Important: All injuries and incidents must be reported within critical timelines.

See Ericsson Injury Incident Reporting Instructions

(JSA) Job Safety Analysis

Complete Daily (Before Beginning Work or for Pre-Job Planning/Analysis) Page 1 of 2
(Must be updated if the work or exposures change)
Job Information
Date: Site Name: Site ID or FA Loc. #
Site Address: Person Completing JSA:

Project Personnel
Name: Company: CPR/First Name: Company: CPR/First
Aid Aid
Yes Yes
No No
Yes Yes
No No
Yes Yes
No No

Emergency Procedures
List telephone numbers and attach directions to the site:
Are 911 systems functional with cell phone use? Yes No
Tower Rescue Procedures to be used (per your company policy):

Fire Department: In House Crew Other

Ambulance: Telephone Co:
Local Hospital: Police:
Evacuation Point: Utility Co:

Job/Task for Today or Pre-Job Analysis

Check which is being performed:

Line and Antennas Tower Work/Erection Civil/Concrete Electrical Hot Work/Hot Work
Permit
Crane Operations Critical Lift If yes, you must complete a Critical Lift Permit. Rooftop Work
Controlled Descent If yes you must submit a Controlled Descent Plan to the Ericsson PM/CM and receive approval prior to performing the
descent
Hot Work Procedures- electrical panels etc.
Welding and grinding safety precautions on Towers, Roofs, and ground.(These are minimal requirements, additional precautions may be necessary):
o Fire blankets on site
o Spotter(s) should be where the welder is working and in a position to see where sparks and slag is falling or blowing
o Spotter(s) should be on the ground to perform spot checks and to put fires out as they start
o Welding is not permitted with wind in excess of 20 mph unless additional precautions are taken and approved by the Ericsson
market PM/CM
o Review site access - water truck needs access to anywhere sparks could be present
o Minimum of two easily accessible fire extinguishers. More may be required depending on site conditions and area
o Contact the local fire department before the job starts to verify current conditions. (Restrictions, Permits).

Other - Describe Job/Issues: Please use the back of the form for additional notes, comments or drawings if needed

Rev F 09.15.2015
 Important: All injuries and incidents must be reported within critical timelines.
See Ericsson Injury Incident Reporting Instructions
(JSA) Job Safety Analysis
Page 2 of 2
(Job Exposures)
Hazards Identification: (Items checked below relate to existing conditions, or may be a result of site operations)

Physical Hazards Health Hazards

Falls from elevations Electrical Heat Stress Cold Stress
Slips, Trip, or falls Underground utilities High Noise (>85 dBA) Chemical Exposure
Vehicle Traffic Elevation/Site Terrain Silica Exposure (Concrete Cutting)
Hot Work( including welding and/or grinding) EME/RF Lifting Hazards
(see precautions under Job task) Other: _______________
Other :_____________________________
(3) Hazard Control Measures
Personal Protective Inspections Inspections Safety Program/Training
Equipment/Monitoring
Equipment
Hard Hat Safety Glasses Tools/Equipment Rigging Tailgate Meeting 4 in-1 Signs
Hearing Fall Protection Housekeeping Tag Lines Lockout/Tagout Excavation Log
Gloves RF Suits Ground Fault Protection Permit System (Hoisting Personnel, Confined Space,
RF Monitors Gin Poles Hoists Excavation, Critical Lifts, Controlled Descents etc.)
RF Training
Complete for Civil Work
1. Describe type and depth of excavations:
2.Cave-in control measures to be used if excavation will be greater than 5 feet and personnel are entering the trench:

Sloping Benching Shoring Trench Shield/Box Ladder in Trench at @ 4+ Feet Required

3. Describe elevation/site terrain/environmental concerns or hazards:

4. Describe hazards with site/vehicle access (i.e. boom and cranes/electrical lines) and storage of materials:

5. Describe the type of electrical concerns or hazards:

Complete for Tower/Rooftop Work (Fall Protection & Using Suspended Personnel Platform)
Type of Tower/Rooftop: Type of Antenna Boom:
Fall protection to be used:
Full Body Harness Double Leg or Two Lanyards Rope Grab Cable Grab
Retractable Lifeline Anchorage Straps Ropes Descenders
NOTE: Controlled Descents and Suspended Positioning
Anchorages used to support suspended positioning rigs shall be independent of any anchorage being used for attachment of a PFAS and shall be capable of
supporting at least 5,000 pounds per employee attached.
Ropes and straps (webbing) used in suspension and descent rigs shall be made from synthetic fibers. Suspension and descent lines or systems and all
necessary slings, connectors and friction devices shall have a minimum breaking strength of 5,000 pounds. All lines shall be protected against being cut or
abraded. Each employee on a suspended positioning rig shall be protected by a PFAS.
1. Has each employee inspected his or her fall protection equipment? Yes No
2. Describe the fall protection system to be used for the job including Controlled Descent Applications: Use back of the form
3. Describe the fall protection system to be used when accessing antenna booms or performing tower erection: Use back of the form
4. Hoisting Equipment to be used:
Suspended Personnel Platform (Man-basket) Crane/Boom Truck Gin Pole
5. Has a Suspended Personnel Platform Permit been completed and submitted to the Ericsson PM/CM?
JSA Review - Managers/Supervisors/Leads Contractor All Crew Members
Name Signature Name Signature

Additional Comments: Use back of form

Rev F 09.15.2015