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JSA Template
JSA Template
0
Prepared by:
(FM/Supervisor)
Reviewed by :
(HSSE Dept.)
To be sign by ARCC
Name/Signature/Date
Approved by :
(Const./ Project Manager)
To be sign by ARCC
Name/Signature/Date
Job Step 1. Verify pre-planned access to top of panel has been completed
Potential Hazard 1a Injury from fall resulting in cut or fractures. 1b Damage to adjacent equipment in the event of a fall or dropping tools. 2a None 3a Electrical shock by touching exposed wiring on connections.
H/M/L Risk M
Mitigating Steps 1a and b Work will not start until pre-planned access is in place.
2. 3.
Open the front cover of the panel Verify that there are no cables in the work area and that no live electrical connections are in the work area.
M M
L L
Hold point if exposed wiring or connectors are evident in the work area stop and develop appropriate hazard and mitigation steps. If none found (compartment is as expected) then proceed to next step. 4. Worker performing drill / punch position himself and tools to execute work. 4a Fallen tools damage adjacent equipment. M 4a Take tools to work face one at a time and ensure they are appropriately secured with straps to L
5.
Worker performing drill / punch position himself and tools to execute work.
4b Fallen tools injure, cut or bruise, co-worker in the area. 5a Worker struck in head or other body part from falling tools dropped by worker on upper level of cabinet drilling holes. 6a Hot shavings burn lower worker on face or arms or lodge in his eye. 6b Flying metal particle lodges in eye of the upper worker. 7a Punch bit falls and damages internals of equipment. 8a Upper worker activities hydraulic punch before lower worker hand is clear and pinches finger between punch bit and cabinet causing laceration.
prevent fall to lower level. 4b Co-workers remain outside of the area until tools are secured and work is ready to start. 5b Lower worker does not go to cabinet until upper work area and tools are secure.
L L
6.
6a Lower work ensures that there is no exposed skin when his arms are extended holding debris container and wears full wrap around eyewear. 6b Upper workers wears full wrap around eyewear.
7.
7a Worker screws bit to anvil while holding a container with the other hand.
8.
8a Upper worker does not activate hydraulics until visual clearance that lower worker is out of the cabinet.
9.