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Job Safety Analysis

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Site: _______________________ Project: ______________________________ Date: _______________

Owner: ______________________________________________________________________________

Address: _____________________________________________________________________________

Tel. office: ______________________________ Mobile: ______________________________________

Owner sign _____________________________ HSE sign _____________________________________

 

Highlight item / Consideration / Observation

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Permit To Work N°. Area Coordinate

Date : Work description: Supervisor : Sign:

Potenzial hazards Applicable safe work practices

Lifting   Barrier/Fence/warningtape  Suspendedload   Pre-jobsafetymeeting  Fall   SpecificPPEs  Electricalshock  

PermittoworkN…………………………………………………………………………

  Burying   Energyisolationprocedure  Flooding/drowninghazard   Communicationsystem  Chemicalexposure   Confinedspaceentrypermit  Elevatedworks   Worksiteorientation  Confinedspace    Availability/reviewofemergencyactionplan  Pinch,crush,striking   Safetysigns  Shortserviceemployees   Other……………………………………………………………………………….  Fireorexplosionhazard

Special precaution  PotenzialrelaeaseofEnergy  Excavation   Simultaneousoperations:Whichones?.................................  Noise   ……………………………………………………………………………………………………………………………

  Ionizinghazard   Pollutionprevention  Enviromentalhazard   Worksnearpressurizedpipeline  Sharpedges/hotsurface   Overheadenergizedcables  particleprojection   Crossing  Other……………………………………………………………………………………….   Other……………………………………………………………………………………………………

N. Work phase N. Potenzial hazards N. Measure to reduce / eliminate hazards

Name and surname Application Sign

 

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Date : Work description: Supervisor : Sign:

Potenzial hazards Applicable safe work practices

Lifting   Barrier/Fence/warningtape  Suspendedload   Pre-jobsafetymeeting  Fall   SpecificPPEs  Electricalshock  

PermittoworkN…………………………………………………………………………  Burying   Energyisolationprocedure 

Flooding/drowninghazard 

Communicationsystem  Chemicalexposure   Confinedspaceentrypermit  Elevatedworks   Worksiteorientation  Confinedspace    Availability/reviewofemergencyactionplan  Pinch,crush,striking   Safetysigns  Shortserviceemployees   Other……………………………………………………………………………….  Fireorexplosionhazard

Special precaution  PotenzialrelaeaseofEnergy  Excavation   Simultaneousoperations:Whichones?.................................  Noise   ……………………………………………………………………………………………………………………………  Ionizinghazard   Pollutionprevention

  Enviromentalhazard   Worksnearpressurizedpipeline  Sharpedges/hotsurface   Overheadenergizedcables  particleprojection   Crossing  Other……………………………………………………………………………………….   Other……………………………………………………………………………………………………

N. Work phase N. Potenzial hazards N. Measure to reduce / eliminate hazards

Name and surname Application Sign

 

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Composto da n. xx facciate, fronte retro, piegato al centro,

L’HSE deve: 

a)  consegnarlo ogni supervisore all’arrivo in site per il turno e ritirarlo alla fine del medesimo;

b)  illustrarne lo scopo, l’utilità, il contenuto, l’uso, 

c)  partecipare, osservare,supportare, suggerire, nel caso intervenire;

d)  verificare la corretta compilazione ed applicazione;

e) 

verificare che tutti i lavoratori siano resi partecipi;f)  analizzare le osservazioni e farne oggetto di discussione nel monthly meeting;

Il supervisore deve:

a)  ricevere e conservare con cura il JSA

b)  compilarlo per ogni attività;

c)  condividerlo e discuterlo con il suo team;

d)  firmarlo e farlo firmare;

e)  Compilare la pagina delle osservazioni;

f)  Riconsegnarlo all’HSE quando è completato in ogni foglio.