JSA (Job Safety Analysis) Sheet

Activity Name:- Deshuttering of Plinth Ref-

Location:- Date :

Sr.No. Sub-Activity Name Type Of Hazard Risk(s) Involved Risk Control measures

Manpower Only inducted worker shall be deputed at the work place.

Untrained worker,lack
1 Personal injury
Mobilization of skill awareness
Given Tool Box Talk to all workers.

Area barricade to restrict entry.

Ensure (FBSH)full body safety harness anchor by each workmen.

Fall of Cuplock verticals are checked against bending & breakages
2 Staging Personal Injury
person,material
Ledgers shall be placed at every 500mm & same shall be covered
with the cups.
Maintain good house keeping at work site.

Area barricade to restrict entry.

3 Deshuttering
Engaged trained & experienced psreson on the job.
Maintain good house keeping at work site.
Fall of material Personal Injury Conduct tool box talk before starting the work.
Ensure all hand tools are inspected.
Ensure recommended PPE should be worn the worker such as
safety shoes,helmet, hand gloves goggles & dust mask.

Night work permit to be taken from concern engg.and safety dept.

Darkness, fall of Ensure proper illumination during dark hours.

Work during dark Personal injury,
4 person, fall of
hours damage to property Electrical cable should lead min 2 m height. No exposed electrical
machinery
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 : ______