Job Safety Analysis

1
1. JOB DESCRIPTION: Thickness measurement ultrasonic Location:
JSA Team Leader Name: Christian Ramirez Position: Inspector Date: Signature: Work Order:
JSA Reviewer Name: Carlos Loo Position: Inspector Date: Signature: PTW Number:
Step Sequence of Basic Job Steps Potential Safety & Environmental Recommended Corrective Action or Procedure
No. Break down Job into steps. Each step should Hazards/Impacts Determine what actions are necessary to eliminate or minimize all hazards that
Logical accomplish a major task and be logical. Identify the hazards (health and safety or environmental) could lead to an accident, injury, illness or environmental incident. The risk must be
sequence associated with each step, examine each to find all possible risk reduced or controlled to a level that is acceptable before work commences. Indicate
factors who is to perform the action where applicable against each action

Coordinate with the supervisor of the work who are realization about the team, for
1 Check the work area Men at work / shock
thickness measurements and liquid penetrant

Shock
2 Location of equipment Leather gloves

3 Calibration of thickness measurement Ground level / shock Use of PPE not be distracted during the inspection

4 Thickness measurement Shock Leather gloves

5 Permit closure Slips / sprains Walk in safe areas

¿What to do in case of an emergency alarm?

Evacuate the nearest meeting point

¿What to do in case of an earthquake?

Evacuate the nearest meeting point

Rev.01 16.Aug.2013 Page 1 of 2 SAF-000-FOR-0112

 Job Safety Analysis

2. HAZARD IDENTIFICATION Identify hazards that may be present by ticking items on the list below. 3. PRECAUTIONS: hard hat, safety glasses, safety boots
WORK LOCATION HAZARDOUS AREA HIGH RISK HIGH RISK ADDITIONAL PRECAUTIONS PERMITS
Difficult Entry/Exit Falling Objects Suspended loads Gloves: type ………………….
Hot Work
Hazardous Substances
4. ENVIRONMENTAL ASPECTS tick those
Oxygen Deficiency - attach MSDS to JSA
X Poor Lighting Poor Visibility Goggles X Excavations
Oxygen Excess Working at Heights Slippery Surfaces Inhalable Dusts/Fibers identified 5. EQUIPMENT
Full Face Shield REQUIRED:
Confined Space Entry
Waste generation
Engulfment (trench/ collapse) PotentialArea
Remote spillage of Potential spillage Feeds
Multiple Electrical of HazMat High Noise Levels High Visibility Vest Heavy and/or Critical Lift
disposal HazMat to soil to drains/waterways Static Plant & Equipment:
Air emissions generation X
Poisonous Gas Present Substations Trip Hazards Use of Chemicals Harness Zero Energy LOTO
Effluent generation /
Temperature Extremes Toxic
NoiseSubstances
generation Electrical Hazards - LV ElevatedMobile
Work Platform
Plant & Equipment: Fire Extinguishers Radiation
discharge (dust, fumes, etc.)
Defined Confined Space DifficultySafety
to Communicate Barricades Fire Safety Impairment
Hazard to Flora /Fauna Potential
Potentialfor
soilDifficult
erosion Rescue Electrical Hazards - MV
Other: / Emergency
Explosive Gas Present amongst workers Ventilation Diving
Equipment:
HAZARDOUS SUBSTANCES in work area / to be used -attach Manual Handling Moving Machinery 6.Lighting
JSA SIGN-OFF RECORD:
Other?
MSDS
NAME SIGNATURE DATE NAME SIGNATURE DATE
Sharp Materials Tools & Equipment Erect Scaffolding to access
Ladders used in the task Heat/ Sunlight/ Radiation Respirator or Dust mask Permit to Work #
1 9
Working at Heights Traffic Movement Erect Warning signs
Working near Crane Running or rotating Personal Locks or Tag system
2 & Crane Runways
10
equipment Group isolation
Flamm. Materials Present Pneumatics Welding screen
3 Pressurized Fluids 11 Fall Arrest systems
Welding Face Shield
4 12

5 13

6 14

7 15

8 16
I confirm by my signature below, that I have attended a briefing on the requirements of the attached Job Safety Analysis and agree to perform the work in the manner detailed on it. I confirm that copies of
the relevant Permits, MSDS's, Isolation Plans etc. have been reviewed.

Rev.01 16.Aug.2013 Page 2 of 2 SAF-000-FOR-0112