Job Safety Analysis (JSA) Worksheet

Job Safety Analysis (JSA) Worksheet
Procedure A Job Title & Job Description: Required Date:

To strengthen trailer main chassis
Page : ___ of ___ Expected Completion Date:
Tools and Equipment needed: Personal Protective Equipment:

1. Hydraulic jack
2. I-Beam
3. Lifting belt
4. Level block
5. Cutter
6. Welding set
Step Hazards (Potential Who / What Might Control Measures Or Recommended Action Or Action / Responsible
Sequence Of Basic Job Steps
No. Incident) Be Harmed Procedure Party
1. Chassis or frame is measured and inspected to determine Personal physical Wear a proper personal protective equipment.
modification or repair requirements injury.
2. Inspection report and work plan are prepared during Personal physical Wear a proper personal protective equipment.
inspection injury.
3. Park the trailer on flat ground Personal physical Wear a proper personal protective equipment.
injury.
4. Chock all the tires using wheel chock Personal physical Wear a proper personal protective equipment.
injury.
5. Place I-beam under the bended area of trailer main chassis Personal physical Wear a proper personal protective equipment.
injury.
6. At the both end of the beam, put lifting belt and level block Personal physical Do not use worn or defective pulling clamps, chains,
to secure it with the bended frame injury. or other equipment.
7. Put hydraulic jack at the bended area Personal physical Follow the equipment maker’s instructions.
injury. Use caution when operating hydraulic pulling
equipment. This equipment uses very high pressure
8. Monitor the jacking process visually, including spot weld Personal physical ❏ Do not stand directly in front of, or behind, the
locations. It may be necessary to re-weld damaged spot injury. pulling equipment or in line with chains.
welds before or after the pulling process. Measure the ❏ Warn others in the area to stay clear of the
complete vehicle to ensure all damage is being corrected. pulling operation.
9. Continue jacking until the dimensional alignment is Personal physical ❏ Use safety cables or chains to protect from
restored injury. backlash, should a chain or hook break or a
clamp slip.
❏ Watch and listen for signs of pulls letting loose,
such as weld seams splitting, spot welds
popping, or metal tearing.
10. Release the lifting belt and the level block Personal physical ❏ Do not exceed the pulling equipment or
injury. anchoring system’s limits.
❏ Retighten the anchoring and pulling clamps
after the initial pull.
11. Inspect the frame again Personal physical Wear a proper personal protective equipment.
injury.
12. Once repairs are complete, do a final alignment check. Personal physical Wear a proper personal protective equipment.
injury.
Procedure B Job Title & Job Description: Required Date:

To strengthen trailer main chassis

1. Hydraulic jack
2. I-Beam
3. Lifting belt
4. Level block
5. Cutter
6. Welding set
1. Attach pulling clamps, weld-on tabs, or other devices to
areas that will allow the damage to be removed, reversing
the direction of damage.
2. Set up multiple pulls, if necessary, to remove as much

damage as possible at one time, and to prevent tearing or
distorting the metal.
3. Apply pressure evenly to all points at one time, or pull

small amounts time moving from one attachment point to
another, depending on the plan.
4. Monitor the pulling process visually, including spot weld

locations. It may be necessary to re-weld damaged spot
welds before or after the pulling process. Measure the
complete vehicle to ensure all damage is being corrected.
5. Correct secondary damage and damage farthest from the

impact point before removing all primary damage. Follow
a last-in, first-out order.
6. Relieve stress frequently throughout the pulling process.
Monitor the pulling pressure to ensure stress is being
relieved.
7. Continue pulling until the dimensional alignment is

restored.
8. A calculated over pull may be necessary, to allow the parts

to stay in correct dimensional alignment when the pulling
pressure is released. If not, the process must be repeated.
9. Use a three-dimensional measuring system to verify the

repair. Record the measurements.
10. Restore the corrosion protection to the repaired areas, and

to the areas where anchoring and pulling clamps were
installed.
11. Refinish as necessary to restore the appearance.
Procedure A Job Title & Job Description: Required Date:

To reinforce and weld trailer main chassis

1. Hydraulic jack
2. I-Beam
3. Lifting belt
4. Level block
5. Cutter
6. Welding set
1. Clean the mating surfaces to remove oxides and any other
residual contaminants that could adversely affect weld
quality.
2. Clamp the mating surfaces tightly together.
3. Make sample test welds on scrap pieces of the same alloy

and thickness as the parts to be welded. Make the sample
welds in the same position as the welds on the vehicle.
4. Visually inspect and destructively test the sample welds to

verify the welder settings and the welding technique.
5. Locate the work clamp as close to the welding site as

possible.
6. Make the welds on the actual parts. Weld as far as possible

in one pass to avoid defects caused by cold starts. Some
vehicle makers recommend preheating the weld area to
reduce defects caused by cold starts.
7. Dress the welds, as required. Do not reduce the thickness

of the surrounding metal.
List Of Manpower Involved

We, the undersigned, hereby:
1. Have been briefed and shall observe and comply with the JSA requirements at all time.
2. Are deemed fit to work
No. Name NRIC or Passport No. Citizenship Designation Signature

1. CHIN KOK PING 851130-12-6409 MALAYSIAN SUPERVISOR
2. SAMUEL TIAU 960702-13-5013 MALAYSIAN ADMIN
3. ELVISSION EDDY MUGANG 880824-13-5353 MALAYSIAN MECHANIC
4. MORRIS CHANG MARKUS 951028-13-6465 MALAYSIAN MECHANIC ASSISTANT
5.
6.
7.
8.
9.
10.
11.
12.
Note: Please fill in at the appropriate column below i.e. name of company, your name, signature and stamp, and date.
INSTRUCTIONS FOR COMPLETING JOB SAFETY ANALYSIS WORKSHEET

Job Safety Analysis (JSA) is an important accident prevention tool that works by finding hazards and eliminating or minimizing them before the job is performed and before they have a chance to
become accidents. Use your JSA for job clarification and hazard awareness, as a guide in new employee training, for periodic contacts and for retraining of senior employees as refresher on jobs
which run infrequently, as an accident investigation tools and for informing employees of specific job hazards and protective measures. Set priorities for doing JSA's : Jobs that have a history of
many accident s , job that have produced disabling injuries, job with high potential for disabling injury or death, and new jobs with no accident history
Control Measures Or
Step Who / What Might
Sequence Of Basic Job Steps Hazards (Potential Incident) Recommended Action Or Action / Responsible Party
No. Be Harmed
Procedure
Break the job down into steps. Each of the Identify the hazard associated with each Parties expose to Using the first two columns as a Workers involved in the job.
steps of a job should accomplish some major step. Examine each step to find and the hazard. guide, decide what actions are
task. The task will consist of a set of identify hazards actions, conditions and necessary to eliminate or minimize
movements. Look at the first set of movements possibilities that could lead to an the hazards that could lead to an
used to perform a task and then determine the accident. It's not enough to look at the accident, injury or occupational
next logical set of movements. obvious hazards. It's also important to illness. Among the actions that can
For Example; look at the entire environment and be taken are :
The job might be to move a box from a discover every conceivable hazard that 1-engineering the hazard out. 2-
conveyor in the receiving area to a shelf in the might exist. providing personal protective
storage area. How does that break down into Be sure to list health hazards as well, equipment. 3-job instruction
job steps? Picking up the box from the even though the harmful effect may not training. 4-good housekeeping. 5-
conveyor and putting it on a hand truck is one be immediate A good example is the good ergonomics (position the
logical set of movements, so it is one job step. harmful effect of inhaling a solvent or person in relation to the machine or
Everything related to that one logical set of chemical dust over a long period of time. other elements in the environment in
movement is part of the job step. It's important to list all hazards such a way as to eliminate stresses
The next logical set of movement might be contribute to accidents, injuries and and strains). List recommended safe
pushing the loaded hand truck to the storeroom. occupational illness. In order to do JSA, operating procedures on the form,
Removing the boxes from the truck and placing you must identify potential and existing and also list required or
them on the shelf is another logical set of hazards. That's why it's important to recommended personal protective
movements. And finally, returning the hand distinguish between a hazard, an equipment for each step of the job.
truck to the receiving area might be the final accident and an injury. Each of these Be specific. Say exactly what needs
step in this type of job. Be sure to list all the terms has a specific meaning. to be done to correct the hazard,
steps in a job. Some steps might not be done HAZARD - A potential danger. Oil on such as "lift" using your leg
each time- checking the casters on a hand- the floor is a hazard. muscles. Avoid general statements
truck. ACCIDENT – An unintended like "be careful". Give a
happening that may result in injury, loss recommended action or procedure
or damage. for every hazard. If the hazard is a

INJURY – The result of an accident. A serious one, it should be corrected
sprained wrist from the fall would be an immediately. The JSA should then
injury. be changed to reflect the new
conditions.
Typical Example Of Completed Job Safety Analysis
Location : Job Title & Job Description : Required Date:

Storage Godown No 1 Banding Pallets
(Description of your task) Page: 1 of 1
Expected Completion Date:
Primary Hazard : Required Personal Protective Equipment:

1-Sharp object & Splinter cuts to the body parts (hand, fingers legs, etc.) 1) Safety Helmet. 2) Safety Shoes. 3) Goggle. 4) Dust Mask. 4) Long sleeves
Step Who / What Might Be Control Measures Or Recommended Action Or Action / Responsible
Sequence Of Basic Job Steps Hazards (Potential Incident)
No. Harmed Procedure Party
Position portable banding cart and place Cart positioned too close to
Leave ample space between cart and pallet to feed
1. strapping guide on top of boxes. pallet (strike body & legs Bander Bander & supervisor
strapping - have firm grip on strapping gun.
against cart or pallet
Wear gloves, eye protection & long sleeves - keep

Withdraw strapping and bend end back about 3". Sharp edges of strapping (cut
2. Bander firm grip on strapping - hold end between thumb & Bander & supervisor
hands, fingers & arms)
forefinger - watch where stepping.
Walk around load while holding strapping with

Projecting sharp corners on the Bander & other Assure a clear path between pallet and cart - pull
3. one hand. Bander & supervisor
pallet (strike feet on corners) workers passing by smoothly - avoid jerking strapping.
Splinters on pallet (punctures to Wear glove - eye protection - long sleeves.

Pull and feed strap under pallet. hands and fingers) Point strap in direction of bend - pull strap
4. Bander Bander & supervisor
Sharp strap edges (cuts to smoothly to avoid jerks.
hands, fingers and arms)

Job Safety Analysis (JSA) Worksheet

Uploaded by

Copyright:

Available Formats

You might also like

Job Safety Analysis (JSA) Worksheet

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Job Safety Analysis (JSA) Worksheet

Uploaded by

Copyright:

Available Formats

Job Safety Analysis (JSA) Worksheet

Procedure A Job Title & Job Description: Required Date:

Tools and Equipment needed: Personal Protective Equipment:

Procedure B Job Title & Job Description: Required Date:

Tools and Equipment needed: Personal Protective Equipment:

2. Set up multiple pulls, if necessary, to remove as much

3. Apply pressure evenly to all points at one time, or pull

4. Monitor the pulling process visually, including spot weld

5. Correct secondary damage and damage farthest from the

7. Continue pulling until the dimensional alignment is

8. A calculated over pull may be necessary, to allow the parts

9. Use a three-dimensional measuring system to verify the

10. Restore the corrosion protection to the repaired areas, and

11. Refinish as necessary to restore the appearance.

Procedure A Job Title & Job Description: Required Date:

Tools and Equipment needed: Personal Protective Equipment:

2. Clamp the mating surfaces tightly together.

3. Make sample test welds on scrap pieces of the same alloy

4. Visually inspect and destructively test the sample welds to

5. Locate the work clamp as close to the welding site as

6. Make the welds on the actual parts. Weld as far as possible

7. Dress the welds, as required. Do not reduce the thickness

List Of Manpower Involved

No. Name NRIC or Passport No. Citizenship Designation Signature

2. SAMUEL TIAU 960702-13-5013 MALAYSIAN ADMIN

3. ELVISSION EDDY MUGANG 880824-13-5353 MALAYSIAN MECHANIC

4. MORRIS CHANG MARKUS 951028-13-6465 MALAYSIAN MECHANIC ASSISTANT

INSTRUCTIONS FOR COMPLETING JOB SAFETY ANALYSIS WORKSHEET

or damage. for every hazard. If the hazard is a

Typical Example Of Completed Job Safety Analysis

Location : Job Title & Job Description : Required Date:

Primary Hazard : Required Personal Protective Equipment:

Wear gloves, eye protection & long sleeves - keep

Walk around load while holding strapping with

Splinters on pallet (punctures to Wear glove - eye protection - long sleeves.

You might also like