HSE-SAF-SFM-00-0018

Job Safety Analysis Worksheet

Work Activity (Job): JSA for Tubing works at WWT Floatation Effluent ,Common Effluent Composite And WWT FEED from TK-1244 Areas
JSA Date:2013-08-25 JSA Location: WWT FEED from TK-1244(31-S-06001), WWT Floatation
Effluent(31-S-06002)
JSA Facilitator (Name): JSA Facilitator (Sign):
JSA Participants:
Approved By:
Shift / Area Supervisor (Name): Shift / Area Supervisor (Signature):

JSA Team to confirm for below screening criteria prior to proceeding with JSA

YES NA Screening Questions YES NA Screening Questions

X JSA Hazard checklist is available for reference. NOTE: The
completed checklist must be attached with the JSA.
X If a similar activity was performed in past, a copy of previous JSA
should be available.
X If it is a high risk activity then HSE Department must be involved.
X Visit to job location is made.
X If team is aware of any history of incident / near-miss on similar
job at Q-Chem, lesson learned report (LLR) should be available
for review.

Note: JSA shall be revalidated at maximum 30 days interval i.e. if same job continues more than 30 days.

Sequence of Basic Job Steps Potential Incidents or Hazards** Ways to Eliminate or Reduce Potential Hazards
For all job steps Slip, trip and fall hazards  Housekeeping shall be done to ensure work
place is clear all the time
 All materials shall be removed from site to a
safe area immediately after the work
 Wear full body harness while working on
heights
Noise  Wear ear plugs/ double hearing protection
according to nature of job and plant noise
areas instructions
Injury due to inadequate weight lifting/ body  Communicate best practices and correct body
posture posture to work

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Job Safety Analysis Worksheet
Site preparation and mobilization
Morning Tool box Meeting & JSA
discussion
Qatar Chemical Company Ltd.
Lack of safety awareness and knowledge
for the task
Vehicle entry hazard
Pinch points & sharp edges
Dropping/fall of materials
a) People not understanding what the
plan or Hazards are: People afraid
to ask questions.
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HSE-SAF-SFM-00-0018
 Loads should be shared and 1 person should
not carry more than 20 kg at a time
 Use manual handling techniques to avoid
internal injury of back hips
 Any change on job scope afterward PTW is
issued Must be reviewed with the permit issuer
before proceeding.
 Work area to be barricaded with information
tag.
 Hot PTW shall be obtained for vehicle entry
 Spotter is mandatory for vehicle entry to
process area plus signal man
 Avoid wearing rings, jewellery for pipe fitting/
bolt tightening jobs
 Keep body parts away from pinch points and
sharp edges
 Wear leather gloves/ proper PPE
 While working at height, Insure ground floor
barricading underneath scaffolding works
 Ensure avoiding full road blocking while
scaffolding works above road crossing pipe
rack
 Maintain proper handling
 Use mechanical lifting methods when
applicable
 Secure materials while lifting/handling
- Make sure everyone is involved with the
JSA/JHA discussion and understands
- Encourage Everyone to ask Questions &
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Job Safety Analysis Worksheet

Participate. Don’t make any one feel speaking
up or Questioning
b) Presence of toxic gas in work
- Try to identify these types of things in your
areas
work area before starting the work
c) Presence of Chemical or flammable
- Clear carefully work areas by gas testing &
items
daily site inspections.

- Authorized work permit holder shall ensure

Work Permit
a) Unauthorized commencement of
works
b) May result in exposing people
and/or potential to harm or danger
obtaining and marinating valid work permits.
- The supervisor responsible for these activities
has to check the PPE of his staff to ensure
that’s all required items are available and
properly used.
- Inform all people regarding permit condition
before work starts.
- Supervisors must conduct daily tool box talk
about nature of work and associated potential
Hazards and their essential precautionary
measures.

Laying of Tubing a) Proper Supervision

Use of compression fittings
b) Use tools for the purpose which is intended to
a) Personal injury use
c) Proper inspection of the hand tools
d) Use of Appropriate PPE
a) Personal injury a) Proper Supervision
b) Use tools for the purpose which is intended to
use
c) Proper inspection of the hand tools

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d) Use of appropriate PPE

Additional PPE: (Tick the box ‘√’ for YES and ‘X’ for NO and ‘NA’ for Not Applicable)
Did you refer to PPE Matrix?
Is any specialized PPE required for the job?
Are employees trained on proper inspection of PPE before use?

Goggles Dust Mask Other PPE or Equipment

Face Shield Respirator Double Hearing Protection
Welding glass Air Line (Supplied Air)
Chemical Suit SCBA
Disposable Coveralls Half Face Full Face
Thermal Radiation Suit
(Aluminized Suit) Cartridge Type_ _ _ _ _ _ _ _ _

** Refer to Hazard Checklist (Annexure B: Job Safety Analysis Worksheet)

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Job Safety Analysis Worksheet

Annexure A – JSA Hazard Checklist

(To be used in conjunction with the JSA Worksheet to ensure consideration of all hazards
associated with a job or task.)

Potential Hazards
Environmental
YES NO NA

Adverse weather condition (rain, high winds, temperature extremes, humidity, dust, chemical,
radiation, welding rays, darkness, sunlight, lightning, storms, insects, snakes etc.).
Heat Stress (ambient temperature, air movement, PPE and clothing required, etc? heat stress
prevention such as adequate water, ventilation, frequent breaks and rotation?
Oxygen Deficient Atmosphere
Nitrogen Rich Atmosphere
Collapse of inadequately shored/battered/stepped excavation. Will excavations be required for the
job? Is the excavation properly shored/braced? Is a competent person on site for daily inspections of
the trench? Has underground utilities been identified prior to digging? Has protection from hazards
associated with water accumulation been identified? Has the stability of adjacent structures been
reviewed? Are barricades up and secure? Has a confined space permit been issued?
Environment excessively hot or cold, resulting in operator fatigue or diminished reactions.
Inadequate lighting - Will work occur during non-daylight hours? Are lights properly installed,
grounded?
Inadequate ventilation, especially in confined or enclosed spaces?
Electrical
YES NO NA

Contact with electrical current as a result of inadequate electrical Lock out/Tag Out.
Contact with electrical current as a result of un-insulated live conductors or damaged cables.
Static electricity
Thermal / Radiation
YES NO NA

Contact with excessively hot or cold equipment, as a result of inadequate guards.

Exposure to inadequately controlled/contained source of ionizing radiation.
Exposure to ultraviolet radiation e.g. welding, sunshine
Source of ignition / hot work - Not all hazards are readily apparent. When doing work in columns or
vessels over packed beds, consider the packing itself to be a fuel source even if it is metal. The thin
metal packing can burn through; this phenomenon is called “metal fire”. People performing hot
work over packed beds of any type (new or old) should treat it as if they are working over a major
fuel source. New packing contains a flammable oil coating from the manufacturing process. Normal
cleaning processes are not adequate to completely clean hydrocarbon off of used packing.
Machinery / Guarding / Barriers
YES NO NA

Contact with high velocity ejected particles / objects.

Contact, caught in or between machine parts with moving parts, due to inadequate guards.
Equipment with moving or rotating parts e.g. grinding machine
Wearing clothes or jewellery that could get caught in the machinery
Moving vehicle, forklift
Mechanical stops or limits missing or damaged
Pressure
YES NO NA

Damaged hose on gas cylinders

Damage to gas cylinders.

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Failure of plant or equipment causing release of stored pressure

Incorrect pressure regulator fitted to gas cylinder.
Stored pressure (behind non-return/check valves, etc.).
Objects under compression e.g. spring
Objects under tension e.g. wire rope, polyester slings and chains
Working at Height / Dropped Object / Slips, Trips, Falls
YES NO NA

Dropping objects from height

Dropped object into excavation / pit or through hole opening in floor structure.
Fall at the same level (slip, trip)
Fall from height.
Fall into water, or other hazardous fluid.
Slips/Trips/Falls: Are there materials in the area that could trip a worker? Is there oil, mud or slime
that would cause a slip? Is the worker in an off-balance position? Is adequate freeze protection
provided?
Substandard / damaged ladders and steps
Egress / Ingress / Restriction
YES NO NA

Restricted / unsafe access or egress - Are emergency exits clearly marked? Are the employees aware
of emergency evacuation procedures?
Restricted mobility due to poor access or confined space. Access to valves, equipment, etc.: Is the
equipment, valves, nozzles, easily accessible? Will the worker be in unusual or cramped positions to
perform the job?
Struck against fixed object
Struck by moving (e.g. broken, flying) object
Tools and Equipments
YES NO NA

Equipment noise level at or above action level. Is there excessive noise in the work area? Will this
noise hinder worker communication?
Contact with sharp blades/edges.
Excessive exposure to vibration generated by equipment.
Flammable or oxidizing material present.
Incorrect valve operation as a result of inadequate identification with respect to open/closed
positions, and the line they serve.
Pinch / nip points - Are there any fixed objects that may cause injury such as sharp edges or tight
spaces?
Critical Lifts
Heavy equipment (proper signals, alarms, gauges, warning lights, certified operator etc.). Is the
equipment certified?
Pyrophoric material
Non intrinsically safe equipment
Substandard / damaged PPE
Chemical
YES NO NA

Non availability of MSDS, unapproved chemical

Improper container, lack of secondary containment, inadequate labelling, etc
Exposure to chemical (in the form of gas, vapour, mist, fumes, dust etc) could be through inhalation,
absorption, ingestion or injection. Examples include:
i. Asphyxiant or narcotic atmosphere.

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ii. Exhaust fumes e.g. forklift, generator

iii. Other chemical substances (benzene, butadiene, organic vapour etc.). hazardous to health
iv. Oxygen deficient or enriched atmosphere.
v. Toxic gases e.g. H2S, CO
vi. Welding fumes
Biological Hazards
YES NO NA

Bacteria / Virus
Plants
Birds, animals, insects
Ergonomic Hazards
YES NO NA

Manual handling for heavy objects: Can the worker be injured from lifting, pushing, pulling or
carrying heavy objects? Are there other means of transporting the heavy object, such as using a
handcart or hoist?
Awkward posture
Excessive force
Alarms or communications inaudible.
Repetitive motions - Is the worker required to make movements that could lead to or cause hand or
foot injuries or strains from lifting or any repetitive motion? Is the worker required to pull, push or
carry objects repeatedly?
Psychological Hazards
YES NO NA

Stress
Fatigue
Peer pressure
Housekeeping
YES NO NA

Is housekeeping required or any other material need to be removed or cleaned which restricts the
movement or creates any hazard before starting or during the activity?
Are appropriate and trained staffs involved in the housekeeping such as waste management
contractor to handle the hazardous waste?
Miscellaneous Hazards
YES NO NA

Is there is standard SOP available for this job or need to develop the procedure.
Is there any MOC required for the job?
Does the job required Confined Space Entry, LT & T, blinding or involve any life critical
procedure.
Individual roles & responsibilities with regard to a job not clear / understood.
Untrained or incompetent personnel (including vendors, subcontractors, etc,).
Unclear interface arrangements i.e. conflicting activities
Equipment trip due to safety interlock unintended activation. (Involve DCS Engineer in JSA to take
necessary steps for safe handling / bypassing of safety interlocks)
Tools & equipment - Are tools (including hand tools), machines and equipment in need of repair?
Are they the proper tools for the task? Are they inspected? Is any special equipment needed for the
task?
Poor communication. Is communication equipment in good working order? Does communication
equipment such as pagers, phones, cell phones, radios, and computers create an energy source for
ignition?

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Annexure B - Pre-job Confirmation Checklist
NOTE: Must be signed by the Lead Worker and Permit Issuer

Before Starting the Work:

YES NO NA YES NO NA
Do you notice unusual odors, vibration, noise, temperature that might be Are safety equipments / tools in good condition and certified? Basic PPE,
an indication of a potential hazard? Specialized PPE, Emergency Equipment, harness, lanyard, lifting belts, hammer,
grinder, extension cords, hoses, etc
Is hot piping and equipment insulated or guarded to reduce the risk of Are gas cylinders secured properly?
burn?
Communication: Is the job properly communicated to all workers? Chemical: Are the chemical containers proper for the material stored?

Has the JSA been reviewed with workers before the job begins? Are containers labelled properly?

Are radios available / necessary for communication during the work Are the containers placed on the secondary containment?
process?
Life Critical Procedure: If open flame hot work, confined space, blinding, Scaffold: Are scaffolds erected properly, in correct location and inspected?
etc needed for this job?

If yes, then all control measures implemented? Do scaffolds limit access?

Exit/Egress Routes: Are the employees aware of emergency egress and
nearest assembly point?
Access to valves, equipment, etc.: Is the equipment, valves, nozzles,
easily accessible?
Will the worker be in unusual or cramped positions to perform the job?
Ventilation: Is adequate ventilation provided, especially in confined or enclosed
spaces?
Energized Sources: Are electric sources grounded?
Are hazards introduced by using non-intrinsically safe equipments (vehicles,
welding machine, cell phones, cameras, etc)

Heat Exposure: Does the worker know the signs and symptoms of heat Health: Does the worker have any restrictions on job duties?
stress such as headache, dizziness, weakness, cramping or nausea?

Do workers know methods of heat stress prevention such as adequate

water, ventilation, frequent breaks and rotation? Are they well rested? Do they feel well?
Has the fall hazard been identified and mitigated? Does the work area pose a slip / trip hazard?

Is equipment properly isolated, tagged and locked as per LT & T Restricted area/Barricaded area: Is the work area properly barricaded and
procedure? identified?

During the work:

 If the job condition change (e.g., leak, drip, movement, smoke, high wind, etc). Must STOP the job, inform to supervisor and revisit the JSA.
 Permit Issuer and Lead Worker must revalidate / sign the pre job confirmation checklist in the beginning of each shift if the job to be continued for the
extended shifts or days.

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Job Safety Analysis Worksheet
Permit Issuer: ___________________________ Lead Worker (Name / Sign): _______________________________

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