Rules and Procedures Committee 619144340.

xlsx 10/15/2022

Job Safety Analysis Checklist

Job Supervisor and Company Name

What is the Job to be Done?:

Name
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REQUIRED AND/OR RECOMMENDED PERSONAL PROTECTIVE EQUIPMENT (PPE):

[ Y ]Safety glasses [ Y ] Safety shoes [ Y ]Dust Mask
[ Y ]Chemical goggles [ Y ] Safety Helmet [ ]Welding gloves
[ ]Face shield [ ] Harness lanyard [ ] Leather gloves

STEP 1 - LIST THE SEQUENCE OF BASIC

JOB STEPS
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Work start up & obtaining PTW

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Motor Decouple

Pump overhauling
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Proper Housekeeping
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alysis Checklist
Has it been done before?
Yes/No?

Sign.
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AL PROTECTIVE EQUIPMENT (PPE):

shoes [ Y ]Dust Mask [ ]Welding goggles [ ] Other __
y Helmet [ ]Welding gloves [ ]Hearing protection [ ] Other
ss lanyard [ ] Leather gloves [ Y ]Chemical resistant gloves [ ] Other

STEP 2 - POTENTIAL HAZARDS and WHAT COULD GO WRONG

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1.Unauthorized Work
2.Invaild Permit
3.Lack of Competency
4.Lack of Poor Communication
5.Haste or Shortcut
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Electrical Hazards

2.Mechanical Hazards
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1.Slip Trip Fall

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DIC:

Associated PTW No. / WO No.

Name
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[ ]Welding goggles [ ] Other ____________________

[ ]Hearing protection [ ] Other ____________________
[ Y ]Chemical resistant gloves [ ] Other ____________________

WHAT COULD GO WRONG

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on
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LOCATION:

Is there an SOP or SMP for this Job?

Yes/No? Title of SOP/SMP?

Yes -

Sign.

:
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er ____________________
ther ____________________
ther ____________________

STEP 3 - RECOMMENDED ACTION OR PROCEDURE

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1. Get the permit validated fir specfic day.

2.Supervisior must be ensure that all work activites
are carried out by comptent personnel. 3.conducting
Tbt meeting, review the method statement and job
safety analysis to all craftsmen invilved in that work
activities 4.Responsible person will
conduct inspection, monitor the work activities and
have to ensure safety standards and procedures are
strictly adhered to.
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1. Proper Isolate the system

2..Loto(logout & Tagout )

1.Always use proper Tools with out damage

2. Always proper communocation
3.Always supervision.
4.Use Proper PPE( Halmet,
Hand Gloves,Safety Shoe)
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1.Remove of un Wanted Materials to near work

2.Remove of Spillage of oil
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DATE:

Is there an established HIRA for this job?

Yes/No? Title of HIRA?

No

Additional Safety Recommendations from

the SOP/SMP/HIRA?
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STEP 4 - ANY SUGGESTION FOR

MODIFICATION/IMPROVEMENT FOR
FUTURE SAFE WORK?
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