Job Safety Analysis Form

Doc. no: MS-FR00890 Rev: 9 Published: 23.08.2019

Permit to Work No.

JSA No. C/2023/0081
Work Description To Install Protective Canvas on Pick up Line for Export Hose via Rope Access
1. Rescue Plan
2. Toolbox Talk Checklist
Information / Specific
Documents / Drawing / Cause & 3. Work Aloft and Over Sea Checklist
Effect / P&ID
4. COSHH
5.
STEP 1: CARRY OUT AN INITIAL TASK RISK ASSESSMENT ON-SITE TO IDENTIFY ANY HAZARDOUS CONDITIONS & ITEMS THAT
SHOULD BE CONSIDERED DURING JSA. HIGHLIGHT / COMPLETE THE NECESSARY SECTIONS BELOW. THE HEAD OF
DEPARTMENT RESPONSIBLE FOR THE JOB SHALL NOMINATE PERSONNEL TO CARRY OUT THE JOINT SITE INSPECTION.
HAZARDOUS CONDITIONS
Asbestos Ignition Sources
Adjacent Work / Simultaneous Operations Manual Handling
Confined Space Noise
Chemical Exposure Norm / Radioactive Substances
Dropped Objects Potential Loss of Containment
Dust Rotating Machinery
Exposure to Hazardous Materials Safety System Disabled
Exposure to Hydrocarbons Slip / Trip / Fall
Exposure to Toxic Gases Vibration
Flammable Materials Weather / Sea State
High / Low Pressures Working Aloft / Over Sea
High / Low Temperatures Working at Height
Inadequate Guards for Equipment Parts Work on Live Systems
Others: Others:
Others: Others:

ITEMS FOR CONSIDERATION DURING JSA

Access, Egress and Escape Routes Lifting Plan
Communication Protocols Need for Securing Tools and Equipment
Competency of Personnel Pre-Work Inspection of Area
Contractor Competence and Verification of Certificates Signs / Barriers
Communication Methods Including During Emergency Supervision Required
COSHH Assessment Sheet Briefed to Work Party Training Requirements Completed (Including Contractors)
Draining / Purging / Gas Freeing Tools are Inspected and Are in Good Working Condition
Task Familiarisation Ventilation & Lighting
Gas Testing / Gas Monitoring Working / Rest Hours for Work Party
Isolations in Place Others:
Others: Others:
Others: Others:
We confirm that a task risk assessment was carried out on-site during a joint inspection by the following parties:
Name Position
Edet E Construction Supv.
Henry U Marine Superintendent
Dickson E RatL3/NDTL2

The inspection was carried out on:

Date: 02/3/2023 Time: 14:00hrs

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 Job Safety Analysis Form
Doc. no: MS-FR00890 Rev: 9 Published: 23.08.2019

JSA No.: C/2023/0081 JSA Meeting Date: 02/3/2023

Additional Information of Relevance to the JSA:

STEP 2: CARRY OUT A RISK ASSESSMENT OF THE JOB, CONSIDERING THE INITIAL HAZARDS AND ITEMS IDENTIFIED DURING THE JOINT SITE INSPECTION.
 The Job Safety Analysis (JSA) Form should be completed by the JSA Team Leader (HOD responsible for the job) prior to commencement of work listed as “requiring a JSA” under the Permit To Work procedures.
 JSA Form must be endorsed by JSA Team members and appended to the Permit.

1. JSA Team Participants

Name Position Signatures

Henry U Marine Superintendent Refer To MS-PO01401 Risk Assessment Matrix and MS-PR00841 PTW System – Procedure- Job Safety
Analysis for guidelines on evaluating risks
Edet E Construction Supv.
All residual risks should be L (Low). For Medium (M) risks, reduce to ALARP. If not, the job has to be re-
Maya, Bright HSE Superintendent. classified as a Special Operation and either cancelled or a Formal Safety Assessment (FSA) must be conducted.

Mathew Olibe RAT L3/NDT/Rigger - WRP All employees, contractors, and site visitors have the authority and responsibility to stop work or decline to
perform an assigned task, without fear of reprisal, when an imminent risk or danger exists. Individuals calling for
Stop Work should inform the Supervisor or other person in charge of the work being performed immediately.
Dickson E RAT L3 / NDTL2/Safety Lead - WRP

Mathew Ekene RAT L2/NDTL2/Rigger Hazard controls/barriers should be considered in the following order:
1- Eliminate (The task)
2- Substitute (Use a less hazardous method)
3- Engineering controls (Isolation, equipment)
4- Administrative Controls (Procedures)
5- PPE

2. Risk Assessment

Remarks / Actions / Person Responsible Control Actions

Activity description Hazard Consequence Initial Risk Controls / Barriers Residual Risk
Recommendations for Control Actions in Place

Responsible
List person(s) that will Person to confirm
Step Describe the controls/barriers that will reduce the
(C) (P) (RL) (C) (P) (RL) implement Risk Control that these are in
possibility of a Hazard occurring in the Hierarchy of Risk Describe any Recommendations/
No. Describe potential measures place as the job
Split activity into steps. Give brief Control order. Note, if the Risk Control level is not remaining Actions that should be
List each hazard outcomes of the progresses.
description of each step available, please state N/A within the space provided and taken prior to Job Execution with
hazard move down the Hierarchy of control order.
High High reference to the Hazard
1-5 1-5 Med 1-5 1-5 Med Signature Yes / No
Low Low

1 Preparation/Access to work area / Slip, trip and fall. Injury to Follow work at height / overboard procedure MS- Ensure Weather report is
Selection of Rope Access gears & personnel PR00934 confirmed with CCR before
Radiation commencing task.
tools.
Equipment FRC / standby boat available
Defect
- FRC on Standby prior to damage.
tools/materials. Ensure all tools are inspected and in good working Heat Radiation Check to be
start of activity. 3 3 M 3 1 L
condition before use. carried out, Readings to be
Adverse Weather.
Proper toolbox carried out with work team ensuring allowable for task
Work overboard
all hazards are discussed, mitigation put in place
Pinch point and everyone understands the task. Inform CCR and ensure
Slip, trip and fall Clear work area to allow for free movement during availability of rescue team
material transfer. before commencing task.
Man Overboard CCR Operator to inform
WRP should ensure work team understands their Addax Security of the task

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overboard and in turn Addax

Security will inform the
security boats for alertness.
individual task.
Only competent & trained
Inspect work area, ensure obstruction around work personnel will be involved in
area is removed. the operation.
Health vital checks to be done on
all pax by Medic before start of
work.
Mandatory PPE/ Rope Access Harness, Work Vest
and Leather Gloves.

2 Rigging of Rope Access for Work at height / Injury to 4 2 M Ensure task is carried out by competent persons. 4 1 L
personnel personnel
Overboard Ensure all gears used for task are in good condition.
Equipment
Equipment failure Ensure use of proper PPE and gears for task.
damage.
Pinch point Area to be barricaded from unauthorized access.
Fatality
Cuts from Razor Standby man to be with functional radio, buoy with
Wire line while task is ongoing.
Dropped object In the event of adverse weather condition all task to
be stopped and area kept safe.
Weather condition
Adhere to company Rope Access and IRATA Code
Slip, trip & fall
of practice (ICOP)
Restricted access
Personnel should not climb with tools in hand to
Poor avoid dropped object, use tool bags to bring tools
communication into the working area and equally secure work tools
Noise Ensure use of double point hang-off as per rope
access procedures.
Human Error
Remove / Reinstate Razor wire before and after
work.

Mandatory PPE/ Rope Access Harness, Work Vest

and Leather Gloves.

3 Fixing of Protective Canvas on Work at height / Injury to 4 2 M Ensure task is carried out by competent persons. 4 1 L
Pick Up Rope personnel
Overboard Ensure all gears used for task are in good condition.
Equipment
Equipment failure Ensure use of proper PPE and gears for task.
damage.
Pinch point Area to be barricaded from unauthorized access.
Fatality
Hose whip Standby man to be with functional radio, buoy with
line while task is ongoing.
Dropped object
In the event of adverse weather condition all task to
Weather condition
be stopped and area kept safe.
Slip, trip & fall
Adhere to company Rope Access and IRATA Code
Restricted access of practice (ICOP)
Poor Personnel should not climb with tools in hand to
communication avoid dropped object, use tool bags to bring tools
into the working area and equally secure work tools
Noise
Ensure use of double point hang-off as per rope
access procedures.

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Doc. no: MS-FR00890 Rev: 9 Published: 23.08.2019

Human Error Adhere to instructions in the COSHH while coating.

Install whip-check on hose connections.
Use Rope access harness, Work Vest and Leather
Gloves. Ensure use of proper PPE and gears for
task (Nose-mask, ear-defenders)

Proper PPE. Use Rope access harness, Work Vest

and impact glove.

4 House Keeping Slips, trip and fall Injury to 3 2 M All razor wire should be re-instated properly. 3 1 L
personnel
Human error
Equipment
damage.
Mandatory PPE

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