A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN

NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 1 of 14

Contractor Performing The Job: Nostradamus Date of Work:

Job Safety Revised JSA

Analysis (JSA) 16.08.2023 New JSA

Location of work: Job/Task To Be Perform: JSA Prepared By:
US Embassy Malabo II,
Equatorial Guinea Replacement of 84 Perimeter Wall Lights Rager Etuka Mokobo
Fixtures - US Embassy Compound

Name of Person Supervising The Job: Task Supervisor:

Rager Etuka Mokobo Rager Etuka Mokobo

Personal Protective Specify/Describe Pieces(s) of Equipment Hand Signature Only
Equipment Needed: Worked On: HES retain original – Scanned copies used on site
Safety toe footwear, FR Electrical tool kits, man-lifts, and scaffold HES Review: Date: COR Approval: Date:
coverall, hand gloves, eye
goggles with side shield,
respirator, hard hat, ear
plug/muffs, fall protection, as a Signature: Signature:
minimum requirement

Procedures REQUIRED to be Reviewed by Team Members for this job:

Confined Space Lifting Equipment Hot Work LOTO Fall Protection Hot Tapping/ In-service Weld

Opening Process Piping and Equipment Scaffolding Safety System Override PPE Other: Manual Lifting

Key Job Elements Potential Hazards Recommended Corrective Actions

Hazards (energy sources), Dangers Assignment to make before the job is completed to minimize exposure to dangers
Sequence of Basic Job Steps
(potential harm from those sources), and and Environmental Impacts.
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!
JSA No.:
JSA-NOST-US EMB EG-23-001 rev.0
US Embassy Permit No. & Date:
Potential Environmental Impacts.
1. Pre-job checks and 1a. Miscommunication
preparation
1b. Unauthorized commencement of work may
result in exposing workers and or potential to
harm or danger
1c. Unauthorized person entering the area when
excavation work is ongoing – close proximity of
barrier and warning signs to restricted work area
Project No.:
Page 2 of 14
1a1) Task Supervisor __________________ will conduct a toolbox talk with all work-party
members prior to commencing removal and replacement of the existing perimeter wall
lights and will verify that key personnel are aware of their responsibilities
1a2) Task Supervisor ___________ will ensure area needs to be barricaded and
signboards need to be in place
1a3) Task Supervisor ___________ will ensure work team maintains clear communication
at all times
1a4) Task Supervisor ___________ will ensure utilization of a traffic controller or flagman at
site
1b1) Task Supervisor ___________ will obtain and maintain a valid work permit from COR
issuing office
1b2) Task Supervisor ___________ will check the PPE of all personnel to ensure all
required items are available and properly used
1b3) Task Supervisor ____________ will inform all personnel regarding permit condition/
requirements before work starts
b4) Task Supervisor ____________ will conduct toolbox talk about nature of works and
associated potential/ hazards and their essential precautionary measure
1c1) Task Supervisor ____________ will ensure that only qualified personnel executing the
work shall enter the work area. Monitor the restricted areas to ensure controlled access
1c2) Task Supervisor ____________ will stay on site throughout the duration of this job
while Nostradamus personnel is working
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!
2. Pre-Task Briefing
Toolbox Talks
JSA No.:
JSA-NOST-US EMB EG-23-001 rev.0
US Embassy Permit No. & Date:
1d. Slip/Trip/Fall
1e. Manual Lifting
1f. Pinch point
2a. If the workers do not understand the pre
task briefing therefore may not understand the
potential dangers and control measures to be
implemented. Some of the workers could be
lacking of PPE or using defective PPE
Project No.:
Page 3 of 14
1c3) Task Supervisor ____________ will ensure that barrier and warning sign will be
placed to identified areas before work starts
1c4) Task Supervisor ____________ will ensure that barrier is in correct distance from
restricted work area
1c5) Task Supervisor ____________ will ensure area is free of unauthorized person
1c6) Task Supervisor ____________ will ensure that barriers are correct color scheme and
display safety and warning signs
1c7) Task Supervisor ____________ will ensure that all people in surrounding areas are
warned of the dangers of presence of hazard at the workplace
1d1) Task Supervisor ___________ will ensure work team identify/mark slip, trip, and fall
hazards and maintain proper body positioning
1d2) Task Supervisor ___________ will ensure work team perform and maintain good
housekeeping
1e1) Task Supervisor ____________ will ensure that workers demonstrate correct lifting
posture. Use proper lifting techniques/team lift
1f1) Be aware of objects that could strike the body or result in a whole body pinch point type
of injury. Wear appropriate PPE – safety toe footwear, FR coverall, hand gloves, eye
goggles, dust/mist respirator, hard hat, ear plug, fall protection, as a minimum requirement
2a1) Task Supervisor____________ will ensure that the pre-task briefing is understood by
the workers. Prior to start of removal and replacement of light fixtures, all workers exposed
to energized or isolated electrical power must have been trained to work within the limited
approach boundaries of exposed live parts
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 4 of 14

2a2) Wear the appropriate PPE and replace PPE that has signs of defect. PPE must
include safety toe footwear, FR coverall, hand gloves, eye goggles, dust/mist respirator,
hard hat, fall protection, ear plug, as a minimum requirement

3. Mobilization of workers, 3a. Incorrect or defective materials / tools / 3a1) Task Supervisor ____________ will ensure key personnel involved in removal and
Materials and equipment/PPE used replacement of the perimeter wall light fixtures are certified, trained, and competent to carry
Equipment/machine out the job safely

3a2) Pre-use inspection of equipment and tools. Defects shall be reported to Task
Supervisor and removed immediately from site

3a3) Task Supervisor ___________ will ensure that all personnel are wearing proper
gloves while handling tools, materials, equipment and ensure that all employees not to lift
beyond their load capacity/limits

2a4) Work party members will install barrier/barricade tapes to work site and affected area
to keep non-essential personnel clear of the work-site

2a5) Task Supervisor ___________ will ensure that all affected personnel completed a
mandatory safety awareness training before work starts

3b. Slip/Trip/Fall due to poor housekeeping, 3b1) Task Supervisor___________ will ensure to discuss in toolbox talks/pre-job safety
obstructions, wet and/or slippery surfaces meeting

3b2) Task Supervisor___________ will ensure unnecessary materials are removed from
pathways. Remove rubbish, unnecessary or loose items on the vehicle bed before loading
the materials

3b3) Task Supervisor___________ will ensure loading and unloading areas are stable
ground, flat, and free from potholes and other obstructions

3c. Fall of materials from truck/pick-up bed 3c1) Task Supervisor___________ will ensure materials are secured with tie-rope or web
binders where applicable and stable on the truck or pick-up bed
A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 5 of 14

3d. Pinch point due to improper coordination 3d1) Task Supervisor___________ will discuss and remind the proper hand and finger
while offloading materials placement during toolbox talk

3d2 Task Supervisor___________ will ensure workers wear appropriate hand gloves for
the manual handling

3e. Dehydration due to hot weather 3e1) Task Supervisor___________ will ensure adequate drinking water and disposable
cups are provided near the working area, heat stress/dehydration shall be reviewed during
toolbox talk and regular breaks are scheduled

3e2) Task Supervisor___________ will ensure temporary facility or shaded area is

designated/assigned to serve as resting area of the personnel during breaks

3f. Struck by or motor vehicle crash 3f1) Task Supervisor___________ will ensure vehicle to be used have been inspected prior
to use

3f2) Task Supervisor___________ will ensure only qualified and authorized drivers and
operators operate or drive vehicle and heavy equipment

3f3) Task Supervisor___________ will designate or assign a traffic controller or flagman to

keep pedestrians out of the work area, install barricade or traffic cones where necessary to
delineate the project area, and in tight areas or areas where there are fixed obstructions or
blind spots

3g. Musculoskeletal disorder from manual 3g1) Task Supervisor___________ will ensure the crew is aware of the associated hazards
handling, heavy load and review manual handling techniques during the pre-task meeting

3g2) Task Supervisor___________ will ensure the proper manual handling technique is
followed and to avoid personnel carrying materials heavier than (25kg max) per person

3g3) Task Supervisor___________ will ensure that manual handling is minimized by

utilizing wheel borrows or other mechanical lifting equipment
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!
4. Erection, modification,
and dismantling of
scaffold
JSA No.: Project No.:
JSA-NOST-US EMB EG-23-001 rev.0
US Embassy Permit No. & Date:
Page 6 of 14
4a. Falling from height 4a1) Task Supervisor ___________ will review precautions at toolbox talk with the work
team
4a2) Task Supervisor ___________ will ensure the fall protection is followed as per the
Nostradamus’ fall protection standards which could include installation of standard guard
rail and/or use of personal fall arrest system
4a3) Task Supervisor ___________ will ensure that 100% tie-off is being utilized by all
workers with use of harness and self-retracting inertia reel to suitable anchor, and that full
body harness in use has updated inspection records and pre-use inspection is conducted
by the user daily or before each use
4a4) Task Supervisor ___________ will exercise Stop Work Authority if unsafe conditions
exist at the work area (e.g., bad weather condition, strong winds/rains, lightning, etc.)
Safety precaution must be observed during bad weather condition
4b. Scaffold failure 4b1) Task Supervisor ___________ will ensure only trained and authorized scaffold
builders perform erection, modification, and dismantling of scaffold
4b2) Task Supervisor ___________ will ensure the scaffold is safe to use. Conduct weekly
inspection of the scaffold by a competent person
4b3) Task Supervisor ___________ will ensure standards and base plates rest on
secure/sturdy planks to distribute the load to the top level or ground
4c. Damaged tools, struck by dropped objects 4c1) Task Supervisor ___________ will ensure no personnel working or standing-by under
overhead works or where there is a potential for drop object such as lifting operations
4c2) Task Supervisor ___________ will ensure the work area is barricaded to prevent
unauthorized access. Prohibit non-essential personnel during scaffold erection,
modification, and dismantling
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!
5. Replacing perimeter
wall light fixtures using a
scaffold
a. removing existing light
fixtures
b. installing new light fixtures
JSA No.:
JSA-NOST-US EMB EG-23-001 rev.0
US Embassy Permit No. & Date:
4d. Hand injury/ Pinch point / Caught in between
4e. Muscular-skeletal injuries or back injuries,
due to heavy lift, over stretching, and repetitive
motion
5a. Potential electrocution/electric shock
Project No.:
Page 7 of 14
4c3) Task Supervisor ___________ will ensure toe broads are installed
4d1) Task Supervisor ___________ will remind the work team of proper hands positioning
(avoid line of fire situation) and proper use of hand tools (appropriate and correct tools for
the job). Conduct pre-use inspection of the tools.
4d2) Task Supervisor ___________ will ensure appropriate PPEs’ worn by the work team
(hand gloves) and mindfulness while installing connections/ couplers from the scaffolds
4e1) Task Supervisor ___________ will discuss muscular-skeletal awareness to the work
team during the toolbox talks
4e2) Task Supervisor ___________ will ensure work team minimize the manual handling
with the use of wheel barrow, or other mechanical means
4e3) Task Supervisor ___________ will ensure the proper manual lifting technique is
followed and to avoid personnel carrying materials heavier than (25kg max) per person
5a1) Task Supervisor _________ will ensure to discuss during the toolbox talk to avoid line
of fire
5a2) Task Supervisor _________ will ensure with the COR that all equipment as well as
circuits to be worked on shall be de-energized before work is started and personnel
protected by clearance procedures and grounding
5a3) Task Supervisor _________ will ensure switches and/or breakers shall be locked off
5a4) Task Supervisor _________ will ensure switches and/or breakers will be marked to
prohibit accidental operations during maintenance
5a5) Task Supervisor _________ will ensure light fixtures will be grounded
A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 8 of 14

5a6) Task Supervisor _________ will ensure exposed empty light sockets and broken
bulbs will not be permitted

5a7) Task Supervisor _________ will ensure care will be taken to insure adequate
clearance from distribution lines

5a8) Task Supervisor _________ will ensure portable metal or conductive ladders shall not
be used near energized lines

5a9) Task Supervisor _________ will ensure all electrical wires and cables, power or
portable tools used on site have been inspected

5a10) Task Supervisor _________ will ensure all electrical wires and cables for power or
portable tools used on site are kept away or protected from sharp edges

5a11) Task Supervisor _________ will ensure affected workers are wearing proper and
required PPE such as hand glove, safety toe footwear, safety goggles, FR coverall, hard
hat, ear plug, fall protection, as a minimum requirement

5b. Burn from hot bulb 5b1) Allow bulb to cool before removing

5c. Fall from heights 5c1) Prior to climbing scaffolds, an inspection shall determine that the structures are
capable of sustaining the additional or unbalanced stresses to which they will be subjected

5c2)Task Supervisor____________ will ensure fall protection are properly being used

5c3) Task Supervisor____________ will ensure all affected workers are wearing harness
and is 100% tied-off

5c4) Task Supervisor____________ will discuss in toolbox talk the requirement to avoid
standing directly under the suspended load

5c5) Task Supervisor____________ will ensure access ways shall be clear of material and
A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 9 of 14

any debris that would create a tripping hazard

5c6) Task Supervisor____________ will exercise Stop Work Authority if unsafe conditions
exist at the work area (e.g., bad weather condition, strong winds/rains, lightning, etc.)
Safety precaution must be observed during bad weather condition

5c7) Task Supervisor____________ will ensure affected workers are wearing proper and
required PPE such as hand glove, safety toe footwear, safety goggles, FR coverall, hard
hat, ear plug, fall protection, as a minimum requirement

5d. Dropped tools/ debris 5d1) Task Supervisor ___________ will ensure no personnel working or standing-by under
overhead works or where there is potential for drop object such as lifting operations

5d2) Task Supervisor _________ will ensure only the needed quantity or amount of tools
and equipment is carried while working at the scaffold. Do not store and leave tools and
equipment on scaffolds. Only take needed tools and equipment to complete the job

5d3) Task Supervisor ___________ will ensure work area is barricaded to prevent
unauthorized access. Prohibit non-essential personnel during scaffold erection.
modification, and dismantling

5d4) Task Supervisor ___________ will ensure toe broads are installed

5d5) Task Supervisor ___________ will ensure bags are being used to avoid drop objects

5e. Laceration, cut or abrasion to skin from 5e1) Task Supervisor __________ will ensure to inspect the work area and equipment for
broken bulb hazardous conditions and correct before continuing work

5e2) Task Supervisor____________ will ensure affected workers are wearing proper and
required PPE such as hand glove, safety spectacles or goggles with side shield, FR
coverall, hard hat, safety toe footwear, ear plug, fall protection, as a minimum requirement
and mindfulness while removing light fixtures (hold bulb gently).
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!
6. Replacing perimeter
wall light fixtures using a
man-lift
a. removing existing light
fixtures
b. installing new light fixtures
JSA No.:
JSA-NOST-US EMB EG-23-001 rev.0
US Embassy Permit No. & Date:
5f. Back injury, pinch points
5g. Eye injury from broken bulb
6a) Occupied aerial-lift becoming disabled with
personnel at elevated positions
6b) Fall from or thrown from man-lift type
equipment
Project No.:
Page 10 of 14
5e3) Task Supervisor____________ will ensure work team are provided with awareness
through active safety program and instruction in first aid treatment
5f1) Task Supervisor _________ will ensure that all personnel use a proper body
mechanics while bending or reaching to remove and replace light fixtures
5f2) Work party members will install barrier/barricade tapes to work site and affected area
to keep non-essential personnel clear of the work-site
5g1) Task Supervisor _________ will ensure affected workers wear eye spectacles or
goggles with side shield
6a1) Task Supervisor _________ will ensure a support person shall be assigned any time
the basket is in the air and aerial lift is operating. This person shall be available at the
work-site and shall have been instructed on the means to manually operate and lower the
aerial-lift basket in the event that the personnel in the basket have lost power and cannot
lower the basket themselves. Communication (radio or verbal) between the support
person and aerial-lift basket occupants shall be available at all times.
6b1) Task Supervisor _________ will ensure affected workers utilize a personal fall arrest
system
6b2) Task Supervisor _________ will ensure affected workers wearing harness and is
100% tied-off
6b3) Aerial lifts shall NOT be utilized to gain access to or from elevated levels
6b4) A full body harness and personal fall device or self retracting lifeline for use in the
horizontal configuration or fall restraint shall be utilized by all personnel when operating
A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 11 of 14

equipment. The PFL/SRL being utilized shall be configured and utilized at the shortest
length possible to prevent ejection from the equipment basket/platform

5b5) Both feet are required to remain on floor of lift equipment when personnel are working
from lift equipment

5b6) Restraints shall be utilized on all other aerial lifts

6c) Struck By or Pinch Point (operating man-lift 6c1) Personnel shall be trained and qualified
type of equipment in tight or limited areas)
6c2) Manufacturer’s operation manual shall be present

6c3) Keep ALL non-operating personnel away from man-lift during all driving and swing
operations

6c4) Establish safe work zone, including use of signs and barricades for ground personnel,
as needed

6c5) Utilize a spotter when working in tight locations or limited areas

6c6) Be aware of objects that could strike the body or result in a whole body pinch point
type of injury (such as exposure to low head space clearance, or head/body/extremities
caught between stationary object and man lift equipment components).

6c7) Task Supervisor _________ will ensure the minimum PPE requirements for using
man-lift type of equipment are worn by the workers such as hand glove, safety spectacles
or goggles, FR coverall, hard hat, safety toe footwear, ear plug, fall protection ,as a
minimum requirement
A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!
JSA No.:
JSA-NOST-US EMB EG-23-001 rev.0
US Embassy Permit No. & Date:
6d) Man-lift equipment failure
6e) Electrical shock hazards due to operation
adjacent to or contacting energized overhead
utilities
6f) Tip-over of equipment during operation
6g) Dropped Object or Tool
Project No.:
Page 12 of 14
6d1) Conduct a pre-use inspection/function test on man-lift
6e1) Operating equipment shall maintain a minimum clearance from overhead energized
electrical wires of 10-feet for voltages up to and including 50 kV
6e2) Traveling equipment shall maintain a minimum 4-6 foot clearance (depending on
voltage) from overhead energized electrical lines
6f1) Maintain contact with COR and HES for wind speed evaluation if windy conditions are
anticipated
6F2) Consult Operator's manual for wind speed limitations
6F3) Set outriggers, when provided, on pads or level, solid surfaces
6g1) Be aware - is there anyone working above you?
6g2) Be aware - is there anyone working below you?
6g3) Barricade areas below when working above
6g4) Contact supervision to obtain permission before entering barricade area(s)
6g5) Only take needed tools and equipment to complete the job
6g6) Secure all tools (such as using tool lanyards) and materials when working at height, if
practicable
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 13 of 14

6gh) Practice excellent housekeeping

6gi) Report all dropped object/tool events

6gj) When in the barricaded area, use and wear appropriate PPEs – safety toe footwear,
FR coverall, hand gloves, eye spectacles or goggles, hard hats, ear plug, fall protection, as a
minimum requirement

7. Unexpected Discovery 7a) Electrical shock/ electrocution Task Supervisor _________

of Unknown Electrical
Lines That Are Not Marked 7a1) STOP WORK, re-evaluate job steps in this JSA to determine if proper safety
precautions are instituted. Clear and secure work zone and make contact with COR and
HES

8. General Activities 8a) Slips, trips, and falls 8a1) Task Supervisor ____________ will maintain adequate housekeeping practices
throughout the task

8a2) Clear access road from obstruction

8a3) Dispose all debris in approved disposal site

8b) Biological fatigue 8b1) Task Supervisor ____________ will monitor the work party for signs of heat stress and
ensure they remain sufficiently hydrated and take regular breaks

8b2) Task Supervisor ____________ will ensure to build temporary shelter for shade

8c) Potential exposure to dust 8c1) Task Supervisor ____________ will ensure workers wear dust/mist respirator to
protect against from dust
 A completed JSA is ONLY valid for the job specified and the piece of equipment specified to be worked on – CAN NOT BE USED FOR SIMILAR JOBS!

JSA No.: Project No.:

JSA-NOST-US EMB EG-23-001 rev.0

US Embassy Permit No. & Date:
Page 14 of 14

8d) Emergency situation 8d1) Task Supervisor ____________ will discuss in toolbox talk the requirement that all
work-party members will make their work area safe and tidy. In case of emergency all
personnel must report to their assigned Muster Station located at __________________

8d2) STOP THE JOB when the situation calls for it

GENERAL PRECAUTION:
1. WORK SHALL BE STOPPED IF THERE ARE DEVIATIONS FROM THIS AGREED JSA AND ANOTHER JSA WILL BE DEVELOPED IF THERE ARE CHANGES IN
WORK METHODS.
2. ALL APPLICABLE STANDARD OPERATING PROCEDURES MUST BE FOLLOWED.
3. HIGH LEVEL OF AWARENESS TO BE OBSERVED
4 US EMBASSY EMERGENCY NOTIFICATION NUMBER: _________________