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    Master Copy of JSA Format 3 24 11 PDF

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    jinyuan74
    This document is a job safety analysis worksheet for a third party job location. It records information such as the job description, whether permits or lock out/tag out are required, and weather conditions. The worksheet lists steps of the work sequence, potential hazards, and recommendations to eliminate or reduce hazards. It requires team member signatures and specifies required personal protective equipment including hard hats, steel toe boots, safety glasses, and cotton gloves. The document emphasizes safety and planning the work.

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    Master Copy of JSA Format 3 24 11 PDF

    Uploaded by

    jinyuan74
    56 views2 pages
    This document is a job safety analysis worksheet for a third party job location. It records information such as the job description, whether permits or lock out/tag out are required, and weather conditions. The worksheet lists steps of the work sequence, potential hazards, and recommendations to eliminate or reduce hazards. It requires team member signatures and specifies required personal protective equipment including hard hats, steel toe boots, safety glasses, and cotton gloves. The document emphasizes safety and planning the work.

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    jsa

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    Master-Copy-of-JSA-Format-3-24-11.pdf

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    This document is a job safety analysis worksheet for a third party job location. It records information such as the job description, whether permits or lock out/tag out are required, and weather conditions. The worksheet lists steps of the work sequence, potential hazards, and recommendations to eliminate or reduce hazards. It requires team member signatures and specifies required personal protective equipment including hard hats, steel toe boots, safety glasses, and cotton gloves. The document emphasizes safety and planning the work.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    56 views2 pages

    Master Copy of JSA Format 3 24 11 PDF

    Uploaded by

    jinyuan74
    This document is a job safety analysis worksheet for a third party job location. It records information such as the job description, whether permits or lock out/tag out are required, and weather conditions. The worksheet lists steps of the work sequence, potential hazards, and recommendations to eliminate or reduce hazards. It requires team member signatures and specifies required personal protective equipment including hard hats, steel toe boots, safety glasses, and cotton gloves. The document emphasizes safety and planning the work.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 2

    JOB SAFETY ANALYSIS WORKSHEET Location: Third Party on Location: Job Description: Permit to Work: Rig Name/ Rig

    Crew: Lock Out/ Tag Out: Hot Work: Operator: Confined Space:

    Weather/Temp: Date:

    Page:

    Safety Days: Rig Manager:


    RESPONSIBLE PERSON

    WORK SEQUENCE (JOB STEPS)

    HAZARDS OR POTENTIAL ACCIDENTS

    RECOMMENDATIONS TO ELIMINATE OR REDUCE HAZARDS

    IF ANY REVISIONS ARE NEEDED FILL OUT ON BACK SIDE OF SHEET

    PLAN YOUR WORK & WORK YOUR PLAN!


    *IF JOB SCOPE CHANGES STOP JOB, DO A 5 X 5, REVISE JSA AND IDENTIFY NEW HAZARDS*
    LIST BELOW YOUR PERSONEL PROTECTIVE EQUIPMENT, SPECIAL TOOLS AND FALL PROTECTION REQUIRED TO DO THIS JOB: Hard Hat X Steel Toe Boots X Additional PPE Required: Safety Glasses X Cotton Gloves X TEAM MEMBER SIGNATURES BELOW AND SSE HANDS CHECK BOX BY SIGNATURE 5 1 9

    2 3 4

    6 7 8

    10 11 12

    ELIMINATE

    CONTROL

    PROTECT

    JOB SAFETY ANALYSIS WORKSHEET


    Work Activity (Job) Description: Weather: Permit to Work:
    WORK SEQUENCE (JOB STEPS)

    Page Number: Safety Alert Discussion: Lock Out/ Tag Out:


    HAZARDS OR POTENTIAL ACCIDENTS

    Hot Work:

    Confined Space:
    RESPONSIBLE PERSON

    RECOMMENDATIONS TO ELIMINATE OR REDUCE HAZARDS

    *IF JOB SCOPE CHANGES STOP JOB, DO A 5 X 5, REVISE JSA AND IDENTIFY NEW HAZARDS*
    PERSONEL PROTECTIVE EQUIPMENT, SPECIAL TOOLS AND FALL PROTECTION REQUIRED TO DO THIS JOB: Hard Hat X Safety Glasses X Cotton Gloves X Steel Toe Boots X

    Safety is everyones job! If you dont know ask!!!!!

    PLAN YOUR WORK & WORK YOUR PLAN!


    ELIMINATE CONTROL PROTECT

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