Rev Dt: 18-Jan-2017

JAD CONSTRUCTION LIMITED Revision No: A2

JOB SAFETY ANALYSIS
Document No: JAD-SMS-F7
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Job Planning
Permit Required: Yes/ No Permit No. Date:
Company Name: JAD Dept.: LIFTBOAT, INEZ H. EYMARD
Task Location:
Task Description: TAKING OF FUEL FROM SUPPLY VESSEL
Recognized Existing Hazards: P0LLUTIION, SLIPS, TRIPS AND FALL, BACK SPRAIN / STRAIN
____________________________________________________________________________________________________________
Emergency Action Plan
Contact Emergency Response (describe how):
Evacuation Route:

Assembly Area: Safety Shower/Eye Wash Station Located Yes No

Communication – Job Planning – Risk Management – Job Safety Analysis (JSA)
Task Steps Potential Hazards
PRE-JOB HAZARD ASSESSMENT OF UNIDENTIFIED HAZARDS IN
WORK AREA THE AREA, CONFUSION AND
MISCOMMUNICATION ABOUT
TASK, UNFAMILIAR WITH
EQUIPMENT OR SAFETY
POLICIES.
INSPECTING OF TOOLS AND DEFECTIVE TOOLS AND
EQUIPMENT EQUIPMENT, SLIPS AND TRIPS, EQUIPMENT FROM SERVICE,
CUTS TO HAND
LAYING OF HOSES SLIP, TRIP AND FALL, HAND
INJURY
APPROACHING OF SUPPLY VESSEL ALLISION (HITTING) OF BARGE
LEG
THROWING OF HIVING LINE INJURY TO PERSONNEL ON
SUPPLY VESSEL
RECEIVING OF FUEL INJURY TO PERSONNEL
LOOSE CONNECTIONS
BURST HOSE / SPILL
CHANGE IN JOB PLAN
ADVERSE WEATHER
CONDITION
Hazard Controls Responsible
BE SURE TO RECOGNIZE EACH
SITE SPECIFIC HAZARDS
WHETHER SMALL OR BIG,
DISCUSS THE TASK IN SPECIFIC
DETAILS ENSURING EVERYONE
HAS CLEAR UNDERSTANDING OF
TASK AT HAND.RAISE CONCERNS
IF UNFAMILIAR WITH EQUIPMENT.
REMOVE DEFECTIVE TOOLS AND
APPLY CAUTION.
REMOVE OBSTRUCTION FROM
WORK AREA, USE HAND GLOVES
ALLOW SUPPLY VESSEL TO TAKE
POSITION ASCERTAIN FROM
VESSEL CAPTAIN IF VESSEL IS
READY FOR OPERATION.
EFFECTIVE COMMUNICATION TO
BE MAINTAINED.
APPLY CAUTION AND WATCH OUT
FOR PERSONNEL ON SUPPLY
VESSEL.
PERSONNEL SHOULD NOT STAND
ON THE LINE OF FIRE BETWEEN
ROPES AND ROPES, ENSURE
HOSES/CONNECTIONS AND
FITTINGS ARE OKAY MAINTAIN
GOOD PRESSURE WHILE
PUMPING AND ENSURE THAT THE
HOSE IS OF GOOD INTEGRITY
CALL TIME OUT, DISCUSS THE
CHANGE, AND REVIEW JSA. STOP
THE JOB UNTIL WEATHER
CONDITION IMPROVES.

ROLLING OF FUEL HOSE BACK ON
THE RACK.
SLIPS FROM SLIPPERY
SURFACE ON DECK,
TRIPPING HAZARD FROM HOSE
BODY PAIN
CLEAN UP ANY FUEL THAT IS
SPILLED, WATCH YOUR FOOD
PLACEMENT BETWEEN
EQUIPMENT AND WATER HOSES,
USE PROPER MANUAL LIFTING
TECHNIQUES FOR FUEL HOSES
ROLLING
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Hazard Recognition – Hazard Considerations – Use Hazard ID Tool

Physical Hazards Physical Hazards Health Hazards
Arcing / Sparking Equipment Pinching & Crushing Airborne Particles - Task / Work Created
Electricity - Close Proximity Pressurized Systems & Equipment Chemical - Liquid / Vapor
Electricity, Loss Of Radiation - X-Ray Contaminated Soil or Water
Entanglement Sharp / Jagged Objects Fatigue
Falling Objects Slipping / Tripping Potential Fumes
Fall Potential - Same / Different Level Structural - Surface Openings Noise - Excessive: 85dB +
Fire / Explosion Tight / Close Work Quarters Oxygen Deficient Atmosphere
Flying Debris Vibration - Excessive Temperature - Extreme Heat / Cold
Heavy / Bulky Material Water - Drowning / Hypothermia UV Rays - Eyes / Skin
High Voltage Other: Other:
Hot / Cold Surfaces Environmental Hazards (Air/Soil/Water)
Lighting - Inadequate Chemical Spills / Releases
Moving Hazards Waste Water
Other: Other:
Job Planning
Standard Equipment Requirements Special Equipment / Tools Support Craft – Third Party
______________________________________
Crane______________________________________ Radios _____________________________ ______________________________________
____________________________________ ______________________________________ ______________________________________
______________________________________ ______________________________________ ______________________________________
Example: Back Hoe; Dozer; Crane; Fork-Lift; Truck; ______________________________________ Example: Equipment; Vender; Laborers;
Compressor; Welding Mach; Compactor Example: Radios; Test Meter; Special Tools; Special Hole Drilling; Testing Company
Gas Detector; Self Contained Breathing App.
Risk Management
Safe Work Practices Basic Safeguards PPE Required
Work Permit Required Arc Shields Fire Resistant Clothing
Confined Space Entry Barricades Arc Suit
Crane Lift Study-Critical Lift Crane Suspended Work Platforms Chemical Resistant Clothing
Electrical - Close Proximity Fire Extinguishers Located Eye & Face Protection
Excavations - Shoring/Sloping/Benching Fire Watch / Flagman Fall Protection
Hot Taps Hole Covers Foot Wear
Line Breaking / Equipment Opening Hole Watch Hand Protection
Lock-Out / Tag-Out Housekeeping Head Protection
MSDS & Labeling Lighting - Additional Needed Hearing Protection
Other: Post Warning Signs Respirator
Scaffolding Weather Resistant Clothing
Tools / Equipment in Good Condition Other:
Ventilation / Exhaust Systems
Other:
Communication
Stop Work Conditions
● Adjacent Work Hazards ● Chemical Spills/Releases ● Excessive Noise ● Fires & Explosions ● Civil Disturbance
● Change in Conditions ● Evacuation ● Gas Release ● Violent Weather ● Unusual Odors ● Incident
Task Performer Comments:

I acknowledge receiving and understanding these instructions, I will fully comply with the assigned task requirements:
Name Signature. Name Signature
______________________________ ______________ ______________________________ ______________
______________________________ ______________ ______________________________ ______________
______________________________ ______________ ______________________________ ______________
______________________________ ______________ ______________________________ ______________
______________________________ ______________ ______________________________ ______________
______________________________ ______________ ______________________________ ______________

Supervisor Name (print): Signature: _____________________________

Job Monitored by Manager/Supervisor (initial): ______ ______ ______ ______ ______ ______
(Foreman will ensure completed JSA forms are given to the appropriate Supervisor at shift end)
END OF JOB: Supervisor ensures unnecessary barricades are taken down, scrap/waste placed in proper bin, and excess materials
returned to storage or properly stacked and barricaded. Submit copy to Mate.