Job Safety Analysis (JSA) (Level 2)

JSA Title / Task Description: Forklift use for loading & unloading material.
JSA #   Attachments: YES / NO. If YES state number of attachments  0
Area:  PAU Job Location: Veolia - WTS RO UNITS – PHASE 1 & 2
JSA Team Leader Name & ID:  Yadhukula Babu, 20815 Department: PAU Operation  Date:  07. Mar 2023
PPE Required: Level 3 Anti-Cut Gloves, Clear Goggles, FRC Clothes, Earplugs, Safety Footwear, High Visible Vest, And Helmet.

JOB SAFETY ANALYSIS (to be filled out by Operations/Maintenance Staff or Team Leader together with JSA Team Members)

Sr. No. Sequence of Job Steps to be Per- Potential Hazards
formed
1. Pre task checking and 1.1 Miscommunication / lack of
preparation. planning and coordination.
2. Move the forklift to loads to be 2.1 Impact (including struck by
lifted to load and unload. because of tip‐over, running
into obstacles and objects
falling onto the operator.)
2.2 People be crushed by the
forklift.
2.3 Blind spots
Risk Control Measures Remaining Action By
Level Risk Level
M 1.1.1 Obtain valid work permit L Suez/
1.1.2 Conduct TBT to include Aquatreat
JSA findings, safe work method,
hazards, and control measures.
1.1.3 Ensure take5 form to be
filled up prior to start the job and
JSA sign off sheet to be filled
1.2.1 The Forklift must have a
valid permit for entry inside
process area.
1.2.2 the forklift must be certified
for use by Maaden.
1.2.3 Operator must have safe
driving license.
M 2.1.1 The forklift must be properly L Suez/
daily inspected. Aquatreat
2.1.2 the forklift will move at speed of
less than 15kmph.
2.1.3 Slow down for turns.
2.1.4 Travel with forks approximately
4” above the road surface (travel
height).
2.1.5 Identify all potholes near to the
route, barricade/highlight if required.
2.1.6 Use mandatory PPEs.
2.2.1 Do not allow people to move in
route of the forklift.

MSHEM-02.11-C
 Job Safety Analysis (JSA) (Level 2)
JSA Title / Task Description: Forklift use for loading & unloading material.
JSA #   Attachments: YES / NO. If YES state number of attachments  0
Area:  PAU Job Location: Veolia - WTS RO UNITS – PHASE 1 & 2
JSA Team Leader Name & ID:  Yadhukula Babu, 20815 Department: PAU Operation  Date:  07. Mar 2023
PPE Required: Level 3 Anti-Cut Gloves, Clear Goggles, FRC Clothes, Earplugs, Safety Footwear, High Visible Vest, And Helmet.

Sr. No. Sequence of Job Steps to be Per- Potential Hazards Risk Control Measures Remaining Action By
formed Level Risk Level
2.2.2 The forklift reverse horn must be
working, and flag man must guide re-
versing.
2.3 Ensure that certified flag man
available to guide the operator during
the forklift movement.
3 Loading/Unloading of material 3.1 Load instability M 3.1.1 Make sure that the load is sta- L Suez/
3.2 Material fall. / workers stuck ble. 3.1.2 Aquatreat
by material falls. Don’t exceed the carrying capacity of
your forklift and do not exceed it.
3.1.3 Spread forks as wide as possi-
ble for load, and center forks on the
load. 3.1.4
Proceed slowly and insert the forks
into the base of the load. 3.1.5
Place forks under load as far as pos-
sible. 3.1.6
Lower the load until it is set. 3.1.7 If
stacking loads, adjust the height of
the load as appropriate. 3.1.8 Lift load
only as high as necessary to be able
to move it 3.2.1 loading and un-
loading area must be evacuated and
isolated and unauthorized persons
not allowed to enter the loading and
unloading area.
4 Housekeeping 9.1 Slip Trip and Fall M 9.1.1 Housekeeping shall be done before L Suez/

MSHEM-02.11-C
 Job Safety Analysis (JSA) (Level 2)
JSA Title / Task Description: Forklift use for loading & unloading material.
JSA #   Attachments: YES / NO. If YES state number of attachments  0
Area:  PAU Job Location: Veolia - WTS RO UNITS – PHASE 1 & 2
JSA Team Leader Name & ID:  Yadhukula Babu, 20815 Department: PAU Operation  Date:  07. Mar 2023
PPE Required: Level 3 Anti-Cut Gloves, Clear Goggles, FRC Clothes, Earplugs, Safety Footwear, High Visible Vest, And Helmet.

Sr. No. Sequence of Job Steps to be Per- Potential Hazards Risk Control Measures Remaining Action By
formed Level Risk Level
and after the job completion. 9.1.2 Un- Aquatreat
wanted materials must be removed from
the site.

Area Owner / JSA Team Leader: The team have reviewed all job steps of EHSS Role: I have reviewed and agreed with all steps of this JSA
this job through this JSA
Name & ID: Dept.:
Name & ID: Yadhukula Babu, 20815 Dept.: PAU

Sign: Date:
Sign: Date:
Work crew undertaking the task: Contractor/ Operator/ Technician or any other Operation Supervisor: I have reviewed and agreed with all steps of this JSA
team role: I have reviewed and agreed with all steps of this JSA
Name & ID: Dept.:
Name & ID: Abdullah Abed, 36497 Dept.: Veolia
Sign: Date:
Sign: Date:
Name & ID: Dept.:

MSHEM-02.11-C
 Job Safety Analysis (JSA) (Level 2)
JSA Title / Task Description: Forklift use for loading & unloading material.
JSA #   Attachments: YES / NO. If YES state number of attachments  0
Area:  PAU Job Location: Veolia - WTS RO UNITS – PHASE 1 & 2
JSA Team Leader Name & ID:  Yadhukula Babu, 20815 Department: PAU Operation  Date:  07. Mar 2023
PPE Required: Level 3 Anti-Cut Gloves, Clear Goggles, FRC Clothes, Earplugs, Safety Footwear, High Visible Vest, And Helmet.

Sign: Date: Area Owner Manager: Job steps and remaining risks read and agreed (Only to be
signed by the Area Owner Manager when any of the remaining risks is Moderate).
Name & ID: Dept.:
Name & ID: Dept:
Sign: Date:
Sign: Date:

Area Owner Director: Job steps and remaining risks read and agreed (Only MPC President: Job steps and remaining risks read and agreed (Only to be
to be signed by the Area Owner Director when any of the remaining risks is signed by MPC President when any of the remaining risks is Extreme).
High).
Name & ID: Dept:
Name & ID: Dept:
Sign: Date:
Sign: Date:

MSHEM-02.11-C
 Job Safety Analysis (JSA) (Level 2)
JSA Title / Task Description: Forklift use for loading & unloading material.
JSA #   Attachments: YES / NO. If YES state number of attachments  0
Area:  PAU Job Location: Veolia - WTS RO UNITS – PHASE 1 & 2
JSA Team Leader Name & ID:  Yadhukula Babu, 20815 Department: PAU Operation  Date:  07. Mar 2023
PPE Required: Level 3 Anti-Cut Gloves, Clear Goggles, FRC Clothes, Earplugs, Safety Footwear, High Visible Vest, And Helmet.

JSA SIGN OFF SHEET

All personal involved in performing the work shall enter their names below and sign the sheet to confirm that they have read, understood, and will comply with the
conditions of the JSA

Sr. No. Name Role In Team ID Number Signature Date & Time

1
2
3
4
5
6
7
8
9
10

Supervisor (Execution Team) Name: Signature: Date:

MSHEM-02.11-C