JOB SAFETY ANALYSIS FORM

Appendix 4

Section 1: JSA
Job:

In house dust clean up using vacuum

Date of Issue: 14th Jul 2016

Department:

Mechanical- Rope Access

Analysis By: Mohd. Shazni

Section:

Mechanical

Equipment Service:

Shut down/Live

Additional PPE Required:

Dust mask/Respirator, Gloves, Protective suit,

Tools Required:

Vacuum hose, Cleaning paper/Lint free paper

1a) Initial installation of rope access

working system and pre-rigged
Rescue system

JSA No DMNDT-JSA-028

Quality Check Post Approval By:

Revision No: (0)
Expiry Date (3 yrs): 13th Jul 2019

1.

1. Falling from Height rescue required when personnel

is suspended/hanging on the ropes.

2.

Anchor point & equipment failure

3.

Dropped objects

1b)Work positioning / access to the

work locations
1c)Handling of tools / materials at
height
1d) Dust clean up / Vacuuming the
area
1e) Clean up the area below
1f) Removing the debris

Approved By: Jayesh J Pillai

Rev.2, 25-Mar -2015

Any hard copy printed is uncontrolled

1.1. Only IRATA certified personnel are used to execute the scope of work. All
personnel are to comply with both IRATA guidelines and company
procedures.
1.2. The supervisor is to ensure all working systems and rescue systems are safe
and fit for use. This will require pre-use checks on all equipment and rechecking after breaks.
1.3. Good communication and supervision are to be maintained at all times.
1.4. Buddy to buddy check is carried out throughout the task.
1.5. Maintain a minimum two points of contact with two independent life lines
to the structure. (follow DMNDT procedure)
1.6. All team members are to be briefed of their roles & responsibilities of the
rescue plan & rescue methods. Functional checks to be performed on prerigged rescue systems daily.
1.7. Self-retracting safety knife forms a part of the emergency response
equipment
2.1. Certified equipment is to be used at all times.
2.2. Check all the rope access equipment before starting work and after breaks
2.3. Only use anchor points that have an approved Professional Engineer
endorsement prior to anchoring the ropes.
2.4. Use appropriate anchor and rope protection to avoid any sharp edges, hot
surfaces or any other potential hazards. This may mean packing sharp edges,
using rope protectors, re-anchoring the ropes or deviating the rope away
from the hazard, the exact method to be used will be at the supervisors
discretion.
3.1 All tools and materials to be on lanyards or secured properly
3.2 Small items are to be carried in bags, which are secured using a lanyard tied
with the harness.
3.3 Exclusion zones to be cordoned off with red and white barrier tape and
appropriate warning signs are displayed.
3.4 A grounds man must be present at all times to ensure third parties do not
enter the area
3.5 No equipment heavier than 5kg to be carried by personnel, items heavier
than 5kg to be on independent hauling and / or lowering system. This will
normally consist of a secure method of attaching the equipment to the rope,
the haul / lower rope and a locking device (e.g. Petzl Stop) anchored securely
to the I Beam structure. In certain circumstances, by changing the top locking

Job:

In house dust clean up using vacuum

Date of Issue: 14th Jul 2016

Department:

Mechanical- Rope Access

Analysis By: Mohd. Shazni

Section:

Mechanical

Equipment Service:

Shut down/Live

Additional PPE Required:

Dust mask/Respirator, Gloves, Protective suit,

Tools Required:

Vacuum hose, Cleaning paper/Lint free paper

4.

5.

JSA No DMNDT-JSA-028

Approved By: Jayesh J Pillai

Quality Check Post Approval By:
Revision No: (0)
Expiry Date (3 yrs): 13th Jul 2019

Manual Handling of the equipment heavy loads, sharp

edges, pinch points.

Cleaning the area using vacuum hose

3.6
4.1
4.2
4.3
4.4
4.5
4.6
5.1

device for a pulley and passing the rope back down, the hauling / lowering can
be done from ground, the specific system used will be at the supervisors
discretion.
For larger items two separate haul systems will have to be used.
Maintain proper positioning and/or posture during material handlings
Do not lift more than 23 kg per person.
Keep hands away from pinch points. Particular care should be taken with
beam clamps.
Use appropriate personal protective equipment.
Always ask for assistance if necessary.
For heavy loads use mechanical means if possible
Ensure proper, IRATA approved positioning is adopted during the work.

5.2 Only vacuum hose and wet cotton rugs/mop is allowed to clean the area. No
usage of dry brush or other dry equipments to clean the area.
5.3 Ensure protective suit is don (if required) and half face respirator is donned.
5.4 Ensure PE certified anchor points are used to anchor the ropes.
5.5 An exclusion zone is set up below to warn others of the work being carried
out.
5.6 IRATA Level 3 supervisor shall be on ground to give clear instructions to
working personnel.
5.7 Ensure only certified equipment is to be used.
5.8 Keep Hands away from Pinch points.
5.9 Ensure no tools attached to the personnel are no greater than 5Kg.
6.

Skin irritation

6.1 Use competent rope access technicians to carry out this task.
6.2 Use leather / Rubber hand gloves

7.

Gas Leak

7.1 Use only certified and approved gas monitors.

7.2 An adequate number of gas monitors are to be used subjected to number of
people and work site locations.

Section 2: Field Considerations at time of task

ASK yourself- What could go wrong? What is the worst thing that could happen if something goes wrong?

Type of area hazards to consider through SPSA Assess, Analysis and Act

Site hazard not limited to; Conflicting activities, line of fire, hot/cold surface, slip/trip fall hazards, containment for any potential spill/leak/remnant, tool conditions/ correct tools, pinch
points/obstruction, lighting/visibility, access/escape route, store energy/ in equipment/line etc.
Identified Site Hazards
Additional Site Hazards

Safety Precaution Taken

Section 3: Tool Box Talk conducted by:

I have explained the JSA and identified site hazards to the execution personnel and personnel involved for task/activities and evaluated/confirmed that they well understand as communicated.
Name: ______________________________

Sign: ____________________________

Designation: _________________________

Company: ________________________

Date: _________________

REMINDER: UPDATE/REVISE YOUR JSA AS JOB SCOPE OR HAZARDS CHANGE

I have read and understand the contents in this JSA form and agree to all safety precautions and procedures to complete this job safely.
All personnel MUST sign before starting work.
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