JSA WORKSHEET Appendix 1

Area of Work Considered: A-2401 Cooling Tower Project: ____ Project No.____________________

1) 2 3) 4)
5) 6 8)
JSA Participants: 9) 10) 7) 12)

11)

Job location and details A-2401 Cooling Tower Pond Cleaning

Prepared By:
Distribution:
Reviewed By:

Type of Permit Required Additional PPE Requirements

Special tools or equipment required
(Please indicate by ticking box) (Please list)
Gum Boot
1) Shovels 5)
Disposal Coverall 2) Scrappers 6)
Cold work permit
Isolation Certificate 3) Vipers 7)
Confined space 4) 8)

JSA Review Process Y N Comments

Was the work crew involved in formulating the JSA?
Did the work crew review the JSA prior to task? Y
Was the JSA referred to during the task? Y
Were the job steps followed?
Can you suggest improvements to the JSA? (Provide details)
Provide details of any incidents

Reviewed by: Signature: Date:

INCIDENT SUMMARY

Report
 PROCEDURE FOR WORK PLACE RISK ASSESSMENT

Situation/Activity Hazards Identified Controls & Checks Required Action By

• Water overflow in ditch
• Contaminated water on
ground
Draining of the Cooling Tower
• Slip in the pond
pond
• Drain in control manner through main drain header.
• Drain in the ditch and then pump out to ground
• Report spills in the ground
Mechanical /
• Use gum boots around pond walls walking.
Production
• Do not allow unskilled labor to climb pond walls
without supervision

Isolation of equipment
Opening of Tower Louvers
Entry in First Pond to remove
sludge /
Piping Nozzle inspection /
cleaning
HSEQ-PK-11-06-00
• •
• Failure to isolate • Identify and isolate the P-2411A/B/C Mechanical /
• Pump damage • Lock and chain the inlet lines Production
• • Make sure the Circulation lines are empty.
• • Make sure plant is in isolated condition else blind the Electrical
• water Inlet outlet lines
• Falling in the pond • Make sure the standing surface is dry Mechanical /
• Improper tools • Make sure body posture is not too much leaning Production
• Unskilled manpower forward
• • Right tool for the specific job
• Skilled manpower
• Confine space entry • Obtain Confine space entry certificate Mechanical /
• Fluid in flow from somewhere • Make sure isolation is properly done Production
• Work at Night • Check O2 level and LEL before entry.
• Oxygen deficiency • Place one detector inside for continuous monitoring
• H2S in the bottom • Entry attendant
• Sludge • Rescue equipment on site.
• Slipping • External communication available
• Algae and fungus • Inform ERT for vessel entry
• Residual chemicals • Not more then 2 person in each pond section
• Bad weather, Temperature • Proper Lighting if sun sets.
• Heat related disorders • Wear Gum boots
• Physical Exhaustion • Wear Disposal coveralls
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Second Pond entry for Sludge
removal /
Piping Nozzle inspection /
cleaning
HSEQ-PK-11-06-00
• High wind.
• Snake & Scorpion Bite
• Work In night
• H2SO4 chemical injection
• Confine space entry
• Fluid in flow from somewhere
• Work at Night
• Oxygen deficiency
• H2S in the bottom
• Sludge
• Slipping
• Algae and fungus
• Residual chemicals
• Bad weather, Temperature
• Heat related disorders
• Physical Exhaustion
• High wind.
• Snake & Scorpion Bite
• Work In night
• H2SO4 chemical injection
PROCEDURE FOR WORK PLACE RISK ASSESSMENT
• Avoid skin contact
• Wear splash Goggles
• Wear Rubber Gloves. Dispose sludge in Hazard waste
• Use basic PPE’s and additional PPE identified in PTW
• Adequate drinking Water / ORS
• Do not over exhaust crew
• Stop Maintenance activities in severe weather
condition.
• No lonely person at work
• Provide adequate lighting for night.
• Isolate H2SO4 pump
• Obtain Confine space entry certificate Mechanical /
• Make sure isolation is properly done Production
• Check O2 level and LEL before entry.
• Place one detector inside for continuous monitoring
• Entry attendant
• Rescue equipment on site.
• External communication available
• Inform ERT for vessel entry
• Not more then 2 person in each pond section
• Proper Lighting if sun sets.
• Wear Gum boots
• Wear Disposal coveralls
• Avoid skin contact
• Wear splash Goggles
• Wear Rubber Gloves. Dispose sludge in Hazard waste
• Use basic PPE’s and additional PPE identified in PTW
• Adequate drinking Water / ORS
• Do not over exhaust crew
• Stop Maintenance activities in severe weather
condition.
• No lonely person at work
• Provide adequate lighting for night.
• Isolate H2SO4 pump
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 PROCEDURE FOR WORK PLACE RISK ASSESSMENT

Washing of the both pond • Unskilled manpower • Wear Gum boots Mechanical /
section • Slipping • Wear Disposal coveralls Production
• Avoid skin contact
• Wear splash Goggles
• Wear Rubber Gloves during water collection
• OMV supervision at all times
Filling of the pond • Trapped Manpower inside • Make sure all permits are closed and filling is Mechanical /
• Leakage of the pipe authorized by permit controller. Production
• Water loss • Before filling physically confirm no manpower or
material is inside the pond.
• Make sure all drained closed
•

HSEQ-PK-11-06-00 Page 4 of 4 /opt/scribd/conversion/tmp/scratch2653/31902694.doc