PMT/Contractor JSA Form - 1/12/2008

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JOB SAFETY ANALYSIS WORK SHEET

CAT-02- Contractor: Contracting and Trading Co. “CAT”

JSA # Revised Date January 26, 2009
2009 BI: 10-03005-8032

JSA Function Name Badge# Job Title Mobile Phone #

Contractor Field
Gul Mohd Mohd Bashir 7627044 Foreman Mob. 0507802920
Supervisor/Foreman
Contractor Safety Neptali Lolo 8770333 Safety Supervisor Mob. 0500136243
PMT Representative Mob. 0532039197
P.T.V. Rao Site Superintendent
(CTS/Proj. Engr)
Proponent Rep. (Ops)
(optional)
Proponent Rep. (P/L)
(optional)

DESCRIPTION OF TASK: Excavation & construction works for the new Well HARADH KHUFF GAS-1009 Tie-in to WELL HARADH
KHUFF GAS-602 that is CROSSING THE EXISTING K-4 TRUNKLINE.
Work Location: (Area then station number/s) 16” U/G K-4 TRUNKLINE

Prepared By: (Contractor) Reviewed By: Approved By (PMT Project Engineer)

Neptali Lolo / CAT Safety Supervisor Khalid Al-Wuhaib / Safety and Environment Coordinator Badi Dosarry / Project Engineer
Mob. # 0500136243 Phone # 5767400 Mob. # 0555939138 Mob. # 055000441
Reference GIs & SAES:
Work Permit GI. 2.100, Gas Testing Procedure using 3 in 1 Gas Monitor G.I. 2.709, Electrical Safety for Boom or Derrick-type Hoisting Equipment G.I.
2.702, Traffic and Vehicle Safety G.I. 6.030, Mobile Heavy Equipment Operator Testing and Certification G.I. 7.025, Inspection and Testing of
Requirements of Elevating/Lifting Equipment G.I. 7.030, Street and Road Closure; Excavations, Reinstatement and Traffic Controls G.I. 1021.000, Fire
Fighting Training Company Personnel G.I. 1783.001, Safety Spectacles G.I. 8.002, Protective (Safety) Footwear G.I. 8.005, Environmental
Conservation Policy Implementation G.I. 2.714.

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S/N SEQUANCE OF BASIC STEPS POTENTIAL HAZARDS HAZARDS CONTROLS ACTION BY

CAT/OPR’N/P/L
1 Obtain work permit and Counter signature 1. Miss-communication/understanding 1. Conduct joint site inspection Work Permit
Receiver / Issuer
CAT/OPR’N/P/L
1. Struck by Vehicle 1. Install barricades & sign boards 6 meter a Work Permit
2 Secure the area against traffic 2. Camel falling way Receiver / Issuer
2. Install berms at both direction at a
reasonable distance
3. Install warning signs at a reasonable
distance
CAT/OPR’N/P/L
3 Hand excavate around the existing pipe 1. weather hazards 1. Conduct joint site inspection Work Permit
2. Back injuries 2. Secure cold work permit & a confined Receiver / Issuer
space entry permit if trench is 4 feet or
deeper
3. No machine shall work within 3 meters
from the Pipeline use hand tools / for rock
breaking use Jackhammers only
4. Provide trained employees
5. Provide water and shelter
6. Stop working when weather is too bad
CAT/OPR’N/P/L
1. Affixation 1. Conduct joint site inspection Work Permit
4 Excavate deeper than 4 feet (1.2 meter) 2. Falling 2. Obtain confined Space Entry Permit Receiver / Issuer
3. Cave-in 3. Conduct gas test
4. Use access ladder
5. Keep spoils 2 feet a way
6. Use shoring , benching or sloping
7. keep trained stand by man
8. Remove unnecessary personnel
CAT/OPR’N/P/L
5 Install Temporary Pipe Protection 1. Damage of pipe coating 1. Cover the pipe with polyethylene sheet Work Permit
2. Then cover by good Lumber (no nails) Receiver / Issuer

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CAT/OPR’N/P/L
1. Conduct joint site inspection Work Permit
1. Struck people by equipment 2. Secure a hot work permit Receiver / Issuer
2. Struck life pipeline by equipment 3. Certified / competent operator must be
6 Excavate by Heavy Equipment 3. Fire used
4. Oil/Gas leak 4. Use a trained spotter
5. Unqualified operator 5. No machine shall work within 3 meters
6. Falling from the Pipeline use hand tools / for rock
breaking use Jackhammers only.
6. Maintain safe distance between pipe and
equipment position (minimum 8 meters)
7. Valid equipment sticker / daily operator
inspection check list
8. Keep spoil 2 feet a way, shore, bench or
slop trench
9. Have adequate Fire Extinguishers handy
10. Keep only the needed personnel
11. Use qualified supervision
CAT/OPR’N/P/L
1. Conduct joint site inspection Work Permit
1. Weather hazards 2. Secure a hot work permit & a confined Receiver / Issuer
2. Back injuries space entry permit if trench is 4 feet or
7 Install Sand bedding for the new pipe joint 3. Fall hazards deeper
4. Cave-in 3. Equipment in good condition
5. Side walls collapse 4. Certified / competent operator must be
used
5. Use a trained spotter
6. Maintain safe distance between existing
pipe and equipment within 3 m use hand
tools only
7. Provide access ladder
8. Maintain shoring, benching or sloping
9. Keep only the needed personnel on site
CAT/OPR’N/P/L
1. Struck the existing pipe 1. Conduct joint site inspection Work Permit
8 Laying the pipe joint underneath existing 2. improper use of equipment 2. Secure a hot work permit & a confined Receiver / Issuer
pipe 3. unqualified equipment operator space entry permit if trench is 4 feet or
4. substandard rigging tool/equipment deeper
5. falling hazards 3. Equipment in good condition
6. No qualified rigger 4. Valid equipment sticker / daily operator
inspection check list
5. Certified/competent operator must be

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used
6. Use a qualified rigger
7. Use inspected/good Nylon slings
8. Maintain safe distance no machine shall
work within 3 meters from the Pipeline
9. Provide access ladder
10. Use shoring , benching or sloping
11. Have adequate Fire Extinguishers handy
12. Keep only the needed personnel
13. Use qualified supervision
CAT/OPR’N/P/L
1. Conduct joint site inspection Work Permit
9 Conduct Holiday Test for the pipe 1. Weather hazards 2. Secure cold work permit & a confined Receiver / Issuer
(no hydrotest @ this time) 2. Fall hazards space entry permit if trench is 4 feet or
3. Cave-in deeper
{Backfilling must be done in max hours} 4. Side walls collapse 3. Provide access ladder
4. Use shoring , benching or sloping
5. Keep only the needed personnel
CAT/OPR’N/P/L
1. Weather condition 1. Conduct joint site inspection Work Permit
Partial backfilling with sweet sand for the 2. Truck falling in trench 2. Secure a hot work permit & a confined Receiver / Issuer
10 existing pipe 3. Eye injury space entry permit if trench is 4 feet or
{Backfill to the level of ground} 4. Traffic hazards deeper
5. Dust hazards 3. Certified / competent operator must be
used
4. Use trained spotter
5. Valid truck driver SAG license
6. Use (PPE) mask / safety glasses etc…
7. Use flagman
8. Spray water
9. Use back up alarm
10. Use qualified supervision
CAT/OPR’N/P/L
1. Remove all precaution signs, Work Permit
11 Housekeeping 1. Traffic hazards barricades/drums and berms around the Receiver / Issuer
2. Environment hazards work location
2. Clean/remove all debris
3. Remove equipment to a safe location

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# Recommendations/Notes Assigned to Mobile Phone #

Conduct tool box safety meeting prior to work activities prior to commence of
1 work every day Gul Mohd Mohd Bashir Mob. 0507802920

Explain to the key workers the purpose of this JSA and enforce implementation
2 of content Neptali Lolo Mob. 0500136243

3 If un injury or near miss occurs , the JSA shall be reviewed immediately to Malik Rifat Mehmood Mob. 0505366873
determine whether changes are needed in the job procedures (contractor)
4 Use the JSA to identify the hazards and list the precautions on Rahimuddin Sheikh Mob. 0552739950
the work permit (W/P Receiver)

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