Job Safety Analysis sheet

Main activity : Valve Servicing (other than gland and bonnet)

Plant
:
JSA Sheet No: Date of JSA :

S. No.Sub Activity Hazards and Risks Control measure to be implemented

Physical Injury due to Use job specific tools and PPEs Stay away from hot
improper tools lines
Use certified scafolding/Hydraulic platforms/trolleys
Fall due to not following with wheel lock
Valve york/stem/gear work at height procedure (if Use safety full body harness with double lifeline Use
1
box servicing applicable) tray for small tools. Maintain 3 point contact while
climbing the ladders
Health hazard due to
handling grease (long Use chemical resistant gloves and wash hands
exposure) properly
Physical injury while
2 All sub activities (1) Use correct tools. Use mandatory PPEs
working
Done by :

Name :______________________________ Designation: AM Sign ____________________ Date:

Name :_______________________________ Designation: ______________ Sign

_________________________ Date:

(Note: JSA Sheet to be done by issuer and requestor of work permit . In case of need, representative from other
discipline should also be involved )