MCIS Job Safety Analysis

• Conducted on

  Date

• Prepared by

• Job/Task

• Document Number

JOB SAFETY ANALYSIS WORKSHEET INFORMATION

• JOB/TASK:

• DATE:

  Date

• END DATE:

  Date

• LOCATION:

• RESPONSIBLE SUPERVISOR:

• TEAM MEMBERS:

SAFETY ANALYSIS

• Risk Rating Matrix

  
JOB/TASK STEPS

• Describe Job/Task Step

• Potential Hazards related to the step

• Hazard Management

• Likelihood that hazardous event will occur

  Select 1 - Unlikely - Might occur once in ten years 2 - Remote - Might occur once in five years 3 - Occasional - Might occur once in three years 4 - Moderate - Likely to occur once per year 5 - Frequent - Likely to occur many times per year

  • 1 - Unlikely - Might occur once in ten years
  • 2 - Remote - Might occur once in five years
  • 3 - Occasional - Might occur once in three years
  • 4 - Moderate - Likely to occur once per year
  • 5 - Frequent - Likely to occur many times per year

• Consequence of hazardous event

  Select 5 - Critical - Fatality, single or multiple or permanent body injury or loss of use for more than 30 days, Acute Poisoning, Failure of major bodily functions, Infection with no known cure. 4 - Major - Injury requiring 30 days of hospitalization and/or medical leave. Temporary body injury or loss of use for between 10 and 30 days. Moderate exposure, Reversible injury to Bodily Functions on prolong recovery. Infection with known cure but extensive treatment. 3 - Moderate - Injury requiring 10 days of hospitalization and/or medical leave. Temporary body injury or loss of use for up to 10 days, Mild exposure, reversible injury to bodily functions with less than 30 days recovery. Infection with known cure but extensive treatment. 2 - Minor - Injury requiring maximum of 3 days of medical leave only. Temporary body injury or loss of use for 3 days or less. Very mild exposure, reversible injury to bodily functions with less than 3 days recovery. Infection with known cure but treatment needed. 1 - Insignificant - First aid treatment only, or no or superficial injury. Very mild exposure, reversible injury to bodily functions with less than 3 days recovery. No Exposure to others.

  • 5 - Critical - Fatality, single or multiple or permanent body injury or loss of use for more than 30 days, Acute Poisoning, Failure of major bodily functions, Infection with no known cure.
  • 4 - Major - Injury requiring 30 days of hospitalization and/or medical leave. Temporary body injury or loss of use for between 10 and 30 days. Moderate exposure, Reversible injury to Bodily Functions on prolong recovery. Infection with known cure but extensive treatment.
  • 3 - Moderate - Injury requiring 10 days of hospitalization and/or medical leave. Temporary body injury or loss of use for up to 10 days, Mild exposure, reversible injury to bodily functions with less than 30 days recovery. Infection with known cure but extensive treatment.
  • 2 - Minor - Injury requiring maximum of 3 days of medical leave only. Temporary body injury or loss of use for 3 days or less. Very mild exposure, reversible injury to bodily functions with less than 3 days recovery. Infection with known cure but treatment needed.
  • 1 - Insignificant - First aid treatment only, or no or superficial injury. Very mild exposure, reversible injury to bodily functions with less than 3 days recovery. No Exposure to others.

• Residual risk rating

  Select 1 2 3 4 5 6 8 9 10 12 15 16 20 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 8
  • 9
  • 10
  • 12
  • 15
  • 16
  • 20
  • 25

HAZARD IDENTIFICATION

• Identify hazards that may be present

  Select Difficult Entry/Exit Oxygen Deficiency Oxygen Excess Engulfment Poisonous Gas Present Temperature Extremes Defined Confined Space Explosive Gas Present Hazardous Substances- attach MSDS to JSA Working at Heights Remote Area Motor Room Hazards Toxic Substances Potential for Difficult Rescue Falling Objects Poor Lighting Slippery Surfaces Multiple Electrical Feeds Trip Hazards Electrical Hazards – LV Electrical Hazards – HV Manual Handling Sharp Materials Ladders used in the risk Working at Heights Working near Crane & Crane Runways Rail Movement Pressurised Fluids Flamm. Materials Present Suspended Loads Poor Visibility Inhalable Dusts/Fibres High Noise Levels Use of Chemicals Elevated Work Platform Difficulty to Communicate amongst workers Moving Machinery Tools & Equipment Radiation Traffic Movement Working near Operation Processing Lines Live Rails Pneumatics N/A

  • Difficult Entry/Exit
  • Oxygen Deficiency
  • Oxygen Excess
  • Engulfment
  • Poisonous Gas Present
  • Temperature Extremes
  • Defined Confined Space
  • Explosive Gas Present
  • Hazardous Substances- attach MSDS to JSA
  • Working at Heights
  • Remote Area
  • Motor Room Hazards
  • Toxic Substances
  • Potential for Difficult Rescue
  • Falling Objects
  • Poor Lighting
  • Slippery Surfaces
  • Multiple Electrical Feeds
  • Trip Hazards
  • Electrical Hazards – LV
  • Electrical Hazards – HV
  • Manual Handling
  • Sharp Materials
  • Ladders used in the risk
  • Working at Heights
  • Working near Crane & Crane Runways
  • Rail Movement
  • Pressurised Fluids
  • Flamm. Materials Present
  • Suspended Loads
  • Poor Visibility
  • Inhalable Dusts/Fibres
  • High Noise Levels
  • Use of Chemicals
  • Elevated Work Platform
  • Difficulty to Communicate amongst workers
  • Moving Machinery
  • Tools & Equipment
  • Radiation
  • Traffic Movement
  • Working near Operation Processing Lines
  • Live Rails
  • Pneumatics
  • N/A

PERMITS

• Which work permits required for the Job/Task

  Select Hot Work Excavation Confined Space Hazardous Work Clearance Access to Area High Voltage Access Scaffolding N/A

  • Hot Work
  • Excavation
  • Confined Space
  • Hazardous Work Clearance
  • Access to Area
  • High Voltage Access
  • Scaffolding
  • N/A

ADDITIONAL CONTROLS

• Additional controls required

  Select Gloves Goggles Full Face Shield High Vis. Vest Harness Fire Extinguishers Barricades Ventilation Lighting Erect Scaffolding to access Respirator or Dust mask Erect Warning signs Personal Locks or Tag system Group isolation Welding screen Fall Arrest systems Welding Face Shield N/A

  • Gloves
  • Goggles
  • Full Face Shield
  • High Vis. Vest
  • Harness
  • Fire Extinguishers
  • Barricades
  • Ventilation
  • Lighting
  • Erect Scaffolding to access
  • Respirator or Dust mask
  • Erect Warning signs
  • Personal Locks or Tag system
  • Group isolation
  • Welding screen
  • Fall Arrest systems
  • Welding Face Shield
  • N/A

JOB SAFETY ANALYSIS APPROVAL

• Name & Surname

• Position

• Signature

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JOB SAFETY ANALYSIS ACKNOWLEDGEMENT OF AWARENESS AND UNDERSTANDING

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