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: Dept.: LIFTBOAT, INEZ H. EYMARD
Task Location: IHE LEG TOWERS
Task Description: GREASING / INSPECTING / SERVICING PLANETARIES & LEG TOWERS
Recognized Existing Hazards: Pressurized airline, falling from heights, slips trips & falls, falling objects
____________________________________________________________________________________________________________
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 Hazard Controls Responsible
Job task set up. Gather tools & Slips, Trips. Back Stain Wear PPE, Situational
Equipment. Ladder, awareness, get help

Grease torque tubes & end cap Falls, dropped objects Wear fall protection, one
Bearings Fittings not taking grease person to hold ladder, don’t
stand under work being done
Insure fittings take grease

Checking gear oil Falls, dropped object, over
filling gear box, spills
Use proper sized tools for job
Only fill gear boxes half way
Have absorbent material on
hand, don’t stand under work
being done

Checking inspection boxes Falls, dropped objects, Wear body harness, have one
for deformation of gear and rack Hand injury person holding ladder, use
& adding leg grease if needed gloves and rags.

Put away tools and equipment
Tool damage or unclean
back strain, slips & trips
Clean tools and put away
where they belong, get help
stowing ladder, be aware of
surroundings and body position
At no time climb or stand on
Hoses. Everyone has stop work
Authority. Remove barricades;
remove, stack & secure
materials; waste removed.
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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
______________________________________ Ladder___________________________________ ______________________________________
______________________________________ ______________________________________ ______________________________________
______________________________________ ______________________________________ ______________________________________
______________________________________ ______________________________________ ______________________________________
Example: Back Hoe; Dozer; Crane; Fork-Lift; Example: Radios; Test Meter; Special Tools; Gas Example: Equipment; Vender; Laborers;
Truck; Compressor; Welding Mach; Compactor Detector; Self Contained Breathing App. Special Hole Drilling; Testing Company
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.