PROJECT NAME

Job Safety Analysis (Form 000.653.F0100)

Section I: Enter general information about the site and job task.

Section II: Determine whether any of these operations apply to the job task to be performed. Make note of any special training,
permit, certification, and risk assessment requirements.

Section III:

1. Break the job down into steps and be as specific as possible. List each job step in a new row of column A (Activity/Step).
Number each step consecutively. Each step of a job will accomplish some major task (which may consist of a set of
movements). Each step description defines an action, but does not describe hazards or precautions. Cleanup and stowing of
equipment at the completion of work is considered a step. Add additional rows to the table as needed, or if completing the JSA
on paper, print additional copies of the sheet to accommodate all job steps.

2. Determine the hazards associated with each job step and write them in column B (Hazards). Hazards as associated with each
Activity/Step will be identified and numbered as associated with the respective step. Equipment, personnel, and the activities
that are required to complete each step will be considered. Each step to find and identify hazards that could lead to an accident
will be examined. The preparer will verify that all hazards are listed, including environmental and health hazards.

3. List any control measures that will be taken to ensure that step is done safely in column C (Control Measures). Use the control
measure examples and hierarchy provided to trigger your thinking about different types of controls and their effectiveness at
reducing risk. Controls toward the top of the table tend to be more effective at minimizing the severity and/or likelihood of an
event than the controls toward the bottom of the table. Do not use general statements such as “be careful”.

If this job involves a Life Critical Operation, continue to step 4. Otherwise, repeat steps 2-3 for each of the job steps identified,
then proceed to step 8.

4. Considering the hazards involved and the control measures that will be in place, determine the worst credible severity of an
incident that could result from this job step. Use the severity table provided. Write the severity number in column D (Severity).

5. Considering the hazards involved and the control measures that will be in place, determine the likelihood that an incident will
result from this job step. Use the likelihood table provided. Write the likelihood number in column E (Likelihood).

6. Multiply the severity number by the likelihood number and enter the product in column F (Risk).

7. Consider the risk rating against the thresholds provided in the Overall Risk Ratings.

i. Very low and low risk ratings of 1-3. This level is generally considered acceptable provided that all control measures are
applied.

ii. Medium risk ratings of 4-6. Additional control measures must be considered to determine whether it is practical to further
reduce the risk. If additional control measures will be implemented, write them in the Control Measures column on the
same line or a new line below. Rescore the Severity, Likelihood, and Risk taking into consideration this additional corrective
action.

iii. High and Very High risk ratings of 8-24. Additional control measures must be implemented where practical to further
reduce the risk. Write additional Control Measures in the column on the same line or a new line below. Rescore the
Severity, Likelihood, and Risk taking into consideration this additional corrective action. If the risk rating cannot be reduced
further to a medium or low then the Site Construction manager must approve the activity by signing off the JSA.

8. Repeat steps 2-7 for each of the job steps identified.

Section IV: Provide the name, company, and title of those who prepared and reviewed/approved this form in the signature box
provided. The Site/Construction Manager must review and approve any line items that have a High or Very High risk rating before
the job may proceed. Additional space is provided for crew members to sign the JSA if desired.

Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 1 of 8 Health, Safety, and Environmental
 PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)

CONTROL MEASURE EXAMPLES TABLE (Column C)

Most Effective Controls Examples
Elimination  Make connections at ground level before erecting a  Remove a dangerous machine from service
(Remove the hazard altogether) structure to eliminate work at height  Provide power outlets to avoid trailing cords
Substitution  Use latex rather than oil-based paints
(Replace the material/process with a  Reduce energy, such as speed, force, amperage, pressure, and temperature
less hazardous one)  Use water-based detergents instead of organic solvents
Engineering/Isolation  Ventilation  Isolate hazardous energy sources  Secondary containment
(Design effective control measures to  Machine guarding  Interlocks  Barriers
protect people and the environment)  Enclosures  Platforms and guardrails  Improve lighting
 Circuit breakers  Exclusion zones
Warning  Signs  Horns  Labels  High visibility paint
(Alert people to the hazards)  Backup alarms  Beepers  Tags
Administrative  Work rotation to minimize exposure  Training and supervision
(Provide training, procedures, etc.)  Inspect safety equipment
 Good housekeeping practices
PPE  Safety glasses  Fall harness and lanyards  Respiratory protection
Least Effective
(Personal protective equipment)  Hearing protection  Gloves  High visibility vests
SEVERITY TABLE (Column D) LIKELIHOOD TABLE (Column E)
Impact On Likelihood Chances of
Severity Level Probability
People Environment / Community Equipment / Property Level Occurrence
 Fatality(ies)  Long-term (multi-year) impacts  Extensive losses of high Expected to 1 in 100
to air, surface/ground water, or value occur in most
soil; OR equipment/property; OR circumstances
 Legal liability for related  Losses exceeding
consequences (such as $1,000,000; OR
Critical / Very
6 remediation); OR  Major unplanned impact 4
Catastrophic Likely
 Widespread areas including on project budget and
offsite area or community schedule
affected; OR
 Adverse publicity/media
coverage
 Long-term, life-altering injury  Lasting up to one year, impacts  Losses of equipment that Strong 1 in 1,000
or illness resulting in to air, surface/ground water, or cannot be readily possibility the
permanent total or partial soil; OR replaced; OR event will
disability  Offsite area/community  Losses exceeding occur
‒ Examples: amputation affected; OR $100,000; OR
Major 4 Likely 3
including bone, severe  Notice of violation, citation, or  Significant unplanned
disfigurement, paralysis, fine from regulatory authority; impact on project budget
loss of OR and schedule
limb/organ/vision/hearin  Likely adverse publicity/media
g coverage
 Injury or illness that requires  Temporary, up to one month,  Loss of equipment that The event 1 in 10,000
medical treatment or results impacts to air, surface/ground can be readily replaced; might occur
in temporary disability or water, or soil limited to the OR
loss of function project site; OR  Losses exceeding $10,000;
‒ Examples: deep  Breach of regulatory OR
Moderate 2 Possible 2
laceration, object requirement or limit; OR  Minor impact on project
embedded in eye, bone  Events that are reportable to budget
fracture, concussion, regulatory authorities; OR
dislocation, injury  Potential adverse publicity /
requiring surgery media coverage
 Injury or illness requiring first  No direct impact to air, surface /  No impact on equipment Highly unlikely 1 in
aid treatment only ground water, or soil; OR functionality. but may occur 1,000,000
‒ Examples: minor cuts,  Effects restricted within  Minor, cosmetic damage; in exceptional
Minor 1 bruises, sprains, strains, buildings or containment OR Unlikely 1 circumstances
abrasions, irritation, structures; AND  Repair costs easily
inflammation, object in  No adverse publicity / media covered by normal project
eye removed by flushing coverage operating budget
Risk Matrix (Column F)
Likelihood Overall Risk Ratings
Low Medium High Very High
Unlikely (1) Possible (2) Likely (3) Very Likely (4) Very Low 1
2-3 4-6 8-18 24
Critical (6) 6 12 18 24
Note: The Site/Construction Manager must personally review any items
Severity

Major (4) 4 8 12 16
with a High or Very High residual risk score, and approve by signing this
Moderate (2) 2 4 6 8
form.
Minor (1) 1 2 3 4

Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 2 of 8 Health, Safety, and Environmental
 PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)
SECTION I - GENERAL INFORMATION
Company: LISTENLIGHTS PVT LTD Contract No.: HYD11-K005 New or Revised Date: 23/02/2023
JSA Title: 08 Cable Laying, Wiring, Cable Taging and Building: Area: Specific Location:
Cable Termination.(M3SD -K005-GEN-HYD11-H-
IOM-0008-10.)
Work Scope/Description: Costruction Installation Testing Commissioning of MEPF Plant Tools & Equipment Required: Power & Handtools
Primary Emergency Contact Secondary Emergency Contact
Name: B NARESH KUMAR Phone: 96400442859 Name: RAVINDER Phone: 8008878245
SECTION II - DOES THIS JOB REQUIRE ANY OF THE FOLLOWING OPERATIONS?
 = Requires formal/special training  = Requires a permit/form/report
 = Requires certification or Competent/Qualified Person designations ∆ = Life Critical Operations = Requires Risk Assessment
Refer to the approved site-specific Project HSE Plan for specific requirements on applicable operations, or Fluor’s Project HSE Requirements and Execution Plan (000.653.F0954) if a site-specific plan has not been
approved yet.
Aerial Lifts    ∆ Hazardous Materials Hazardous Waste Operations   Scaffolding    ∆
Confined Space    ∆ Asbestos    Heavy Equipment    ∆ Site/Vehicle Traffic   ∆
Dismantling and Demolition   Benzene   Hot Work   Steel Erection  ∆
Electrical Hazards    ∆ Crystalline Silica    Loading/Unloading Material ∆ Work at Height (> 6 ft)    ∆
Excavation/Trenching    ∆ Cadmium    Noise Exposure  Rigging & Cranes    ∆
First Line Breaks    ∆ Hexavalent Chromium   Powered Industrial Trucks    ∆
Grating, Floor Plate, Guardrail Removal  ∆ Hydrogen Sulfide  Respiratory Hazards   
Hazardous Energy Control    ∆ Lead    Roof Work    ∆
SECTION III - JOB SAFETY ANALYSIS RISK ASSESSMENT
A B C D E F
ACTIVITY/STEP HAZARDS CONTROL MEASURES SEVERITY LIKELIHOOD RISK
1. Mobilization of Manpower 1. Unauthorized entry. 1. The only inducted worker shall be deputed at 1 2 2
2. Unskilled worker the workplace.
2. Given Tool Box Talk to all workers. What are the
activities to be carried out, what are the hazards,
and what are the precautions that are to be taken.
3. TBT should be conducted before starting work.
4. height Work activity permit shall be taken
before the start of work from the concerned
engineer. and HSE Dept.
5. Required PPE use by workers.
6. The area shall be barricaded to prevent
unauthorized entry.
7.Access & egress should be clear, use of required
PPEs only train persons deployed for work
8. Job Specific training should be conducted.
2. Mobilization of Hand tools and Power tools. 1. Damage Cables. 1. All electrical power tools should be checked 2 2 4
2. Electric shock. before entering the premises.
3. Injury to fingers while hammering or using damaged 2. All distribution boards should have ELCB.
hand tools. 3. Competent persons only shall use power tools.
4. Injury because of using the damaged power tool. 4. Cable shall not movements of workmen.
5.Don’t modify the power tools.
6. Ensure the grip of the hammer with wooden
handle and Hand tools is in good condition.
7. Certified and inspected tools & equipment and
maintain color code.
8. Supervision enforced.
9. Use approved tools and power tools.

Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 3 of 8 Health, Safety, and Environmental

3. Shifting of Cable and Wire from Listenlights Store to 1. Unskilled workers,
work area. 2. Fall of material,
3. Caught in between,
4. Wear and tear PPE.
4.Cable & Wire pulling by using Steel wire in the 1. Fall person and material from height.
conduits or Raceway. 2. Topple of the scaffold.
3. Trip hazard,
4. Ergonomic hazard.
5. Cable laying for live panel,Cable pulling, Cable 1. Fall from height
Dressing, Cable laying on live cable tray and cable 2. Material falls from height
taging. 3. Unsafe working platform
4. Improper access and egress
5. Inadequate fall protection
6. Lack of illumination
7. Simultaneous activities
Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 4 of 8
PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)
10. All personnel will wear the appropriate PPE for
their specific task.
1.Only workers are to be deployed and provide 2 2 4
manual handling techniques.
2. Avoid lifting heavy material if required take the
help of co-workers for lifting.
3. banks men should be provided & area to be
barricaded
4. Ensure close and continuous supervision of the
activity
5. Ensure hard and soft barricading of the area
6. All personnel will wear the appropriate PPE for
their specific task.
1. Obtain a work-at-height work permit if required. 2 3 6
2. Trained workers to be deployed for working at
height on mobile scaffolding.
3. All Component of the Scaffold should be in good
condition.
4. Use lanyard for tools to avoid falling hazards.
5. The damaged component of scaffolding must be
removed from the site.
6. Ensure the lock must be tightened properly.
7. Before climbing up on scaffolding inspect
properly and provide the tag ‘Safe for use.
8. Lock the coaster wheel of the scaffolding before
climbing up Do not move when a person is working
on the scaffolding, come down from the scaffold
and move the scaffold.
9. The task must be supervised by a competent
supervisor.
10. Do not allow workers to work
continuously,Provide breaks to the workers &
provide job rotation.
11. Do not allow the worker to do the activity who
already has a back pain problem.
12. All personnel will wear the appropriate PPE for
their specific task.
1. PTW procedure must be followed. 2 3 6
2. Life guard TBT must be conducted.
3. Required shutdown for dedicated panel, room,
feeder.
4. LOTO Procedure must be followed.
5. All hand tools and power tools must be
insulated.
6. Work should be carried in Continuous
supervision
7. The working platform must be good enough to
carry the load.
8. Aluminum scaffold must be used with maximum
safety precautions.
9. Working platform should have proper access.
Health, Safety, and Environmental

6.Cable termination on Live Panel.
• Hole Saw in live panel.
• Glanding in the cable.
•Cable termination.
7. Continuity and insulation
test of the cable by using multimeter / meger.
1. Fall of person and material,
2. Topple of the scaffold.
3. Unskilled workers.
4. Trip hazard.
5. Ergonomic hazard.
6. Manual handling hazard risk.
7. Electrical hazard.
8. Fire hazard(short-circuit)
9. Severity
10. fatality
1. Fall of person and material,
2. Topple of the scaffold,
3. Untrained workers,
4. Trip hazard,
5. Ergonomic hazard.
PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)
10. Lifeline must be used for fall protection along
with safety harness.
11. Provide proper illumination.
12. Provide fall arrest system
1. PTW Procedure must be followed. 2 3 6
2. The shutdown took before the Work in the live
panel.
3. LOTO procedures should be follow as per PDG
standard.
4. After Shutdown the panel confirm with the help
of multimeter the voltag should be 0.
5. Using Aluminum Scaffold or ladder for working
in live Area.
6. While hole saw take aduquate precaution must
be taken to avoid falling of burs in side panel.
7. Trained workers to be deployed for working at
height on scaffolding.
8. Using cut resistance hand gloves for termination
activity.
9.Using rubber mat working on near live panels.
10. Erect the scaffolding properly with railing and
ladder.
11. The damaged component of scaffolding must
be removed from the site.
12. Ensure the caster wheels must be lock properly
before climbing the scaffolding
13. Provide proper access with life line for
anchoring a safety harness if required.
14. Provide diagonal bracing at both the side
15. Before climbing up on scaffolding inspect
properly and provide tag ‘Safe for use’
16. Lock the wheel before climbing up.
17. Do not move when a person is working on
scaffolding, come down from the scaffold and
move the scaffold.
18. Use required personal protective equipment.
19. The task must be Continuous supervised by a
competent supervisor.
20. Use a ladder for climbing up and down from the
scaffold.
21. The working platform must be good enough to
carry the load of the person.
1. Obtain work at height work permit if required. 2 3 6
2. Trained workers to be deployed for working at
height on mobile scaffolding.
3. All Component of Scaffold should be in good
condition
4. The damaged component of scaffolding must be
removed from the site.
5. Ensure lock must be tightened properly.
6. Before climbing up on scaffolding inspect

Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 5 of 8 Health, Safety, and Environmental

8. Site clearance/ Removal of materials
9. Scaffold Erection, Dismantling and Modification.
10. Work at Height
Copyright © 2020, Fluor Corporation. All Rights Reserved.
PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)
properly and provide tag ‘Safe for use’.
7. Lock the coaster wheel of scaffolding before
climbing up Do not move when a person is working
on scaffolding, come down from the scaffold and
move the scaffold.
8. The task must be supervised by a competent
supervisor.
9. Do not allow workers to work continuously.
10. provide breaks to the workers & provide job
rotation
11. Do not allow the worker to do the activity who
already have a back pain problem
12. All personnel will wear the appropriate PPE for
their specific task.
1. Personal injury. 1. Remove unwanted and waste material. 1 2 2
2. Trip, Slip, Fall. 2. Remove trash and debris and dispose it of
1. Poor housekeeping properly.
3. Secure hand tools and carefully place them.
4. Manual handling techniques to be practiced.
5. Keep all surrounding clean and clear for
materials.
1. Toppled. 1. Ensure permit to work available. 2 3 6
2. Fall from height. 2. Use proper Safety Harness and fall arrestor.
3. Material fall. 3. Tag red displayed while Dismantling or Erection.
4. Scaffold material damage. 4. Green tag displayed after scaffolding in safe
5. Collapse. condition.
6. Uneven surface. 5. Competent person should be available while
7. Overloading platforms scaffolding erecting and dismantling.
8. Climbing on scaffolding. 6. Scaffold installed in Firm base.
9. Lack of guardrails. 7. Ensure that scaffold pin available in all Joints.
10. Overhead electrical wires and risk of electrocution. 8. Ensure Outrigger must be placed.
9. Ensure hand rail, top rail, and mid rail provided.
10. Toe guard should be available avoiding material
fall.
11. For fall of equipment lanyard must be tie on
power tool.
12. Overhead cable should be removed and
earthing connected to scaffolding.
13. Power tool supply DB should connect with
30mA RCCB.
14. All Scaffolding should be on placed.
15. Proper access should be provided for climbing
on scaffold.
16. Damage scaffold should be removed/replaced.
17. Proper fall arrested system provided.
18. All required PPEs must be Wear.
1. Slips and trips causing injury. 1. Obtain work permit to work at Height. 2 3 6
2. Fall from height causing severe injury or death. 2. Training on the hazards and control measures
3. Falling objects possibly injuring persons below related to equipment's & related works to be
conducted by the vendor (monthly once).
3. Toolbox talks to be given by the vendor to the
Page 6 of 8 Health, Safety, and Environmental
 PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)
work force daily for the precautions to be taken in
the activity.
4. No work to be carried out other than permitted
(described in work permit).
5. Respective Engineer & site supervisor to be
available during the night work and the continuous
supervision to be in place.
6. Lighting to be provided for clear visibility,
Emergency lights to be available at the stair cases
and lift lobbies.
7. Sleeping in the work premises must be avoided
and such workmen must Eat balanced and regular
meals
8. Ensure all workers are wearing the correct PPE
11. In Case of Emergency 1. Slip and trip hazard 1. Follow your emergency plan 2 2 4
2. Emergency exit block 2. In case of emergency use emergency exit and
3. Panic attack. reach to assembly area.
4. Cut Injury 3. Do not get panic while emergency.
4. In case of accident please call emergency
contact/ambulance contact.
5. Get your emergency kit.
6. Make sure you are safe before assisting others.
7. Contact emergency contact no for information
and follow their instructions.
8. Stay put until all is safe or until you are ordered
to evacuate.
9. Evacuate self and reach to assembly point.
10. Assembly area we conduct head count and
match with DPR report, if any worker missing, we
Apply rescue plan.
11. Follow Evacuation Plan
Select Select X
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE
Select Select DXE

Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 7 of 8 Health, Safety, and Environmental
 PROJECT NAME
Job Safety Analysis (Form 000.653.F0100)

SECTION IV – APPROVALS AND SIGNATURES

HSE Incident Alerts related to similar jobs have been reviewed and considered in the development of this JSA.
PREPARED BY
Name Company Position
B NARESH KUMAR LISTENLIGHTS SR OFFICER EHS

APPROVALS
Name Position Signature
KOTESH Superintendent

RAVINDER HSE Representative

MOHAMMED ALI Site/Construction Manager

High (8-18) and Very High (24) Overall Risk Rankings
require review and approval by the
Site/Construction Manager

REVIEWED BY CREW
Name Company Signature

Copyright © 2020, Fluor Corporation. All Rights Reserved. Page 8 of 8 Health, Safety, and Environmental