JSA (Job Safety Analysis) Sheet

Activity Name:- Backfilling in foundation and Plinth Ref-

Location:- Date :

Sr.No. Sub-Activity Name Type Of Hazard Risk(s) Involved Risk Control measures
Untrained Only inducted worker shall be deputed at the work place.
Manpower
1 worker,lack of skill Personal injury
Mobilization Given Tool Box Talk to all workers.
awareness
Striking of person a.Cleaner to guide during the reverse operation
Use of dumper to during reverse Personnel Injury b.Reverse horn during the reverse operation
2 unload sand at the operation of dumper c.Provision of the hard barricade.
edge of the pit a. Hard barricade provision for pit.
Fall in pit Personnel Injury
b. Hard stopper or sand bags to be used as stopper.

Hit or fall Personnel Injury No person to be available in pit during charging activity

a. Ensuring all the labour for use safety helmet,refrative jacket,safey

shoes PPEs.
a.Fall from height Personnel Injury
b. Conducting Tool Box Talk
b.Fall/Slip of JCB or Major Injury
Use of Pockland JCB c. Hard barricading around all the excavated pits & soft barricading
Pockland Damage to inventory
around the swing area of poclain.
3 to charge the
d. Distinguishing the stoppage area fo
material in pit
Fall/Slip of Evaluating the capacity of the dumper for carting & unloading of
Major Injury
excavator & dumper material
Provision of banks man for guiding the process.
Ensuring the level ground for unloading dumper at backfilling area.
Slip of excavated Ensuring proper spreading of material after unloading of material. Stack
Personal injury
material height shall one to exceed 5 mtrs.
a. Only approved standard ladder to be used.
Entry of the person in b. Placing ladder on the stiff firm base surface.
4 pit for spraying the Fall Hazard Personnel Injury c. Resting ladder against the stiff surface.
water d. Top of the ladder to project atleast 1 mtr outside the pit
e. While accending and descending on the ladder alwa

Darkness, fall of Night work permit to be taken from concern engg.and safety dept.
Work during dark Personal injury, Ensure proper illumination during dark hours.
5 person, fall of
hours damage to property Electrical cable should lead min 2 m height. No exposed electrical
machinery
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 : ______