necessity for or frequency of doing a Safetyous task
Engineered solutions
Provision of personal protective equipment
 Waste Management Controls
 Warning Signs
 Designated Supervision
 Training Passport
 Competence Certification
 Firewatcher / Banksman / Standby Man

 Protection
Personal Protective Equipment (PPE) to minimize impact of the risk if it were to occur.
From the above, elimination has the highest and PPE has the least ranking as a means of
controlling Safety. Methods for controlling Safety include:
Provide additional training
Respiratory protection

 Hard Hat (Mandatory)

 Eye Protection (Mandatory)
 Safety Footwear / Steel toed Boots (Mandatory)
 Gloves (Mandatory)
 Coveralls (Mandatory)
 Hearing Protection (Noise surveys will identify the appropriate hearing protection required for
the area)
 Safety Harnesses (Mandatory at heights greater than 2.0 meters)
 Respirators
 Breathing Apparatus

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 18 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

 Fire Retardant Clothing

 Face Visors / Shields
 High Visibility Vests

10 SWMS &JSA MEETING

Construction teams will ensure that they review each SWMS section with the applicable
construction tasks in mind. When additional information or support is required to complete an
assessment, the immediate construction supervisor and the HSSE Section are to be consulted
and the assessment process shall be completed satisfactorily before commencing the task or
operation.

The risk assessment process will identify critical elements required for the work to be performed
safely. The following key points highlight several critical elements to be considered during the
assessment process.
For effective implementation of the JSA, the Task Supervisor shall brief and explain the contents
of the JSA during the START, to all work leaders and workers involved in the task covered by the
JSA. This will ensure that the workers are following the correct and safe methods for the
task and that any equipment to be used in the task is safe to use.

All SWMS&JSA meeting shall be recorded in the form at Appendix 5. The result of the meeting
shall be reflected to the SWMS & JSA as the result of meeting.

After the draft version is completed by the Subcontractor or Work team, the JSA and SWMS
meeting shall be arranged to review the contents of SWMS and JSA.
The Safe Work Method Statement may also incorporate information and specific requirements
pointed out or discussed at the meeting. Based on the suggestions or pointed out the concerning
by the attendees the specialists of manufacturers / suppliers of plant, equipment and substances;
and other HSSE specialists shall be added to the method statement.
In certain cases, the Safe Work Method Statement may identify training needs for CONTRACTOR
and its Subcontractor employees and the use of competent persons or specially-trained operators
for certain activities.

10.1 The example list of Questions at the SWMS & JSA meeting
10.1.1 General question
What is the task?
Who is going to carry out the task – CONTRACTOR, its Subcontractors, specialist subcontractors
or a combination of these groups?
Who will control and supervise the task?
When the work starts and finishes?

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 19 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

What techniques will be used to perform the work activities?

10.1.2 Resources
What plant will be used? Is this adequate?
Are any special tools, equipment or clothing necessary?
Which persons are required to carry out the work and what will be their individual roles? How will
each person in the work crew be consulted with regards to the work tasks, Safety and local
conditions?
Will members of the work crew need any specialist training?

10.1.3 Vicinity and Existing condition

What hazards will be created by the task?
Do any existing systems of work apply
Does the task require entry into confined spaces or work at height?
Do support services need to be located and/or installed?
Is a survey (Safety / Health / Environmental) of the area necessary?
Will it be necessary to inform other contractors / work parties / third party operators about the
work?
Is the work likely to interfere with other construction operations?

10.1.4 Safety Countermeasure

What precautions (e.g. electrical isolation, mechanical isolation, permits to work) are required and
who will authorize them?
Will personal protective equipment (e.g. ear defenders, breathing apparatus, protective clothing)
be required and has approved up-to-date training in its use been given?
What specifically is the working surface / platform?
Is the surface / platform known to be safe / secure (ground, pipe rack, walking, crane / lifting
operations, etc.)?
What is the means of access / egress, and is this satisfactory?
What other precautions should be taken?

10.1.5 Emergency Response

Are special emergency procedures required, e.g. Emergency Drill, provision of Fire Wardens,
extra First Aid coverage, etc.?
How will persons involved in the work activity, if out of hearing distance or out of sight of each
other, effectively communicate with each other and other work crews in the area?

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 20 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

10.1.6 Confirming the document distribution ,transmittal and communication

Who will need to receive copies of the Safe System of Work?
Has the Site Manager reviewed the Method Statement and Safe System of Work?
Are Notification procedures required for completion of high-risk activity?

11 START MEETING
Having successfully developed a Method Statement with all Safety identified and risks reduced to
ALARP, the next step will be to communicate the contents to the workforce that will be involved in
the task.
CONTRACTOR and its Subcontractors will conduct START meeting, where the Safety and
controls will be communicated and the step by step process (as detailed in the SWMS) will be
discussed, such that all work group members will be able to understand what is required of them to
safely complete the work activity.

12 APPENDIX
Appendix 1: JSA Sample sheet
Appendix 2: JSA Completed Sample
Appendix 3: CONTRACTOR JSA FORM
Appendix 4: JSA Checklists
Appendix 5: SWMS& JSA Meeting Form
Appendix 6: Sample of SWMS Format

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 21 of 28
S-000-1654-0100V

APPENDIX 1: SAMPLE JSA FORM

D R A
N
I 22-JUL 4
- 2 0 1
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 22 of 28
S-000-1654-0100V

APPENDIX 2: EXAMPLE COMPLETED JSA FORM

D R A
N
I 22-JUL 4
- 2 0 1
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 23 of 28
S-000-1654-0100V

APPENDIX 3: CONTRACTORS JSA FORMAT

JSA OVERVIEW

THE COMPLETION OF A QUALITY JSA HAS 4 STEPS: CHECKLIST - These items are required for a quality JSA

STEP 1 – PLANNING & PREPARATION Is the JSA Team Leader familiar with the JSA process? 

If there is no existing JSA relevant to the work, the whole team undertaking the job The JSA must involve the Supervisor and people performing the work 
activity must be involved in the development of a new JSA. JSAs can be typed or Is there an existing WMS or similar JSA for the work? 
handwritten on this template. Where existing JSAs relevant to the job exist, these
can be used or reviewed as a guide and changes can be made on by computer or Are chemicals or hazardous materials involved (include MSDS) 
hand.
Are required Permits and clearance certificates in place? 
STEP 2 ‐ JSA FORM
Effect to others working nearby and surrounding environment considered? 
Use Section (A) and/or the Work Method Statement and JSA Team Member
Is additional PPE required? 
knowledge of the job as a prompt to identify hazards.
Ensure A Step Back 5x5 is completed prior to starting the task 
Identify the potential incidents or hazardous conditions for each step.

Identify controls for each step to reduce the risks to As Low As Reasonably
Practical (ALARP). Work Method Statements (WMS) can be used as a guide. Expiry and Review
The JSA is to be reviewed and signed by the work party on a weekly basis
1.
or when a change in the work activity occurs.
The Hierarchy of Controls shall be applied when identifying controls.
Amendments and reviews shall be reflected in section (F) of the JSA.
2.
- a) Eliminate Hazard If a Permit to Work is governing the job, a copy of the JSA is to be
3.
provided with the closed out copy of the Permit
b) Substitute with less hazardous alternative
Ensure new work crew members to the job review and sign on to the JSA
4.
c) Use engineering controls The JSA is to be retired and stored when that work is completed.
5.

D R A
N
I 22-JUL 4
- 2 0 1
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 24 of 28
S-000-1654-0100V

APPENDIX 4: JSA CHECKLISTS

JSA WORK DETAILS AND CHECKLISTS

Date: Job Title:
Description of Work: JSA Ref#
Originator: Permit# (If applicable)

(A) IDENTIFY POTENTIAL HAZARDS FOR THE JOB

Hazard Prompt List (Review the job steps and identify if any of the following hazards are applicable) Potential Hazard Exposure Mechanisms

 Electricity  Weather  Excavations/Earthworks  Struck – by, against

 Hot/Cold Objects  Insect/Animal Bites  Fire  Contact with

 Rotating Equipment  Lighting  Introduction of Non Native Species  Contacted by

 Vehicles  Driving Hazards  Harm to Flora / fauna  Caught – in, on, under, between, against

 Muscular Stress  Falling Objects  Historical Sites  Exposure – temperature, chemicals, noise, dust

 Mental Stress  Noise  Vegetation Clearing  Slip, Trip or Fall – from heights, same level

 Repetitive Work  Radiation  Spills/Leaks  Complete Manual Handling Risk Assessment attached

 Heights  Hydrocarbon/Gas Release  Other Mobile/Stationary Equipment  Overexertion/ excessive force – lifting, pushing, pulling,

 Lone Worker  Surfaces  Pressure (Stored Energy)  Escape of Material – oil spill, gas release, light spill

 Vibration  Tools/Equipment  Fumes/Vapour/Dust  Human Factors

D R A
N
I 22-JUL 4
- 2 0 1
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 25 of 28
S-000-1654-0100V

 Moving Objects  Human Factors  Light Spill  incorrect use of tools or equipment

 Confined Spaces  Off Road  Depths  repetitive strain

 Asbestos  Chemicals  Other (List additional Hazards below)  perceived pressure, haste

 arduous tasks

Personal Protective Equipment

 Eye/Face protection  Hearing protection  Respiratory protection  uncomfortable work position

 Head protection  Safety/Rescue line  Safety harness  mundane work

 Foot protection  Hand protection  Gas detector  inadequate competency

 Body protection  Spill prevention and clean  Light shields  communications, instruction

up
 Weather conditions

 hot/dry

 Other  wet

 windy

 cold

D R A
N
I 22-JUL 4
- 2 0 1
 Employer Doc. No.
NSRP Complex Project Rev. 0

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK Contractor Doc. No.
Page 26 of 28
METHOD STATEMENT(SWMS) S-000-1654-0100V

APPENDIX 5: SWMS/JSA MEETING FORM

SWMS/JSA MEETING FORM

Work Title

PTW No: Date:

Subcontractor Name/Signature

A. Subject Discussed

B. Attendance List

Name Company Position Signautre

10

C. Feedback

D R A
IN
22-JU
L - 2 014
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 27 of 28
S-000-1654-0100V

APPENDIX 6: SAMPLE OF SAFE WORK METHOD STATEMENT FORMAT

Safe Work Method Statement No. TITLE: DATE:

1.0 Scope 1.1

2.1
2.0 References
etc

3.1
3.0 Responsibilities
etc

4.1
4.0 Equipment
etc

5.1
5.0 Materials
etc

D R A
N
I 22-JUL 4
- 2 0 1
 Employer Doc. No.
NSRP Complex Project Rev. 0

Contractor Doc. No.

Title: JOB SAFETY ANALYSIS (JSA) & SAFE WORK METHOD STATEMENT(SWMS) Page 28 of 28
S-000-1654-0100V

6.1
6.0 Resources
etc

7.1
7.0 Procedure
etc

8.1
8.0 Safety
etc

9.1
9.0 Attachments
etc

Prepared by: Checked by HSE Dept Review CONTRACTOR Approval OWNER Approval

Name Name Name Name Name

Signature Signature Signature Signature Signature

Date Date Date Date Date

D R A
N
I 22-JUL 4
- 2 0 1