JSA (Job Safety Analysis) Sheet

Ref-
Activity Name:- Bolts & template fixing
Location:- Date :

Sr.No. Sub-Activity Name
1 Manpower Mobilization
2 Material shifting
Fixing of bolts &
3 Fall of material
template
4 Work during dark hours
Type Of Hazard Risk(s) Involved Risk Control measures
Only inducted worker shall be deputed at the work place.
Untrained worker Personal injury
Given Tool Box Talk to all workers.
Evaluating the capacity of the dumper
Provision of banks man for guiding the process and stopper
Fall/Slip/Trip Personal injury for vehicle.
Ensuring the level ground for unloading
Material stacking not less than 1.5 mtrs from the edge of the
pit .
Ensure template fixed with binding arrangement with
pedestal.
Ensure sufficient manpower for carriage & fixing of bolts &
Personal injury template at place
Ensure use of rubber gloves for fixing template
Ensure use of inspected tools & tackles
Night work permit to be taken from concern engg.and safety
dept.
Darkness, fall of
Personal injury, damage Ensure proper illumination during dark hours.
person, fall of
to property Electrical cable should lead min 2 m height. No exposed
machinery
electrical wire.Earthing.
Route shall be illuminated.

Name & Signature of Site Engineer / Supervisor :___________

Name & Signature of Site In-charge :___________

Name & Signature of Project In-charge :__________

Name & Signature of HSE Officer : ______