JSA form Instructions:

To create the Job Safety Analysis, it should be used the spreadsheet JSA at this doccument. The head of this sheet identifies the job or activitie to be done, as far as the participants of the analysis and the execution of the job.

This sheet contains 9 columns, which are fulfilled as the description presented bellow:
- 1st column: ITEM
This column contains a number for the identification of the basic step, being fulfilled in sequence to make easier to consult any step you want.
- 2nd column: JOB STEPS
This column contains the steps to be executed to the analyzed job. The steps are defined by the teams participating on it, based on the existent procedures and/or identification and local observing.

Describe by clear and specific language the main steps, always beginning the text with a word representing an action (a verb at the infinitive form). Examples: to remove, to put, to turn on, to open, to close, to tight, to loose, and others.

NOTE: If an important step of the job is omitted, it can result in exposure of the workers to potential risks or accidents.
- 3rd column: RISK SITUATION
This column contains the possible risk situations identified for the job task. In general, these risk situations are related to accidental events that have the potential to damage the integrity of the people involved in carrying out the task. Therefore, these risk situations refer to events such

as:
SAFETY
AIRCRAFT FALL
ANIMAL ATTACK (VENOMOUS, WILD, INSECTS ETC.)
BODY PRESSING
BUMP
COLLAPSE: STRUCTURES / EQUIPMENT / BUILDINGS
COLLISION / TIPPING OVER
CONTACT / EXPOSURE TO CHEMICALS
CONTACT WITH - MOBILE OR ROTARY PARTS OF STRUCTURES, MACHINES OR EQUIPMENT
CONTACT WITH ENERGIZED SURFACE
CONTACT WITH... (OTHERS)
CUTTING / DRILLING / ABRASIVE CONTACTS
DAM BREAKING OR LEAKING
DROWNING
ELECTRIC OR SHORT CIRCUIT ARC
EXPLOSION
EXPOSURE TO CONFINED SPACE
FALL / SLIDE (DIFFERENT LEVEL)
FALL / SLIDE (SAME LEVEL)
FIRE
GAS LEAKAGE (FLAMMABLE / TOXIC / POLLUTING)
HIT BY BREAKING OF CABLES / HOSES / FLUIDS UNDER PRESSURE
HIT BY FALLING PARTS / STRUCTURES / EQUIPMENT / TOOLS
HIT BY PROJECTION OF MATERIALS (TOOLS, PARTS, FRAGMENTS, SPARKS)
HIT BY... (OTHERS)
IMPLOSION
LOAD / ORE FALL
ORE PILE EROSION OR SLIDE (ORE, STERILE, AMONG OTHER TYPES OF MATERIALS) OR SLOPES
OVERFLOW OF SILOS (INPUTS OR PRODUCTS)
PANE ON AIRCRAFT
PHYSICAL AGGRESSION
RUN OVER - VEHICLES OR AUTOMOTIVE EQUIPMENT
RUN OVER - VEHICLES OR RAILWAY EQUIPMENT
SOTTERRAMENTO / SWALLOWING
STRIKE AGAINST - STRUCTURE AND EQUIPMENT
STRIKE BY ATMOSPHERIC DISCHARGE
STRIKE BY... (OTHERS)
VEHICLE / EQUIPMENT FALL IN WATER OR SEA

HEALTH
DYNAMIC MUSCLE OVERLOAD
EXPOSURE TO ABNORMAL PRESSURES
EXPOSURE TO BIOLOGICAL AGENTS
EXPOSURE TO DUST / PARTICULATE
EXPOSURE TO EXCESSIVE HUMIDITY
EXPOSURE TO HIGH OR REDUCED LUMINOSITY
EXPOSURE TO HIGH TEMPERATURES
EXPOSURE TO LOW TEMPERATURES
EXPOSURE TO METAL SMOKES
EXPOSURE TO NOISE
EXPOSURE TO OTHERS
EXPOSURE TO SOURCES OF IONIZING RADIATION
EXPOSURE TO SOURCES OF NON-IONIZING RADIATION (SOLAR RADIATION, MAGNETIC FIELDS, ETC.)
EXPOSURE TO VAPORS / FOGS / MIST
EXPOSURE TO VIBRATION (WHOLE OR LOCATED BODY)
MENTAL / COGNITIVE OVERLOAD
STATIC MUSCLE OVERLOAD

- 4th column: CAUSES

The generic causes of each risk are to be inputted in this column. These causes involve both intrinsic equipment failures (mechanical failures, instrument failures, leaks and others) as human errors of operation and maintenance. These causes are evaluated separately for each task
step.

- 5th column: Consequence/ Effect

Type Effect Severity
Events that result in the first aid of Own
Health and safety LOW
Employees or Third Parties
Events that result in injuries/illnesses with
absence from work or with medical treatment or
Health and safety MODERATE
restriction to work by Own Employees or Third
Parties
Events resulting in life-changing injury/disease
Health and safety SIGNIFICANT
or 1 fatality of Own Employees or Third Parties
Events that result in multiple fatalities of Own
Health and safety CRITICAL
Employees or Third Parties

Multiple Fatalities in which the cause is related

Health and safety to operational processes that affect the VERY CRITICAL
Community

- 6th column: Control Measures

This cell contains the mitigation measures of risk proposed by the performers.
Write clearly and specifies that promote the elimination or reduction of risk situations identified in the second step.
Establish procedures Insurance to perform the steps of the task safely, avoiding undesirable situations and preventing accidents.
Describe the recommendations clearly and objectively, avoiding generalizations such as: "be alert", "take care". At each step of the task, we must be specific, describing exactly what the performer should do, and what resources should be used. Start writing with an action word (a verb

in the imperative form) "isolate, block and signal the valve," "use semi-facial mask with filter for organic vapors / Dust", "use wrench ¾ inch" "gloves type vaqueta / PVC", "use PVC boot".

7 th to 09 Column: Risk rating

The risk must be rated according to its probability and severity of occurrence considering the controls already implemented. Severity must be made according to the effect (table above) and the probability classification must be made according to the probability table, available in NOR -
0003 - G - Risk Managment Norm.
 PNR 000068 - Job Safety Analysis Associated PRO*: SWP no*: Work Order
n°*:
Task description: Date: ___/___/___

Execution team: (Name/ Area/ ID/ Signature)

Change Ramp Curve
Name Area/ Company ID Signature

Task Location: DN

Issuer Company/ ID

* Not mandatory field

 VERY HIGH AND HIGH RATED RISKS

Job task description: 0

VERY HIGH AND HIGH RISKS OF THE TASK

Risk Task Step Risk Situation Causes Control measures

Control 1
HIGH EXAMPLE OF STEP EXAMPLE OF RISK Cause1
Control 2
 PNR 000068 - Job Safety Analysis
Job task description:

Item Task Step Risk Situation Causes Effects Control measures Probability Severity Risk

Multiple Fatalities in which

the cause is related to
1.1 Step 1 ANIMAL ATTACK (VENOMOUS, WILD, INSECTS ETC.) Cause 1 Control 1 VERY LIKELY VERY CRITICAL VERY HIGH
operational processes that
affect the Community

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Job task description:

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Job task description:

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 VERY REMOTE REMOTE POSSIBLE LIKELY VERY LIKELY
1 2 3 4 5
VERY CRITICAL 1 HIGH HIGH VERY HIGH VERY HIGH VERY HIGH
CRITICAL 2 HIGH HIGH HIGH VERY HIGH VERY HIGH
SIGNIFICANT 3 MEDIUM MEDIUM HIGH HIGH VERY HIGH
MODERATE 4 LOW LOW MEDIUM MEDIUM MEDIUM
LOW 5 LOW LOW LOW LOW MEDIUM