JOB SAFETY ANALYSIS FRONT SHEET

INSTALLATION / SITE DATE

JSA REF NUMBER JSA TEAM (NAME LIST)
DEPARTMENT NAME POSITION
PERMIT TO WORK NO
TASK DESCRIPTION

REFERENCES AND ANY OTHER RELEVANT INFORMATION ( e.g P CONFIRMED ALARP

& ID's , Drawings,Procedure , Work Instructions, Certificates , Special Tools or Equipment) JSA APPROVED BY (Installation / Facility /Site Manager)

Name
Signature
Position
Date
 JOB SAFETY ANALYSIS WORKSHEET
Task Description Summary - FABRICATION & ERECTION OF PIPING AND STRUCTURE
JSA Ref No- SW/Mech/JSA/Piping-1
1. 2. 4. IR 6. 7. RR
Potential 3. 5.
STEP

Activity
Description Hazard Hazard Effect E P R Existing Controls & Controls Required Responsible E P R
1. Working without work permit 1. Illegal Operation 1. Strict compliance of PTW procedure and requirements
2. Performing authority not available 2. Clash of activities Unlikely 2.PTW must be kept visible at work location
at work location Serious could occur Site engineer, Serious Very unlikely
1 Obtain Permit To Work single injury less than L Performing single injury to chance of L
and LTI 50/50 3. Permit issuer and receiver must conduct work site inspection prior issuing the permit authority and LTI occurrence
chance
4. Performing authority must be available at site until the work is in progress

1. Slippery surface 1. Slip trip and fall on same level 1. Inspection of work location prior to start the job
2.Defective tools 2. Personal injury Unlikely 2. Clear the area and access/ egress to be used identified us lines to be isolated if identify
2 Work Area Preparation 3. Damage to equipment tools and tackles Serious could occur M 3. Clear the area and access/ egress to be used identified us lines to be isolated if identify
Site engineer, Serious Very unlikely
L
less than Performing single injury to chance of
single injury
50/50 authority and LTI occurrence
chance 4. No unauthorized movement

1. Inadequate use of tools 1.Finger caught in between 1. Inspect tools before using
2. Failure to use of PPEs 2. Personal injury Unlikely 2. use right tools for right job

3 Use of hand tools

3. Using makeshift tools 3. Damage to equipment Serious could occur L
3. Use appropriate PPEs Site engineer, Serious Very unlikely
L
less than Performing single injury to chance of
single injury 50/50 authority and LTI occurrence
chance 4. Do not use makeshift or damage tools at site

1. Exposure to CO.CO2. H2S 1. Gas monitoring to be done

2. Fire 2. Area inspection checks to be done
3. Explosion 3. Ensure no combustible/Flammable material around and ensure good housekeeping
4. Strictly follow zero tolerance and life saving guideline
5. Appropriate fire extinguisher to be made available Very unlikely
Possible Site engineer,
4 Work on HC atmosphere 1. Leakage of toxic and flammable Major more 50/50 H 6. Ensure adequate supervision Performing Major more little or no M
gases than one LTI than one LTI chance of
chance 7. No mobile allowed inside the working site authority occurrence
8. Ensure atmospheric test to prevent exposure carry gas detector all time at working location
9. Crew should be aware about emergency and response
10. Emergency action should be communicated during the TBT
11. All personals within well pad to be H2S trained and equipped with H2S mask
1. Working in direct line of fire 1. Personal injury 1. Permit to work system shall be strictly followed Escape H2S mask
2. Human error 2. Damage to plant utility or material Unlikely 2. Permit issuer and receiver shall jointly inspect the job site. Identified site
3. Damage of property 3. Damage to equipment Serious could occur 3. Conflict in the task shall be assessed by issuing and performing authority Site engineer, Serious Very unlikely
5 SIMPOS (Simultaneous M L
single injury less than Performing single injury to chance of
operation) and LTI 50/50 authority and LTI occurrence
4. Conflict of activities chance 4. Conduct job specific tool box talk before job start

1. Uncontrolled lifting
Unauthorized crane operation Injury to personnel 1. Only certified rigger shall be deployed.Only one authorized signal man shall be deployed for signaling
activity
Poor rigging
Possible Site engineer, Very unlikely
6 Unloading / Loading of material 2. Fall of material Property Damage Major more H
2. Only certified crane operator shall operate the crane. Major more little or no M
on trailer bed than one LTI 50/50 Performing than one LTI chance of
chance authority
3. High wind speed Adverse weather occurrence
Crane toppling 3. Ensure all lifting appliances tested and certified
condition high temperature

4. In case of high wind speed and adverse weather condition stopp the activity
Working at height 1. Unsafe Working platform. Fall of material/ personnal injury 1. Ensure to provide safe working platform while work.
Inadequate working platform
Possible Site engineer, very unlikely
7 2. Fall of material Personnal injury/ Property Damage Major more H 2. Use proper lifting tools and tackles while work Major more little or no M
than one LTI 50/50 Performing than one LTI chance of
chance authority
occurrence
3. Fall from height Personnal injury 3. Ensure TBT conducted heighlighting working at height requirements. Ensute all persons working at
height wear safety harness and anchor to rigid support
Erection of pipe by using crane 1. Failure of lifting equipments / 1. Use only certified crane / tackles, Safety devices in crane, Competent operator and banks man, Proper
Injury to personnel
tackles, slinging, PPE
2. Uneven ground. Overload. 2. Inspection for even & stability of ground surface, Provide steel plates / wooden planks under crane
Property Damage Possible Site engineer, very unlikely
Major more jack, Load calculation (SWL), Major more little or no
8 50/50 H Performing M
than one LTI chance authority than one LTI chance of
3. Lifting in congested area, Crane toppling 3. Ensure all lifting appliances tested and certified occurrence
4. Suspended load.
Fall of material/ personnal injury 4. Barricade the area, Sign boards, Stop unauthorized entry , Environmental limits,

Alighnment & fit up

9 1. Pinch points Finger and hand injury 1. Ensure persons working for fit up wear hand gloves and work away from line of fire Moderate Very unlikely
Serious Possible Site engineer, ffsite little or no
single injury 50/50 M Performing M
and LTI chance authority medical chance of
treatment occurrence
2. Line of fire

1. Welding arc/ Gas leak Fire/ Explosion 1. Continuous gas monitoring

Possible
Arc /tig Welding 2. Generation of Hazardous Waste Property Damage, Soil contamination Major more 2. Hot work compliance checklist shall be ensured prior to start the work activity. Fire Watch, Fire Very unlikely
(Electrodes) than one LTI 50/50 blankets and extinguishers available on site at all times Site engineer,
10 chance H Major more little or no M
Performing than one LTI chance of
3. Flying object Personnal injury/ Eye injury 3. Remove all combustible materials from the hot work area. authority
occurrence
 occurrence
4. Fire hazard Fire 4. Inspect the equipment, including welding machines, generators,Cables etc./RCCB for power tools and
body earthling for DG set

1. Fire hazard & Arc flash Eye injury 2 . Flash back arresters at both sides (Torch and cylinder) shall be ensured. ● Keep gas cylinders at safe
location
Very unlikely
Possible Site engineer,
11 Gas Cutting/ Welding Major more H Major more little or no M
than one LTI 50/50 3. Use fire blankety for work/Sparks / spatters to be contained & booth to be ensured by approved fire Performing than one LTI chance of
2. Generation of Metal Waste chance authority
retardant material/ Ensure Proper ventilation occurrence
4. Regulator & gauges are to be in good condition . Dispose metal waste at designated place

1. Shattering of grinding / cutting 1.Grinding area enclosure with approved fire blanket shall be ensured.
wheel Physical injury
2. Noise Noise hearing impairment 2. Ensure workers working with gringing wear ear plugs Very unlikely
Major more Possible Site engineer, Major more little or no
12 Grinding 3. Flying metal particles Eye and face injury 50/50 H 3. Job specific PPE’s (Face Shield, Helmet, Safety Shoe & hand gloves) shall be ensured. Tool box talk prior Performing M
than one LTI chance to work to be ensured. authority than one LTI chance of
occurrence
4. Fire Hazard 4. Fire extinguishers shall be placed at hot work area.

5. Electrocution Electrocution 5. All electrical connections should be routed through 30mA ELCB / RCCB for power tools and body
earthling for DG sets. Industrial socket / plug tops shall be ensured.
1. Failure to use of PPEs Personnal injury
2. Adequate ladder in to Cellar pit Fall of persons into the excavation Unlikely
3. Presence of toxic gases Personnal injury Serious
4. Poor housekeeping could occur Site engineer, Serious Very unlikely
13 Confined space entry single 1. Ensure appropriate PPEs is used by all engaged workmen Performing single injury to chance of L
less than H 2. Adequate access should be provided for Cellar pit 3.
injury and authority and LTI occurance
50/50 Ensure atmosphiaric gas test done/ Maintainn entry and exit log sheet
LTI
chance 4. Keep work area free from obstructions

14 Housekeeping and close of work
for the day
15 Emergency response
1. Accumulation of debris 1. Slip trip and fall on same level Unlikely 1. Housekeeping shall be maintained during the activity and end of the job
unlikely could
2. Fire and explosion 2. Non closer of permit Serious could occur 2. Remove all the debris from the site and disposed in designated place Site engineer, Moderate off occur less
single injury less than M Performing site medical L
3. Electric shock 3. Electrocution and LTI 50/50 3. Permit must be close and submit upon completion of job authority treatment than 50/50/
chance
4. Personal injury chance
1. Extreme weather condition 1. Collapse of individuals 1. Evacuation procedure shall be in place
Unlikely unlikely could
2. lack of supervision 2. Unavailability of emergency vehicle Serious could occur 2. Effective TBT shall include emergency response Site engineer, Moderate off
single injury less than M Performing site medical occur less L
3. Leakage of toxic or flammable gas 3. Fire 3. Ensure emergency vehicle arrangement is in place than 50/50/
and LTI 50/50 authority treatment chance
chance
4. Proper arrangement for coming out from excavated pit to be ensured
1. Poor communication 1. Working without extension of PTW 1. Ensure engaged crew is trained in working night shift

2. In adequate illumination 2. Human fatigue 2. Ensure adequate illumination arrangement. Ensure workers working in night shift wear clear safety
Unlikely goggles. unlikely could
Serious could occur Site engineer, Moderate off occur less
16 Night shift work 3. lack of supervision 3. poor visibility single injury less than M 3. Ensure effective night shift supervision Performing site medical L
than 50/50/
4. Eating at site 4. Attracting live reptiles and LTI 50/50 4. Stop work in the event of adverse climate authority treatment chance
chance
5. Ensure night shift personals get enough sleep or rest during day
6. Ensure that personal are trained to meet emergency that may occur at night
1.unavailibility of drinking water 1. Heat related illness
2. Lack of rest shad 2. Collapse of workmen Moderate Unlikely 1. Ensure plenty of cool drinking water is available at site unlikely could
could occur Site engineer, Moderate off
17 Heat stress management off site M occur less L
medical less than Performing site medical than 50/50/
50/50 2. Ensure adequate rest shelter is available for workmen to take rest as per procedure and heat index flag authority treatment
3. Failure to follow heat index flag treatment chance chance
system
 RISK MATRIX

Severity
1. 2. 3. 4.
Minor Moderate Serious Major
No or Minor Off Site Serious Injury More than One
Injury Medical Treatment & LTI LTI

5.
Will Occur in 5 10 15 20
present state
Probability (Likelihood of the Occurance)

4.
More likely to 4 8 12 16
occur than not

3.
Possible 50/50 3 6 9 12
chance

2.
Unlikely Could 2 4 6 8
occur less than
50/50 chance
1.
Very Unlikely
little or no 1 2 3 4
chance of
occurrence

1-3 Low Risk Managed by routine procedures.May be acceptable,however review

to see if risk can be reduced further

4-6 Modrate Risk Task should only proceed with appropriate management
authorisation

8-12 High Risk Task needs further review and consultation with specialists and
where possible the task should be re-defined to take account
of the hazards involved or the risk should be reduced to further before
the task is allowed to commence

15-25 Extreme Risk Task should not proceed

 5.
Significant
Permanent
Disability and
Fatality

25

20

15

10

able,however review

h specialists and
o take account
duced to further before