Prairie Companies JSA

• Driver Being Observed:

• Tractor & Trailer Number

• Conducted on

  Date
• Location
  Address

Arriving at Worksite Location - Potential Hazards

• Fencing, Pump Jack, Berms, People, Water, Mud, Snow, Ice, Deadman Hooks

  Safe

  At Risk

  N/A

Arriving at Worksite Location - Steps To Eliminate / Reduce Hazards

• Drive No Faster Than 5 MPH

• Make Wide Turns To Avoid Hazards

• Constant Observance

• G.O.A.L. (Get Out And Look)

• List Any Other Steps That Can Reduce or Eliminate Hazards

Exit Vehicle - Potential Hazards

• Mud, Grease, Ice, Snow, Ruts, High Winds, etc.

  Safe

  At Risk

  N/A

Exit Vehicle - Steps to Eliminate / Reduce Hazrds

• Maintain 3 Points of contact

• Observe Surroundings

• Proper Footwear, Cleats, etc.

• List Any Other Steps That Can Reduce or Eliminate Hazards

Chock Wheels - Potential Hazards

• Vehicle Roll

  Safe

  At Risk

  N/A

Chock Wheels - Steps to Eliminate / Reduce Hazards

• Chock Wheels

• Stay Outside of Vehicle

• List Any Other Steps That Can Reduce or Eliminate Hazards

Check Tank Production - Potential Hazards

• Slips, trips, Falls, H2S gas, Benzene, Snow, Ice, Mud, Pathway

  Safe

  At Risk

  N/A

Check Tank - Steps to Eliminate / Reduce Hazards

• Observe Surroundings

• H2S Monitor

• Maintain 3 Points of Contact

• List Any Other Steps That Can Reduce or Eliminate Hazards

Access Catwalk - Potential Hazards

• Slips, trips, Falls, H2S gas, Benzene, Snow, Ice, Mud, Pathway

  Safe

  At Risk

  N/A

Access Catwalk - Steps to Eliminate / Reduce Hazards

• Observe Surroundings

• H2S Monitor

• Maintain 3 Points of Contact

• List Any Other Steps That Can Reduce or Eliminate Hazards

Tank Work - Potential Hazards

• Slips, Trips, Falls, H2S gas, Benzene, Snow, Ice, Mud, Pathway, Contact with Crude

  Safe

  At Risk

  N/A

Tank Work - Steps to Eliminate/ Reduce Hazards

• Observe Surroundings

• Maintain 3 points of Contact

• H2S Monitor

• Identify Wind Direction (WindSock)

• Respirator (if required)

• Chemical Resistant Gloves

• Have an Escape Route

• List Any Other Steps That Can Reduce or Eliminate Hazards

Grind Out - Potential Hazards

• Slips, Trips, Falls, H2S gas, Benzene, Snow, Ice, Mud, Pathway, Contact with Crude

  Safe

  At Risk

  N/A

Grind Out - Steps to Eliminate/ Reduce Hazards

• Observe Surroundings

• Maintain 3 points of Contact

• H2S Monitor

• Respirator (if required)

• Chemical Resistant Gloves

• List Any Other Steps That Can Reduce or Eliminate Hazards

Hook Up Hoses - Potential Hazards

• Risk of Strains / Back Injury, Pinch Points, Spills

  Safe

  At Risk

  N/A

Hook Up Hoses - Steps to Eliminate / Reduce Hazards

• Impact Gloves

• Proper Lifting Techniques / Ergonomics

• Use Caution - Handle Hose Carefully

• List Any Other Steps That Can Reduce or Eliminate Hazards

Load Trailer - Potential Hazards

• Overfill, Spills, H2S

  Safe

  At Risk

  N/A

Load Trailer - Steps to Eliminate / Reduce Hazards

• Stay By Controls

• H2S Monitor

• Duck Ponds at Connections

• List Any Other Steps That Can Reduce or Eliminate Hazards

Disconnect Hoses - Potential Hazards

• Risk of Strains / Back Injury, Pinch Points, Spills

  Safe

  At Risk

  N/A

Disconnect Hoses - Steps to Eliminate / Reduce Potential Hazards

• Impact Gloves

• Proper Lifting Techniques / Ergonomics

• Use Caution - Handle Hose Carefully

• List Any Other Steps That Can Reduce or Eliminate Hazards

Obtain Closing Tank Level - Potential Hazards

• Slips, Trips, Falls, H2S gas, Benzene, Snow, Ice, Mud, Pathway, Contact with Crude

  Safe

  At Risk

  N/A

Obtain Closing Tank Level - Steps to Eliminate / Reduce Potential Hazards

• Observe Surroundings

• Maintain 3 Points of Contact

• H2S Monitor

• Identify Wind Direction ( windsock)

• Use Respirator if Required

• Use Chemical Resistant Gloves

• Have an Escape Route

• List Any Other Steps That Can Reduce or Eliminate Hazards

Enter Vehicle - Potential Hazards

• Mud, Grease , Snow, Ice, Ruts, Wind, Rain. Etc.

  Safe

  At Risk

  N/A

Enter Vehicle - Steps to Eliminate / Reduce Potential Hazards

• Maintain 3 Points of Contact

• Observe Surroundings

• List Any Other Steps That Can Reduce or Eliminate Hazards

Depart Worksite Location - Potential Hazards

• Fencing, Pump Jack, Berms, People, Water, Mud, Snow, Ice, Deadman Hooks

  Safe

  At Risk

  N/A

Depart Worksite Location - Steps To Eliminate/ Reduce Potential Hazards

• Drive No Faster Than 5 MPH

• Make Wide Turns

• Constant Observance

• G.O.A.L. (Get Out And Look)

• List Any Other Steps That Can Reduce or Eliminate Hazards

• Driver's Signature Indicating JSA is Completed With Safe Outcome

  Sign