JOB SAFETY ANALYSIS RECORD SHEET

PLANT/EQUIPMENT Department: Date: 04-Dec-2019 Field visit conducted by all JSA participants? Yes/ No
Division/Unit: JSA # 01 Field Visit date;

DESCRIPTION OF ACTIVITY

Sand Removal Using Super Sucker

Prepared by: APPROVAL

NAME SIGNATURE
(for participation and field visit)

Unit Head:______________________ Date:________________

(concurrence)

Division Head: Abdullah Fahad Al-Essa

Date:________________
o Notify the Safety Compliance Team and Loss Prevention o Safety Compliance Team representative may conduct
representatives prior commencing the job unannounced audits or spots checks as per procedure
References(GI, SMS): Special safety equipment required:

 G.I 2.100 Work permit system

 G.I 2.709 Gas testing Cover-all Uniforms(FRC) w/ visibility vest
 G.I 2.711 Fire and safety watch Safety Glasses
 SMS 6.01 Hot work permit Working Gloves (Rubberize or equivalent)
 SMS 6.24 Hand tools inspection process Helmet/Hard hat
 SMS 6.27 Personal H2S Monnitor Management Dust Mask
 SMS 6.02 Cold Work Permit Ear Muff/Ear Plugs
 SMS 6.12 Job Safety Analysis (JSA) Process Jersey Barrier
 GI 1021.000, Street and Road Closure: Excavations, Reinstatement and Traffic Personal Gas Monitor
Controls Fire Extinguisher

SA Construction Safety Manual

Aramco Safety Hand Book
 JSA Pre-Approval Checklist Yes/No
Have a field visit been conducted by all JSA participants prior to the JSA development?
Have the JSA been initiated in the system?
Have the Safety Coordinator representative been notified?
Have Loss Prevention representative been notified?
Is the executor (Saudi Aramco and/or Contractor) part of the JSA discussion and development?
Have the complete JSA documentation been loaded to the JSA database?

1. Use as many lines as needed to list the critical steps. Be specific.

2. There may be more than one hazard per step. List each hazard.
3. Identify the proper control for addressing each hazard.
4. Identify any recommended actions required.
5. Identify responsible position for each critical step and its corresponding hazard controls implementation

NOTE: Any deviation from the agreed on steps and/ or controls will require reevaluation and further assessment of the JSA and the
corresponding job.

Sequence of Basic Potential Hazards
Job Steps
1..Hand excavation using 1.1 Hand tool- Injury of hand, eye,
shovel back and feet
1.2 Slip Trip & Fall
1.3 Harmful Dust
1.4 Exposure of H2S
2. Sand removal using 2.1 Position of equipment
Super Sucker equipment
2.2 During Operation
2.3 Electrical shock/Electrocution
2.4 High Noise
2.5 Operator/Driver
Responsible Party
Required Hazard Controls Responsible Completion
Party Signature
1.1.1 Use Proper protective
equipments such as; Safety shoes,
rubber/Cotton gloves, safety goggles,
safety helmet and Fire resistant cover WPR/Civil
all. supervisor/Project
Engineer/Safety
1.2.1 Provide proper access for Officer
workers to enter the channel
1.3.1 Provide dust mask to all workers
(3M or N70 dust mask)
1.4.1 Conduct gas test regularly by
using MX-4 (Ventis) gas detector by
approved gas tester
1.4.2 Provide personal H2S gas
detector (Rattler T-40) for each crew
2.2.1 Park the equipment in the safest WPR/Civil
place and provide barricade around supervisor/Project
the equipment Engineer/Safety
Officer
2.2.1 Secure all hoses without defect
and should be inspected
2.2.2 Secure all hose fitting are safe
for operation
2.2.3 Check the hoses and
connections for wear and tightness
and replace if necessary
2.2.4 Check the suction and discharge
valves on the rear of the tank. Check
the vacuum/pressure gauge, safety
# Recommendations/Notes Remark or Comment
o All site personnel are required to wear proper PPE such as flame resistant coveralls, safety
helmet, safety glasses, gloves and safety shoes.
o Conduct toolbox safety meeting prior to every work activity.
o Contractor equipment must be maintained in good working condition
o Proper arrangement and maintenance of tools and equipment

o Strict permit work permit system shall be complied and maintained liaison to updated drawings
and other related development.
o Ensure that hazardous atmospheric condition are monitored and tested e.g. oxygen deficient,
flammable explosive and toxic atmospheres.
o Barricades and sign boards shall be installed around the area.
o Operators are duly certified by certifying Third Party Company and ARAMCO.
o Stability of the excavation must be checked prior to allow heavy equipment close to the
excavation area.
o Excavated material will be kept away from the edge of the excavation (Excavated Soil).
o Dust control must be maintained during the execution of the work activity at area.
o In the event that there is an emergency, all workers are aware of the emergency procedures such
as Assembly Point Location purposely for head counts and other related emergency instructions.
o Observe good housekeeping