JOB SAFETY ANALYSIS (JSA) FORM

Job Location/Site: JSA NO:11

Task/Activity: ERECTION AND DISMANTLING OF SCAFFOLDING PCR NO :
PCR NO:
Work Area: Permit N0: Date:
Gas Leak / Fire /Any Emergency: In case of emergency, all works must be stopped, equipment must be switched off
Emergency situation /Evacuation and left in safe condition. All personnel shall reach the nearest muster point considering the wind direction (upward or
cross-ward)

SL.
WHO IS AT
NO ACTIVITY STEPS HAZARDS INVOLVED CONTROL MEASURES
RISK

1 Morning tool box ●People Not Understanding What ● People ● Make Sure Everyone Is Involved With The JSA/JHA Discussion And
Meeting And JHA The Plan Or Hazards Are; People ● Equipment Understands; Encourage Everyone To Ask Questions And Participate.
Discussion  Afraid To Ask Questions ● Facility Don't Make Anyone Feel For Speaking Up Or Questioning 
  ●Presence Of H2S gas and Toxic ● Environment ●Try To Identify These Types Of things In Your Work Areas Before
gas In Work Areas  Starting the work; Clear Carefully Work Areas By gas testing and
●Presence of chemical or flammable ●daily site inspection
items
2 Work Permit ● Unauthorized commencement of ● People ● Authorized work permit holders shall ensure obtaining and maintaining
works ● Equipment valid work permits.
● May result in exposing people ● Facility ● The supervisor responsible for this activity has to check the PPE of his
and/or potential to harm or danger. ● Environment staff to ensure that all required items are available and properly used.
● Inform all people regarding permit conditions before work starts.
● Supervisors must conduct daily toolbox talk about nature of work and
associated potential hazards and their essential precautionary
measures.
3 Gas test ●May found toxic gas or H2S gas leak ● People ● Carryout gas test by QP Authorized gas tester time to time.
or extreme oxygen limit in air Environment ● All groups working in different area inside station shall have H2S
personal gas monitor(certified)
4 ● Mobility restriction, access ● People ● Survey the area and confirm safe location of temporary of material prior
Scaffolding obstruction, congestion in the work ● Equipment to hauling.
Preparation of area if hauling/storing of material in ● Facility ● Provide temporary holding area at location that will not congest/obstruct
work/Hauling of not properly planned and plant access or restrict mobility of other activities.
materials coordinated. ● Obtain necessary permit
● Nearby existing facilities if any ● Provide temporary holding area at location that will not congest/obstruct
subject to physical damage during site access or restrict mobility of other activities.
PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
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 JOB SAFETY ANALYSIS (JSA) FORM
SL.NO
ACTIVITY STEPS HAZARDS INVOLVED WHO IS AT RISK CONTROL MEASURES

material hauling ● Scaffold rack is a must for holding scaffolding material. No pipes,
couplers will be stored on the ground or anytime scattered on the
ground.
● Observe extra caution in mobilizing material at site

5 ● Erection & Use ● Damage to onsite detectors ● People ● Take extreme care during erection and override it if needed.
of Scaffolding /switches / transmitters etc ● Facility
● Equipment
●
6 ● Fall of objects / Tools. ● People ● Provide guardrail & toe board to prevent falling of tools /objects
● Facility ● Don’t keep the unnecessary materials on the scaffold platform
● Equipment ● Hand tools to be tied with permanent structure or person
● If required barricade the area during erection work.

7 ● Accidental Fall of Person ● People ● The Scaffolder must use Safety Harness/full body harness to prevent
● accidental fall
8 ● Unstable Scaffold ● People ● The scaffold must be inspected, certified & tagged bythe competent
● Facility person confirming its suitability
● Equipment
9 ● Weak Scaffold ● People ● The scaffold tag must indicate the maximum load that itcan bear
● Facility
● Equipment
10 ● Damaged Scaffold ● People ● The scaffolding is to be inspected at least weekly for any damage due
● Facility to weather condition (rain, high windetc) or other unsafe conditions.
● Equipment ●
11 ● Modified Scaffold ● People ● In case of any modification, addition in the scaffold, ithas to be re-
● Facility inspected & certified
● Equipment
12 ● Improperly Supported Scaffold ● People ● Ensure Scaffold is securely supported on a rigid groundand not on
● Facility process piping / vessel or equipment

13 ● Incomplete Scaffold ● People ● Do not use if green Tag is missing

● Facility

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PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
 JOB SAFETY ANALYSIS (JSA) FORM
SL.NO
ACTIVITY STEPS HAZARDS INVOLVED WHO IS AT RISK CONTROL MEASURES

● Do not use if red tag is available.

14 ● Old Scaffolding ● Doubtful Integrity ● Do not use if it does not have valid inspection tag attached

15 Housekeeping  Slips trips and falls due to poor ● People ● Remove tools equipment and rubbish from worksite and maintain a
Clean up worksite housekeeping ● Environment clean work environment.
● Facility ● Arrange housekeeping on daily and every shift bases 
● Equipment ● Supervisor shall conduct tool box meeting in this regards

Project Engineer HSE/QA/QC Manager Project Manager

PREPARED BY: REVIEWED BY: APPROVED BY:

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PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING