Job Safety Analysis (JSA) - GES

• Site conducted

  Select

• If site is not listed type site name here and email the Safety Department to get the site NAME/NUMBER added to your account

• Title

  Job Safety Analysis

• Conducted By

• Conducted on

  Date
• Location
  Address

1.1 Tasks to be accomplished today

• Project/Job/Task

  Select Installing underground conduit 4' or deeper Equipment Operation -- Back hoe, Boom lifts, Scissor lifts Running overhead conduit using ladders including multi purpose ladders Material handling pulling wire Working on systems while building is energized Roughing in walls Non-routine tasks / concrete penetrations/chipping concrete Working on energized equipment working in or around excavations Working on scaffolds Material handling pushing , lifting Installing underground less than 4' deep Potential fall greater than 6 feet

  • Installing underground conduit 4' or deeper
  • Equipment Operation -- Back hoe, Boom lifts, Scissor lifts
  • Running overhead conduit using ladders including multi purpose ladders
  • Material handling pulling wire
  • Working on systems while building is energized
  • Roughing in walls
  • Non-routine tasks / concrete penetrations/chipping concrete
  • Working on energized equipment
  • working in or around excavations
  • Working on scaffolds
  • Material handling pushing , lifting
  • Installing underground less than 4' deep
  • Potential fall greater than 6 feet

• Each employee on walking/working surfaces shall be protected from falling through holes (including skylights) more than 6 feet (1.8 m) above lower levels, by personal fall arrest systems, covers, or guardrail systems erected around such holes.

• Is there a potential cut hazard?

  Yes

  NO

• Did you provide kevlar sleeves?

  Yes

  No

  N/A

• Has the scaffold been inspected by a competent person?

  Yes

  NO

• Are there other tasks not listed

  Yes

  No

• Describe task, associated hazards and elimination methods in detail.

Hazards

• List of Identified Hazards

• Cave ins, hazardous atmospheres when team members are inside

  Select Install shoring system Verify proper oxygen levels Inspections, access egress competent person N/A

  • Install shoring system
  • Verify proper oxygen levels
  • Inspections, access egress competent person
  • N/A

• Are we using a fork lift/telescopic handler/skytrak?

  Yes

  No

• Is operator certified?

  Compliant

  Non-Compliant

• STOP! Contact supervisor or safety department for training.

• Has operator performed required inspections/ workplace inspection/equipment inspection

  Yes

  NO

• If no inspection is performed why not.

• Struck by incidents / caught in between hazards

  Select SLAM Possible hazards Wear high visibility clothing Asses the situation wear PPE and rotate personnel as needed situational awareness /be aware of your surroundings Fork lift / Telescopic handler N/A

  • SLAM Possible hazards
  • Wear high visibility clothing
  • Asses the situation wear PPE and rotate personnel as needed
  • situational awareness /be aware of your surroundings
  • Fork lift / Telescopic handler
  • N/A

• Is equipment going to be used for its intended purpose?

  Yes

  No

• Describe what you will be using it for and, potential hazards and elimination methods associated with the task.

• Falls from ladders, missing last step, repetitive motion

  Select Ladder inspections / position ladder in a manner that will decrease undue stress Three points of contact at all times Do not rush while decending Use ladders for its intended purpose DO NOT WORK OF EXTENSION LADDERS Follow manufacturer and company rules

  • Ladder inspections / position ladder in a manner that will decrease undue stress
  • Three points of contact at all times
  • Do not rush while decending
  • Use ladders for its intended purpose
  • DO NOT WORK OF EXTENSION LADDERS
  • Follow manufacturer and company rules

• Potential falls greater than six feet

  Select Fall Arrest System Guard Rail System Site Specific Fall protection Plan Not applicable

  • Fall Arrest System
  • Guard Rail System
  • Site Specific Fall protection Plan
  • Not applicable

• Each employee on walking/working surfaces shall be protected from falling through holes (including skylights) more than 6 feet (1.8 m) above lower levels, by personal fall arrest systems, covers, or guardrail systems erected around such holes. Site-Specific plan must be updated.

• soft tissue injuries to back shoulder, legs etc

  Select Stretch and flex exercises DO NOT LIFT MORE THAN 50 LBS, Use mechanical aids or ask for help Avoid awkward postures and undue stress to your body

  • Stretch and flex exercises
  • DO NOT LIFT MORE THAN 50 LBS, Use mechanical aids or ask for help
  • Avoid awkward postures and undue stress to your body

• Electrocutions / shock / Arc blast / arc flash

  Select De-energize the system (work safe condition) Obtain a hot work permit LOTO with qualified person Qualified person with proper PPE

  • De-energize the system (work safe condition)
  • Obtain a hot work permit
  • LOTO with qualified person
  • Qualified person with proper PPE

• cuts / lacerations / crushed fingers

  Select Cut resistant gloves Long sleeves situational awareness Make sure hands are clear before engaging equipment that can potentially pinch hands or fingers

  • Cut resistant gloves
  • Long sleeves
  • situational awareness
  • Make sure hands are clear before engaging equipment that can potentially pinch hands or fingers

• Silica exposure

  Select Exposure control plan / Competent person Exposed employees trained on SOP # 1 Follow table 1 guidelines

  • Exposure control plan / Competent person
  • Exposed employees trained on SOP # 1
  • Follow table 1 guidelines

• Other hazards associated with the work to be done

  Select Yes No

  • Yes
  • No

• Describe the hazard and elimination method

• competent person

  Sign

2.1 Declaration

• we understand the Job/Tasks

• I/We have an understanding of the Job/Task(s) and have discussed these with team members to the best of my/our knowledge

• We understand our individual role in this Job/Task(s)

• I/We have an understanding of my/our roles in this Job/Task(s) and have discussed the potential hazards and how to eliminate them with the Site Supervisor/ team members to the best of my/our knowledge

• We know the site safety rules applicable to the Job/Task(s)

• I/We have an understanding of the safety rules applicable to the Job/Task(s) and have discussed these with the site Supervisor/Contractors/Employees to the best of my/our knowledge

• We have identified all required PPE for the Job/Task(s)

• I/we have an understanding of all PPE required to perform the Job/Task(s) and have discussed these with the Site Supervisor/Contractors/Employees to the best of my/our knowledge

• We have identified the potential known hazards

• I/we have an understanding of the potential Hazards and steps to Eliminated/Isolate/Minimized those Hazards to the best of my/our knowledge

• The purpose of having a safety huddle every morning with a JSA is.......

• I/we have an understanding that the main objective of communicating the hazards associated with the task to be performed today, is to make sure every team members goes home the same way they came to work every morning. No accidents.

• We know the purpose of having a safety huddle every morning with a JSA is .......

• I/We have an understanding that the main objective of communicating the hazards associated with the tasks to be performed today , is to make sure every team member goes home the same way they came to work this morning. Safety is no Accident.

• We understand our responsibility to take time out for safety when there are hazards not addressed on the JSA.

• I/We understand our responsibility to comply with "time out for safety" by speaking out about hazards not addressed.

3.1 Team members working under this JSA

• Team members

Team member signature

• Add signature

  Sign