Dawood Engineering Job Safety Analysis

• Client

• Project Name

  Select

• Project Number

• Task Number

• Today's Date

  Date
• Location
  Address

Project Information

• Job/Task Description

• Work Environment

  Select Indoor Outdoor Urban Suburban Rural

  • Indoor
  • Outdoor
  • Urban
  • Suburban
  • Rural

• Today's Weather

  Select Clear Mostly Sunny Mostly Cloudy Overcast Extreme Heat Extreme Cold Thunderstorms Rain High Winds Snow Hail Sleet

  • Clear
  • Mostly Sunny
  • Mostly Cloudy
  • Overcast
  • Extreme Heat
  • Extreme Cold
  • Thunderstorms
  • Rain
  • High Winds
  • Snow
  • Hail
  • Sleet

• Emergency Contact (Name and Phone #)

• Location and Name of Nearest Medical Facility:

• Start Time:

  Date

• End Time:

  Date

Potential EH&S Hazards

• Hazardous Atmosphere

  Yes

  No

  N/A

• What hazardous agent(s) is/are present?

• What mitigations/safeguards are in place to protect workers?

• Hazardous Gases or Vapors

  Yes

  No

  N/A

• What is the source of the hazardous gas or vapor?

• What mitigations/safeguards are in place to protect workers?

• Chemical Exposure

  Yes

  No

  N/A

• What chemicals are you using?

• Have you reviewed the Safety Data Sheet?

  Yes

  No

  N/A

• What mitigations/safeguards are in place to protect workers?

• Flammable/Combustible Materials

  Yes

  No

  N/A

• List flammable materials.

• What mitigations/safeguards are in place to protect workers?

• Electrical Hazards

  Yes

  No

  N/A

• What mitigations/safeguards are in place to protect workers?

• Excavations/Trenches

  Yes

  No

  N/A

• Are workers entering the excavation?

  Yes

  No

  N/A

• Soil Type?

  Stable Rock

  Type A

  Type B

  TypeC

• Excavation's walls are sloped to 90 degrees or less

  Yes

  No

  N/A

• Excavation's walls are sloped to 53 degrees or less

  Yes

  No

  N/A

• Excavation's walls are sloped to 45 degrees or less

  Yes

  No

  N/A

• Excavation's walls are sloped to 34 degrees or less

  Yes

  No

  N/A

• Has a competent person inspected the excavation?

  Yes

  No

  N/A

• How deep is the excavation (in feet)?

• Access and egress points within 25 feet at all times?

  Yes

  No

  N/A

• Access and egress within 25 feet at all times?

  Yes

  No

  N/A

• Which cave-in protection system used?

  Sloping

  Benching

  Shoring

  Shielding (Trench box)

• Access and egress within 25 feet at all times?

  Yes

  No

  N/A

• Cave-in protection system used?

  Sloping

  Benching

  Shoring

  Shielding (Trench box)

• Atmosphere tested before entry?

  Yes

  No

  N/A

• Atmosphere continuously monitored during work in excavation?

  Yes

  No

  N/A

• Confined Space Entry

  Yes

  No

  N/A

• Permit-Required or Non-Permit-Required?

  Permit-Required

  Non-Permit-Required

• Upload a picture of the completed and signed permit

  Media

• Employees have a rescue team available and on stand-by.

  Yes

  No

  N/A

• Employees have all necessary tools and equipment to do the job safely

  Yes

  No

  N/A

• Hot Work

  Yes

  No

  N/A

• Upload a picture of your completed and signed Hot Work Permit.

  Media

• Hot Work is at least 35 feet away from any explosion hazards (gas under pressure/chemical storage vessels).

  Yes

  No

  N/A

• Yes

  No

  N/A

• Continuous atmospheric monitoring is available.

  Yes

  No

  N/A

• High Noise Level

  Yes

  No

  N/A

• Noise level

• What safeguards are in place to keep workers safe from excess occupational noise exposure?

• Low Visibility

  Yes

  No

  N/A

• What source(s) of light are available for workers?

• Mobile Equipment Operations

  Yes

  No

  N/A

• Who is operating the equipment?

  Select A Dawood Engineering Employee A Dawood Engineering Sub-Contractor Another contractor, not affiliated with Dawood Engineering

  • A Dawood Engineering Employee
  • A Dawood Engineering Sub-Contractor
  • Another contractor, not affiliated with Dawood Engineering

• Employee is authorized to operate the equipment.

  Yes

  No

  N/A

• Employee inspected equipment before use.

  Yes

  No

  N/A

• All employees understand to make eye contact with equipment operators before crossing their path.

  Yes

  No

  N/A

• Employee is approved to operate the equipment by the sub contractor.

  Yes

  No

  N/A

• Employee inspected the equipment before use.

  Yes

  No

  N/A

• Equipment passed the inspection.

  Yes

  No

  N/A

• All employees understand to make eye contact with equipment operators before crossing their path.

  Yes

  No

  N/A

• All employees understand to make eye contact with equipment operators before crossing their path.

  Yes

  No

  N/A

• Hand Tool Use

  Yes

  No

  N/A

• List the tools you are using.

• What hazards are present with these tools?

• What safeguards are in place to protect workers?

• Power Tool Use

  Yes

  No

  N/A

• List the tools you are using.

• What hazards are present with these tools?

• What safeguards are in place to protect workers

• Pneumatic Tool Use

  Yes

  No

  N/A

• List the tools you are using.

• What hazards are present with these tools?

• What safeguards are in place to protect workers?

• Powder-Actuated Tool Use

  Yes

  No

  N/A

• List the tools you are using.

• What hazards are present with these tools?

• What safeguards are in place to protect workers?

• Hydraulic Tools

  Yes

  No

  N/A

• List the tools you are using.

• What hazards are present with these tools?

• What safeguards are in place to protect workers?

• Cutting Tools

  Yes

  No

  N/A

• List the tools you are using.

• What hazards are present with these tools?

• What safeguards are in place to protect workers?

• Heavy Lifting

  Yes

  No

  N/A

• How heavy is the object?

• Are you performing a Team Lift?

  Yes

  No

  N/A

• Do you have material handling equipment such as a pallet jack, an appliance dolly, or a fork truck?

  Yes

  No

  N/A

• Overhead Work

  Yes

  No

  N/A

• List the hazards of overhead work.

• How will workers stay safe from the hazards?

• Working at Heights

  Yes

  No

  N/A

• Which fall protection standard is applicable?

  Construction

  General Industry

• Distance (feet) from working level to next lower level.

• How will workers stay safe from fall hazard?

• Distance (feet) from working level to next lower level.

• How will workers stay safe from fall hazard?

• Select the means of access to elevated work.

  Ladder

  Scaffold

  Mobile Elevating Lift Platform

• The selected ladder is appropriate for accessing the elevated work.

  Yes

  No

  N/A

• Scaffold has been inspected by a competent person and is safe to use.

  Yes

  No

  N/A

• MEWP has been inspected before use.

  Yes

  No

  N/A

• Adverse Weather Conditions

  Yes

  No

  N/A

• Describe the adverse weather condition

• How is the adverse weather condition a hazard to workers?

• What safeguards are in place to keep workers safe?

• Wildlife

  Yes

  No

  N/A

• What types of wildlife could be expected in the work environment?

• What hazards does the presence of these wildlife present?

• What safeguards are in place to keep workers safe?

• Harmful/Poisonous Vegetation

  Yes

  No

  N/A

• Which harmful/poisonous vegetation could be expected in the work environment?

• What hazards does their presence present?

• What safeguards are in place to keep workers safe?

• Traffic

  Yes

  No

  N/A

• Select the option that applies, work area is on the road or near the road.

  On the road

  Near the road

• Roadwork signs are present.

  Yes

  No

  N/A

• Traffic Control Devices are present.

  Yes

  No

  N/A

• Qualified flaggers are present.

  Yes

  No

  N/A

• All employees reviewed and understand the traffic control plan.

  Yes

  No

  N/A

• Employees do not work outside of the traffic controlled areas.

  Yes

  No

  N/A

• Adequate warning of your presence is given to motorists.

  Yes

  No

  N/A

• Vehicle is using hazard lights to indicate it is stationary.

  Yes

  No

  N/A

• Workplace Distractions

  Yes

  No

  N/A

• What types of distractions could give rise to an incident?

• What safeguards/procedures are in place to reduce the risk of distractions?

• Other

  Yes

  No

  N/A

• Describe the additional hazard.

• Describe the potential effects of this hazard.

• What procedures/safeguards are in place to protect workers?

• Select necessary PPE and Safety Technology to keep yourself and others safe.

  Select Hard Hat Safety Glasses Safety Goggles Type II Safety Vest Type III Safety Vest Lifting Belts Gloves Protective Clothing FRC Safety-Toed Footwear Leg Gaiters Boot Traction Systems Respiratory Protection Fall Protection Gas Monitoring Equipment SPOT GPS Messenger

  • Hard Hat
  • Safety Glasses
  • Safety Goggles
  • Type II Safety Vest
  • Type III Safety Vest
  • Lifting Belts
  • Gloves
  • Protective Clothing
  • FRC
  • Safety-Toed Footwear
  • Leg Gaiters
  • Boot Traction Systems
  • Respiratory Protection
  • Fall Protection
  • Gas Monitoring Equipment
  • SPOT GPS Messenger

• What type of gloves?

  Select Fabric/Cotton Leather Cut-Resistant Impact-Resistant Kevlar Nitrile Butyl-Rubber (Chemical) Aluminized (Heat) Insulating Rubber (Electrical)

  • Fabric/Cotton
  • Leather
  • Cut-Resistant
  • Impact-Resistant
  • Kevlar
  • Nitrile
  • Butyl-Rubber (Chemical)
  • Aluminized (Heat)
  • Insulating Rubber (Electrical)

• Have the gloves been inspected and ready to use?

  Yes

  No

  N/A

• Describe the protective clothing?

  Disposable

  Reusable

• The protective clothing has never been worn before.

  Yes

  No

  N/A

• Protective clothing has been decontaminated since last use.

  Yes

  No

  N/A

• Has the protective clothing passed a pre-use inspection?

  Yes

  No

  N/A

• What is/are the hazard(s) that require respiratory protection?

• What type of respirator are you using?

  Air Purifying Respirator

  Supplied Air Respirator

• What type of Air Purifying Respirator?

  Select Filtering Facepiece Respirator Elastomeric Half Facepiece Respirator Elastomeric Full Facepiece Respirator

  • Filtering Facepiece Respirator
  • Elastomeric Half Facepiece Respirator
  • Elastomeric Full Facepiece Respirator

• This is a new respirator.

  Yes

  No

  N/A

• Select level of protection.

  Select N95 N99 N100 R95 R99 R100

  • N95
  • N99
  • N100
  • R95
  • R99
  • R100

• Select filter cartridge type.

  Select Acid Gases (White) Hydrocyanic Acid Gas (White with Green Stripe) Chlorine Gas (White with Yellow Stripe) Organic Vapors (Black) Ammonia Gas (Green) Acid Gases and Ammonia Gas (Green with White Stripe) Carbon Monoxide (Blue) Acid Gases and Organic Vapors (Yellow) Hydrocyanic Acid Gas and Chloropicrin Vapor (Yellow with Blue Stripe) Acid Gases, Organic Vapors, and Ammonia Gas (Brown) Radioactive Materials, except Tritium and Noble Gases (Purple/Magenta) Pesticides (Purple and Black) Multi-Contaminant and CBRN Agent (Olive) Any Particulates - P100 (Purple) Any Particulates -P95, P99, R95, R99, R100 (Orange) Any particulates free of oil - N95, N99, N100 (Teal)

  • Acid Gases (White)
  • Hydrocyanic Acid Gas (White with Green Stripe)
  • Chlorine Gas (White with Yellow Stripe)
  • Organic Vapors (Black)
  • Ammonia Gas (Green)
  • Acid Gases and Ammonia Gas (Green with White Stripe)
  • Carbon Monoxide (Blue)
  • Acid Gases and Organic Vapors (Yellow)
  • Hydrocyanic Acid Gas and Chloropicrin Vapor (Yellow with Blue Stripe)
  • Acid Gases, Organic Vapors, and Ammonia Gas (Brown)
  • Radioactive Materials, except Tritium and Noble Gases (Purple/Magenta)
  • Pesticides (Purple and Black)
  • Multi-Contaminant and CBRN Agent (Olive)
  • Any Particulates - P100 (Purple)
  • Any Particulates -P95, P99, R95, R99, R100 (Orange)
  • Any particulates free of oil - N95, N99, N100 (Teal)

• Respirator has been inspected and is ready for use.

  Yes

  No

  N/A

• Select filter cartridge type.

  Select Acid Gases (White) Hydrocyanic Acid Gas (White with Green Stripe) Chlorine Gas (White with Yellow Stripe) Organic Vapors (Black) Ammonia Gas (Green) Acid Gases and Ammonia Gas (Green with White Stripe) Carbon Monoxide (Blue) Acid Gases and Organic Vapors (Yellow) Hydrocyanic Acid Gas and Chloropicrin Vapor (Yellow with Blue Stripe) Acid Gases, Organic Vapors, and Ammonia Gas (Brown) Radioactive Materials, except Tritium and Noble Gases (Purple/Magenta) Pesticides (Purple and Black) Multi-Contaminant and CBRN Agent (Olive) Any Particulates - P100 (Purple) Any Particulates -P95, P99, R95, R99, R100 (Orange) Any particulates free of oil - N95, N99, N100 (Teal)

  • Acid Gases (White)
  • Hydrocyanic Acid Gas (White with Green Stripe)
  • Chlorine Gas (White with Yellow Stripe)
  • Organic Vapors (Black)
  • Ammonia Gas (Green)
  • Acid Gases and Ammonia Gas (Green with White Stripe)
  • Carbon Monoxide (Blue)
  • Acid Gases and Organic Vapors (Yellow)
  • Hydrocyanic Acid Gas and Chloropicrin Vapor (Yellow with Blue Stripe)
  • Acid Gases, Organic Vapors, and Ammonia Gas (Brown)
  • Radioactive Materials, except Tritium and Noble Gases (Purple/Magenta)
  • Pesticides (Purple and Black)
  • Multi-Contaminant and CBRN Agent (Olive)
  • Any Particulates - P100 (Purple)
  • Any Particulates -P95, P99, R95, R99, R100 (Orange)
  • Any particulates free of oil - N95, N99, N100 (Teal)

• Respirator has been inspected and is ready for use.

  Yes

  No

  N/A

• Half Mask

  Full Mask

• What type of Supplied Air Respirator?

  SCBA

  Hoseline/Cascade System

  Escape Pack SCBA

• Supplied Air Respirator System has been inspected and is ready to use?

  Yes

  No

  N/A

• SAR passes the seal-check.

  Yes

  No

  N/A

• Safety goggles are free of damage and ready to use.

  Yes

  No

  N/A

• Hard hat has no signs of damage or brittleness.

  Yes

  No

  N/A

• Hard hat manufacture date is within the past 5 years

  Yes

  No

  N/A

• Safety glasses are free of damage and are ready to use.

  Yes

  No

  N/A

• Safety Glasses are ANSI Z87.1 - approved

  Yes

  No

  N/A

• Safety Vest is clean and reflective striping is present.

  Yes

  No

  N/A

• Safety Vest is clean and reflective striping is present.

  Yes

  No

  N/A

• Yes

  No

  N/A

• Lifting belt is in good repair and is ready for use.

  Yes

  No

  N/A

• FR Clothing is appropriately rated for the task at hand.

  Yes

  No

  N/A

• FR Clothing is the outermost layer of clothing, including safety vest.

  Yes

  No

  N/A

• FR shirts are tucked into pants and sleeves are rolled down.

  Yes

  No

  N/A

• Safety toed footwear is in good repair and is ready for use.

  Yes

  No

  N/A

• Leg gaiters are in good repair and are ready to use.

  Yes

  No

  N/A

• Boot traction system is an approved type for the task at hand.

  Yes

  No

  N/A

• Boot traction system is in good repair and ready for use.

  Yes

  No

  N/A

• Fall Prevention or Fall Protection?

  Fall Prevention

  Fall Protection

• Select Fall Prevention

  Guardrail System

  Body Positioning System

• All guardrail components are in place.

  Yes

  No

  N/A

• Anchor Point is secure and capable of withstanding two times the foreseeable force applied to it.

  Yes

  No

  N/A

• Harness, lanyard, and anchoring system have been inspected and are ready for use.

  Yes

  No

  N/A

• Select Fall Protection System

  Select Personal Fall Arrest System (PFAS) Safety Nets

  • Personal Fall Arrest System (PFAS)
  • Safety Nets

• Harness, lanyard and anchor point have been inspected and are ready for use.

  Yes

  No

  N/A

• Anchor point is capable of withstanding a 5,000 lbs. force

  Yes

  No

  N/A

• Fall rescue plan is available and reviewed by employees

  Yes

  No

  N/A

• Safety net system has been installed by professionals.

  Yes

  No

  N/A

• Safety net system has been tested (drop test) and is safe for use.

  Yes

  No

  N/A

• Safety net is more than 30 feet below the walking working surface.

  Yes

  No

  N/A

• Safety net is free of debris.

  Yes

  No

  N/A

• Safety net has been inspected and is safe for use.

  Yes

  No

  N/A

• Gas monitor has been calibrated within the last six months.

  Yes

  No

  N/A

• Gas monitor has been bump tested before use.

  Yes

  No

  N/A

• SPOT II GPS Messenger has sufficient battery life.

  Yes

  No

  N/A

• Safety Glasses are free of damage.

  Yes

  No

  N/A

• Safety glasses are ANSI Z87.1 - approved

  Yes

  No

  N/A

• JSA Prepared by

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