Appendix A: Format for JHA Worksheet

JHA No:
CPECC-36
JOB HAZARD ANALYSIS Date: 29 / 10 / 2022

Next Review Date /

Non-Routine Job/Task Routine Job/Task 29 / 11 / 2022
PetroChina (Halfaya) Valid till:
Reference: (WO /Project #)
Location: Line from CPF-2 to CPF-1 ( Outside ) 3800 Performing Agency: CPECC

Job/Task Description: Sandblasting and Coating for pipeline for all size ( 4 , 8 , 10 , 12 , 24 ) inch

Section / Section /
No. Name Position Signature No Name Position Signature
Contractor Contractor
1 Li Dengpan Deputy M. CPECC 4

2 Mohammed Site Eng. CPECC 5

3 Wissam HSE CPECC 6

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 1
 Inherent risk Additional Residual risk
Potential consequences on level hazard / risk level
Step Description of job/task step Hazards and threats / Hazard/risk controls already (Acceptable / controls (Acceptable /
Health, Safety, Action by
No. (what and where) causes in place not recommended not Acceptable)
Environment and Asset
Acceptable)
1- All staff shall be
equipped with face mask,
goggles, robber gloves, and
portable sanitizer.
The Way New
2- All staff shall go through
Corona virus
body temperature
Spreads1-By air,
through coughing checking.
and sneezing. 3- All Truck shall be
2-Touching disinfected before come to
contaminated objects site and everytime.
or surfaces then 4- For Crane and other
touching your equipment’s, the driver is
1 Covid-19 mouth, nose or eyes. COVID-19 Pandemic. not allowed to get off. Acceptable ok CPECC Acceptable
3-Close personal 5- Stop work during process
contact with a or quality inspection. Only
positive Covid-19 one party involved in the
patient. inspectionallowed to be on
4-Rarely facial the site.
contamination. Communication will be through
cellophane or walky-talky.
Reports regularly to GM on
the prevailing situation of
theprevention and control
works

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 2
 Obtain a hot work
permit before starting
job.
Ensure that all work
activities are
Unauthorized conducted by
team work competent personnel.
2 Invalid permit Conduct toolbox
Personal injury
Lack meeting to all workers Acceptable ok CPECC Acceptable
Work start up and Property damage
experience involved in the work
Obtaining PTW
Lack of activities.
communication Site Supervisor
conducts inspection,
monitor the work
activities and ensure
the safety standards.

Potential Inherent risk Additional Residual risk

consequences on level hazard / risk level
Description of job/task step Hazards and threats / Hazard/risk controls already in (Acceptable / controls (Acceptable /
Step Health, Safety, Action by
(what and where) causes place not recommended not Acceptable)
No. Environment and
Asset Acceptable)

Proper stacking ok
materials and equipment
Personal injury Proper disposal of waste
Acceptable
3 Housekeeping Slip/trip Environmental Clean the working area Acceptable ok CPECC
pollution after finishing the work

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 3
 A- Mark the exclusion
area and only authorized
personnel are allowed to
enter
Wear proper gloves and a
full-face,
All small tools shall be
inspected prior to use
Correct use of job-specific
A- Eye injury and PPE.
A- Sand projected Inhalation of grit Eye wash available
at high speed dust Ensure daily safety checks
A- Compressed air are carried out
Sandblasting hazard
Highly-pressurized on all compressed air
B- Coating for
4 system equipment. Acceptable ok CPECC Acceptable
pipeline for all B-Splashes in
size ( 4 , 8 , B-Humid weather Compressor PSV must be
Non-qualified eyes/on skin calibrated on
10 , 12 , 24 ) Exposure to
inch person compressor capacity and
Dust paint fumes sand pod PSV
Muscle strain must be calibrated at 100
PSI prior to
commencement of work
activity.

B-Coating slowly to reduce

splash
wearing dust mask
Take rest breaks as
needed

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 4
 Review – Performing Agency Approval – Petro China Authorities

Area Authority
Discipline Engineer ☐Approved - all non-routine jobs/tasks Section Head / Deputy Manager
Contract Focal Department / PMC (If any)
☐Confirmed - all routine jobs / tasks ☐Approved – all routine jobs/tasks
Name: Mohammed Name: Jaafar Abdulqader Name: Name:

Sign: Sign:

Sign: Sign:

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 5
 Hazard Prompt – “Check  ”
Identify the job/task hazards and assess the risks of personnel may be exposed to before safeguards are implemented
☐ Electrical ☐ Chemical ☐ Tools ☐ Gases
☐ Vehicles ☐ Height ☐ ☐
☐ Pressure ☐ Access ☐ Vibration ☐
☐ Weather /Working environment ☐ Bacteria ☐ Dust ☐ Slip / Trip
☐ Radiation ☐ Rotating Equipment ☐ ☐
☐ Heat ☐ Dehydration/ Hot Work / Sun ☐ Hot / Cold Objects ☐ Overhead Hazards
☐ Biological ☐ Entrapment ☐ Lighting ☐ Manual Handling
☐ Conflicting Activities Others:
Personal Protective Equipment for Job/Task
Minimum PPE Requirements: 1) Safety Helmet , 2) Safety Shoes , 3) Safety Uniform, 4) Gloves
☐ Safety Harness ☐ Face Shield ☐ Airline ☐ Gloves – Hyflex (Nitrile)
☐ Face Mask ☐ Sun Screen ☐ Dusk Mask ☐ Gloves – Leather Riggers
☐ Clear Safety Glasses ☐ Hearing Protection ☐ Confined Space Harness Others: __________________
☐ Mon goggles ☐ Breathing Apparatus ☐ Gloves - PVC
Plant, Equipment & Tools for Job/Task
☐ Ladder ☐ Drill ☐ ☐ MEWP (Mobile Elevating Work Platform)
☐ Hand Tools ☐ ☐ Winch ☐ Fans
☐ ☐ Scaffold ☐ Extension Leads ☐ Vacuum Cleaner
☐ Welding Machine ☐ ☐ Power Source ☐ Spill kits / Housekeeping
☐ Compactor ☐ ☐ Others:
Tagging & Signs
☐ Men Working Above ☐ Flagging ☐ Personal Danger Tags ☐ Information Tags
☐ Barrier Mesh ☐ Personal Locks ☐ Out of Service Tags Others: __________________
Instructions, Permits, Certificates
☐ Method Statement ☐ P & IDs ☐ ☐ Isolation Certificate (Electrical) ☐ Radiography Certificate
☐ Procedures ☐ MSDSs ☐ Hot Work Permit ☐ Confined Space Certificate ☐ Demolition of Security Defense
☐ Work Instructions ☐ SIMOPS ☐ Gas test Certificate ☐ Road Closure Certificate
☐ Emergency procedure ☐ Toolbox talk ☐ Isolation Certificate (Physical) ☐ Excavation Certificate

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 6
 Hierarchy of Controls / Additional Notes
Hierarchy of Controls
Examples
Controls
Manual Handling Electrical
Use of other source of energy in place of electrical / use
Elimination / Substitution of Hazard or hazardous Use of mechanical device instead of manual of low voltage equipment
process handling / Reduction in size or weight of the item
Use of specific rated enclosures, identify specific
Reduce the distance & time of exposure to location
Isolation / separation of hazards from receptors
manual handling
Engineering controls / safeguards for prevention Work place design, guarding / securing, local
Use of correct fuses, grounding, proper spacing
and mitigation exhaust ventilation, lighting etc.,
Shift / rotation job, fitness, Method statement, Access control, Barriers, Signage, SOPs, Training,
Administrative & Procedural Controls
Training, Permit to Work Competency, Permit to Work
Personal Protective Equipment Helmet, Electrical Shoe, Face shield, Apron, electrical
Helmet, Shoes, goggles, protective clothing etc., gloves etc.,

Notes:
Location / Agency / Discipline /Serial Number All non-routine jobs / contractors – Valid for specific task
JHA No# (CPF1 / PCH / Mech / XXX) Validity of JHA All routine jobs – Maximum validity should be 1 year or review on any
(CPF1 / CPECC / Mech / XXX) near miss / Incident occurrence.
Jobs/tasks those were identified as repeated nature to execute in
Non-routine jobs/ Jobs that requires a work permit as defined in the operational areas on specific equipment by specific discipline without
Routine jobs/tasks
tasks Procedure on Permit to Work System
change in the nature of working environment.
WO – Work Order number
Reference:
Location Eg., CPF1, Export pump area PM – Preventive Maintenance number (from SAP) Project
(WO /Project #)
– Project ID number
Team Leader should provide the brief description of the job / task being
Details of performing agency planned to carryout
Performing Eg., PCH- Mechanical or CPECC-Mechanical Job/Task
No different jobs / tasks should be clubbed even the execution team
Agency Description:
might be same

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 7
 Team leader will select the team members based on disciplines involving
Job supervisor responsible for the defined job/task in the task execution, area concerned, competency, skills with the
Team Leader Team Members
execution consultation of Area Authority. Team should be limited to maximum of 6
members.
Job / task should be breakdown into basic steps based on
Description of task execution methodology & associated priorities & risks. Hazard and
Refer to Hazard prompt table (pg.3 of this JHA template)
job/task step Threat/Cause
(Maximum of 10 steps)
Potential Define the maximum potential loss /affect to the Health &
consequences on safety of the personnel involved, surroundings people, Hazard / risk
List out the existing controls that can limit the occurrence of loss /
Health, Safety, environmental emissions, damage to the assets etc., from controls already in
damage.
Environment and the identified hazard. It should consider no controls are in place
Asset place.
Acceptability of risk level will be subjected to the JHA team’
discretion based on the assessment of competency & skill
levels of the task execution personnel.
Inherent risk levels JHA team may also consider the guidance from Risk Additional hazard / JHA team should identify the independent control measures as many as
(Acceptable / Not Assessment Matrix (consult with PCH HSE Manager) on risk controls possible even by incremental cost / investment for organizing necessary
acceptable identification of acceptable risk levels. recommended resources like people, equipment, time etc., to achieve the risk levels till
For simplicity, all ‘Low’ category risks can be considered as acceptable levels.
'acceptable' and other categories can be considered as 'not
acceptable'.
Team should determine that all residual risk levels are in acceptable
Team should identify the responsible action party for levels when the identified controls were in place at the time of task
Residual Risk level
establishing the identified controls, and ensure the execution.
Action by (Acceptable / Not
adequacy and efficiency of the functioning of controls on However, Area Authority decision will be the final for confirming that the
acceptable
right time. residual risk levels are acceptable, and will ensure to perform the task
with all identified controls measures in place.
Upon completion of the JHA, concerned discipline engineer
should review and confirm that the identified controls Area Authority shall be responsible to approve all non-routine jobs /tasks
measures will be adequate for safe execution of the task. and contractors’ JHAs by confirming the adequacy of control measures.
Discipline engineer can also suggest additional controls if
Review Approvals
any required.
(performing (PetroChina Area Authority shall be responsible to verity & confirm the adequacy of
PetroChina Contract Holder Department / PMC should be
agency) authority) control measures for all routine jobs / tasks, and Section Head / Deputy
responsible to review the contractors’ JHAs and confirm
that the identified controls will be adequate to perform the Manager in charge of that particular operational area shall be responsible
task by contract workers in a safe manner. to approve all the routine jobs/tasks.

HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 8
HSE Document No. 3.9.5, Revision 2.0 (Trial Version) Form - 01 Page 9