JOB SAFETY ASSESSMENT

Department/Company: CO. Work Location: Description of Work/Activity:

JSA No: Assessors: Reviewed By: Approved

SN Name Position Signature
Revision No:
Last Revision Date:

RISK TO INITIAL
S RESIDUAL ACTIO
JOB STEPS HAZARDS IDENTIFIED WHAT (S) RATING CONTROLS
N RATING BY
P E A R L SxL
1. 3 1 2 - 3 3X3 Low
=9

Company General Use

Form No. KJO-6400-02-02/1 Rev. 02, 25/11/2019
 Note: EMERGENCY NUMBERS. 1. The employees shall be complete safety orientation by concern department.
2. Work safety supervisor shall conduct the daily tool box meeting.
3. Continuous monitoring by work safety supervisor and site engineer, shall be available at all time of the
4. All employee must aware the hazards of place and precautions as per JSA.

LEGEND: (P) - People ; ( E ) – Environment ; (A) – Asset ; (R) - Reputation; (S) – Severity of Consequence ; (L) –
Likelihood of Occurrence
CHECK REQUIRED PPE, SAFETY EQUIPMENT AND CONTROLS REQUIRED
Hard Hats √ Respiratory Eqpt. HEPA filtered Face Protection √ Life Rings √ Man Basket
Safety Glass/Goggles √ Work Disposable Coverall Signs Boards √ Life Jacket √ Permit to Work
Safety Shoes/Boots √ Full Body Harness √ Barricades √ Material Handling Eqpt. √ LOTO
Safety gloves √ Self- Retracting Lifeline(SRL) Fire Protection √ Gas Test √ Other Eqpt.

Company General Use

Form No. KJO-6400-02-02/1 Rev. 02, 25/11/2019