7/18/2019 Sample of Job Safety Analysis Form

http://slidepdf.com/reader/full/sample-of-job-safety-analysis-form 1/1

SAMPLE OF JOB SAFETY ANALSIS FORM

Picture of task/equipment: Task:Opening Electrical Panels – Exposed Electrical Circuitry (fortesting voltages and current

!ame of"#op or $ept:

 FM Electrical Shop

%o& Title(s: Electricians

'nalyed &y:

$ate:

)equired PPE:

Cat 1-2-3FRC/ FS/SG/GLV/HP/H/MI/HP/I

)equired/)ecommended Trainings:

 Arc Flash PPE L!"! First Ai#- AE$ Approach %o&n#ar'(s -- Li)ite# /Restricte# /Prohi*ite#

T'"* +',')$" CO!T)O-"

Re)o+in, -%ranch panelCo+er 2.V- 1/22aic

Ener,i0e# electrical circ&itsElectrical ShocElectrical %&rn

 Arc Flash

%o#il' in&r'Pe#estrian "raic

!nl' &aliie# Personnel to peror) tasPPE- Cat 1%arrica#es/ %o&n#ar'(sSaet' Person

Cat IV Meter %e s&re that Saet' person 4no5s 5here to #e-ener,i0e panel inthe e+ent o e)er,enc'

Re)o+in, -%ranch panelCo+er 6. V-1/22aic

Ener,i0e# electrical circ&itsElectrical ShocElectrical %&rn

 Arc Flash%o#il' in&r'Pe#estrian "raic

!nl' &aliie# Personnel to peror) tasPPE 7Cat 2%arrica#es/ %o&n#ar'(sSaet' PersonCat IV Meter %e s&re that Saet' person 4no5s 5here to #e-ener,i0e panel inthe e+ent o e)er,enc'

Re)o+in, 7$istri*&tion%oar# Co+er 2.-624aic

Ener,i0e# electrical circ&itsElectrical ShocElectrical %&rn

 Arc Flash%o#il' in&r'8na&thori0e# Personnel

!nl' &aliie# Personnel to peror) tasPPE- Cat1%arrica#es/ %o&n#ar'(sSaet' PersonCat IV Meter %e s&re that Saet' person 4no5s 5here to #e-ener,i0e panel inthe e+ent o e)er,enc'

Re)o+in, 7$istri*&tion%oar# Co+er 6.V 624aic

Ener,i0e# electrical circ&itsElectrical ShocElectrical %&rn

 Arc Flash%o#il' in&r'8na&thori0e# Personnel

!nl' &aliie# Personnel to peror) tasPPE Cat2%arrica#es/ %o&n#ar'(sSaet' PersonCat IV Meter %e s&re that Saet' person 4no5s 5here to #e-ener,i0e panel inthe e+ent o e)er,enc'

Re)o+in,- Rear Panels o Secon#ar' %reaers2.V- 9:4Aic

Ener,i0e# electrical circ&itsElectrical ShocElectrical %&rn

 Arc Flash%o#il' in&r'8na&thori0e# Personnel

!nl' &aliie# Personnel to peror) tasPPE Cat 3%arrica#es/ %o&n#ar'(sSaet' PersonCat IV Meter %e s&re that Saet' person 4no5s 5here to #e-ener,i0e panel inthe e+ent o e)er,enc'

Re)o+in,- Rear Panels o Secon#ar' %reaers6.V- 9:4Aic

Ener,i0e# electrical circ&itsElectrical ShocElectrical %&rn

 Arc Flash%o#il' in&r'8na&thori0e# Personnel

!nl' &aliie# Personnel to peror) tasPPE Cat 3%arrica#es/ %o&n#ar'(sSaet' PersonCat IV Meter %e s&re that Saet' person 4no5s 5here to #e-ener,i0e panel inthe e+ent o e)er,enc'