Job Safety Analysis

• Client

  Select Devon Not Listed

  • Devon
  • Not Listed

• Enter Client Name:

• Site

  Select Cana Field Office Haley Not Listed

  • Cana Field Office
  • Haley
  • Not Listed

• Enter Site Name:

• Location
  Address

• Audit Title:

  Select Daily JSA Pre-Job JSA Not Listed

  • Daily JSA
  • Pre-Job JSA
  • Not Listed

• Enter Audit Title:

• Performed by:

  Select Jason Wells Spencer Huiatt Jeremy Jones Zac Rich Bruce Watts Marcus Ware Josh King William Hunt Cothy Phillips Adam Spikes Steve Samples Eric Hartman Brian Gallt Nathanael Helms Caleb Eastman Chad Stuart Bryan Albrecht Preston Allen Ismael De Leon Devin Owens Koby Farmer Sway Martinez Manny Astorga Tony Arreola Not Listed

  • Jason Wells
  • Spencer Huiatt
  • Jeremy Jones
  • Zac Rich
  • Bruce Watts
  • Marcus Ware
  • Josh King
  • William Hunt
  • Cothy Phillips
  • Adam Spikes
  • Steve Samples
  • Eric Hartman
  • Brian Gallt
  • Nathanael Helms
  • Caleb Eastman
  • Chad Stuart
  • Bryan Albrecht
  • Preston Allen
  • Ismael De Leon
  • Devin Owens
  • Koby Farmer
  • Sway Martinez
  • Manny Astorga
  • Tony Arreola
  • Not Listed

• Enter Name:

• Personnel On-Site

  Select Jason Wells Spencer Huiatt Jeremy Jones Zac Rich Bruce Watts Marcus Ware Josh King William Hunt Cothy Phillips Adam Spikes Steve Samples Eric Hartman Brian Gallt Nathanael Helms Caleb Eastman Chad Stuart Bryan Albrecht Preston Allen Ismael De Leon Devin Owens Koby Farmer Sway Martinez Manny Astorga Tony Arreola Not Listed

  • Jason Wells
  • Spencer Huiatt
  • Jeremy Jones
  • Zac Rich
  • Bruce Watts
  • Marcus Ware
  • Josh King
  • William Hunt
  • Cothy Phillips
  • Adam Spikes
  • Steve Samples
  • Eric Hartman
  • Brian Gallt
  • Nathanael Helms
  • Caleb Eastman
  • Chad Stuart
  • Bryan Albrecht
  • Preston Allen
  • Ismael De Leon
  • Devin Owens
  • Koby Farmer
  • Sway Martinez
  • Manny Astorga
  • Tony Arreola
  • Not Listed

• Enter Name:

• Select date

  Date

Pre-Job Information

• What type of work is being performed?

  Select Communications Automation Tower Climb Tower Construction Electrical VAC Electrical VDC Not Listed

  • Communications
  • Automation
  • Tower Climb
  • Tower Construction
  • Electrical VAC
  • Electrical VDC
  • Not Listed

• Enter Type of Work:

• Additional work description:

• Do any additional notifications need to be made before starting this task? (Supervisor, Other workers on-site)

  Yes

  No

  N/A

• Make appropriate notifications before beginning work.

• Is an Energy Isolation Plan necessary (LOTO)?

  Yes

  No

  N/A

• Describe Energy Isolation Plan:

• Are there any trip hazards present?

  Yes

  No

  N/A

• Clear hazard before work begins!

• Take photo of hazard present:

  Media

• Take photo of hazard removed:

  Media

• Is a Fall Protection Plan necessary? (Will work be performed above 4ft?)

  Yes

  No

  N/A

• Is a Fall Protection Plan in place?

  Yes

  No

  N/A

• 1.) Take photo of elevated work area.
  2.) Develop Fall Protection Plan.

• Add media

  Media

• Describe Fall Protection Plan:

PPE & Monitoring

• All Personnel:

• Are wearing Eye Protection?

• Are wearing Hard Hats?

• Have access to Gloves?

• Are wearing steel / composite toe boots?

• Have required gas monitors?

• Gas monitors are charged?

• Tools have been inspected for damage?

• Have access to Element Protection? (adequate water, thermal protection for cold)

• Is additional PPE above the minimum required? Ex: Fall protection, hearing protection, face shield, respiratory protection, etc.

  Yes

  No

  N/A

• Additional PPE:

• Select Fall Protection Electrical Protection Hearing Protection Respiratory Protection Face Protection Other

  • Fall Protection
  • Electrical Protection
  • Hearing Protection
  • Respiratory Protection
  • Face Protection
  • Other

• Describe additional PPE:

Emergencies

• In case of Emergency:

• Where is the designated safe location?

• Who is the Emergency Contact?

• Select Jason Wells - (405)-328-0585 William Hunt - (405)-999-6744

  • Jason Wells - (405)-328-0585
  • William Hunt - (405)-999-6744

• What location/address/coordinates do we give Emergency Responders?

• Add location
  Address

• What is the address of the nearest medical facility?

• Are you North, West, or East of the Cana Field Office? ~There are no medical facilities to the South of the Cana Field Office! Choose a facility based on your East/West location.~

  Select North West East

  • North
  • West
  • East

• Mercy Hospital Watonga
  
  • Address: 500 N. Clarence Nash Boulevard
  Watonga, OK 73772
  
  •Phone: (580) 623-7211
  

• Weatherford Regional Hospital
  
  • Address: 3701 E. Main St.
  Weatherford, OK 73096
  
  •Phone: (580) 772-5551

• Mercy Hospital El Reno
  
  • Address: 2115 Parkview Drive
  El Reno, OK 73036
  
  • Phone: (405) 262-2640

Signature

• Add signature

  Sign