Title of the Form Form No. Rev. No. Reference Document No.

Job Safety Analysis (JSA) Hazard

PR/IS/SFD/F-002 04 PR/IS/SFD/P-003
Checklist

When conducting JSA, the following checklist will be useful. It is based on the principles of anticipate, analyze,
eliminate or control conditions.

Provide √ mark
(as
No Risk/Hazard Check Items confirmation of
referring each
checklist Item)
Is the equipment isolated? N/A
By blinds? By double block & bleed? N/A
Hydrocarbon N/A
1 Is the hydrocarbon removed to correct and safe location?
Release
Is the equipment purged? N/A

Is gas test result acceptable? N/A

Is the equipment isolated? √

Is it tagged? √

Is it locked? √
2 Electric Shock
Did you try to start it? √

All electrical sources isolated? √

Capacitors? Batteries? Static electricity? High-voltage sources? N/A

Chemicals are identified and data from MHB used? √

If no MHB/SDS, have you contacted the environmental engineer N/A

3 Chemicals
for his advice?
Chemical reactions neutralized? N/A

Are the precautions for handling radiation source followed? √

Barricades? √
4 Radiation
Warning lights? √

Will any radioactive waste be generated? √

Are the guards intact? √

Rotating
5
Equipment No leaks of water, steam, product? √

6 Cranes / Is license of operator valid? √

Heavy √
Is sticker for vehicle or crane valid?
Equipment
vehicles / Crane fitness & load testing certificate available √
Excavator √
Is the crane equipped with SLI (safe load indicator)
Visual inspection of all lifting gears is done √

PR/IS/SFD/F-002

Sensitivity: This content has been classified as Petro Rabigh: PRC Only
 Title of the Form Form No. Rev. No. Reference Document No.
Job Safety Analysis (JSA) Hazard
PR/IS/SFD/F-002 04 PR/IS/SFD/P-003
Checklist

Is Hot Work Permit required? √

Can Hot Work Permit be issued safely? √

Is vehicle safe to operate in the planned area? √

Is the requirement of flagman / signalman known (for cranes, √

heavy equipment and mechanical excavator while working) and
considered in the plan?
Are sling inspection data valid? √

Is Critical Lift Plan required? √

Is the Rigger certified for the load to be lifted? √

If chain block to be used, is it of the correct safe working load? √

Is the space safe for human entry? √

Air breathable? √

No hydrocarbons present? √

Biological hazards removed? N/A

Confined
7
Space Temperature not too hot? √

Safe access and egress? √

Knowledgeable standby man? √

Is rescue plan available? √

Is the safety harness in good condition? √

Approved fall protection measures used if the working height is √

8 Heights greater than 1.8 m (6 ft.) from floor or platform level.
Is there a safe location to attach safety harness? √

Is rescue arrangements available? √

If vibration is to be expected, are all fittings tight and protected √

9 Vibration
from Loosening?
Will additional noise be generated? √
10 Noise Have you considered how to protect hearing of all involved √
including contactors?
Is the equipment safely attached to the Petro Rabigh grounding √
system?
Moving
11 (Typical examples: ventilation fan / extraction fan, over-head
Equipment
travelling crane, ejector, educator, portable generator,
compressor, etc.)
12 Scaffolding Is the scaffolding erected as per the scaffold plan and or checklist? √

PR/IS/SFD/F-002

Sensitivity: This content has been classified as Petro Rabigh: PRC Only
 Title of the Form Form No. Rev. No. Reference Document No.
Job Safety Analysis (JSA) Hazard
PR/IS/SFD/F-002 04 PR/IS/SFD/P-003
Checklist

Is there any modification to the scaffold after approval of scaffold N/A

plan?
Is the modification reflected in the revised plan and plan is N/A
approved?
Is the scaffolding inspected and tagged as safe? N/A

Are all employees provided with Personal Protective Equipment √

(PPE) and using it?
Human √
13 Is enough light available?
Factors
Are involved people aware of hazards associated with job and √
competent to do the job?
Will the expected weather affect the safety of the job, i.e., √
14 Weather
sandstorm, lightning, rain?
In cold areas of the Petro Rabigh, has provision been made to N/A
warm the equipment safe for human interface?
In hot areas of the Petro Rabigh, has provision been made to cool N/A
Hot/ Cold
15 the equipment safe for human interface?
Objects
Are sources protected from human contact? N/A

Electrical? Steam? Flames? Solar? Cryogenic materials? √

16 Tools & Equip. Are the tools and equipment safe to operate? √

17 Pressure Are pressure hazards (Water, Air, Fluid etc.) controlled? √

18 SIMOPS Is SIMOPS hazards controlled? N/A

19 Falling objects Is there a danger from falling objects? No

20 Sharp edges Is there a danger from Sharp edges? No

Slip / Trip / Are precautions taken to prevent Slip / Trip / Fall? √

21
Fall
Can it be lifted mechanically? √

Can more than one person share the lift load? √

Muscular
22 Stress Is safe lifting technique understood? √

While lifting, are hazards splash and pour hazards eliminated? √

23 Mental Stress Are the persons performing the work free from outside stress? √

Will the job release harmful elements to the environment (air, N/A
Environmental soil, drains)?
Concerns/ N/A
24 Are precautions known to prevent release?
Impact
Is the approved disposal method available? N/A

PR/IS/SFD/F-002

Sensitivity: This content has been classified as Petro Rabigh: PRC Only
 Title of the Form Form No. Rev. No. Reference Document No.
Job Safety Analysis (JSA) Hazard
PR/IS/SFD/F-002 04 PR/IS/SFD/P-003
Checklist

Is it available? √
Fire Fighting
25 Equipment Is it in working order? √

Method Statement for the work is prepared, approved and copy √

available with the JSA Team for reference during JSA.
Work execution plan is available with the JSA Team for reference √
during JSA (if job requires execution plan).
26 Others Specify JSA Leader is trained in JSA process. √

Applicable standards or codes are referenced where known. √

Required permits, isolations, and hold points listed. √

Involve people performing the job. √

JSA is filed appropriately, and entered into database. √

PR/IS/SFD/F-002

Sensitivity: This content has been classified as Petro Rabigh: PRC Only