TRC Pipeline Services JSA

• Document No.

• Prepared by

• Project Title

• Client Name/ Site Name

• Client Contact

• Estimated Duration of Task

• Conducted on

  Date
• Location
  Address

• Potential Hazards

• List Basic Job Steps

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• Potential Hazard

  Select Electrocution/Shock Fall from Heights Work Overhead/Falling Objects Lifting (Manual or Mechanical) Rough/Sharp Material Slippery/Uneven Surfaces Machinery Hot Surfaces Pinch Points Flying Particles Vehicle Traffic Railway Traffic Welding Arc Driving Hazards Excavations Lead Paint Asbestos Poor Work Position Noise Flammable Materials Climbing, Body Position Chemicals (SDS Review) Restricted Access/ Confined Space Poor Lighting Heat Stress/ Cold Stress Compressed Air Repetitive Motion H2S, Benzene, Other Other Hazards

  • Electrocution/Shock
  • Fall from Heights
  • Work Overhead/Falling Objects
  • Lifting (Manual or Mechanical)
  • Rough/Sharp Material
  • Slippery/Uneven Surfaces
  • Machinery
  • Hot Surfaces
  • Pinch Points
  • Flying Particles
  • Vehicle Traffic
  • Railway Traffic
  • Welding Arc
  • Driving Hazards
  • Excavations
  • Lead Paint
  • Asbestos
  • Poor Work Position
  • Noise
  • Flammable Materials
  • Climbing, Body Position
  • Chemicals (SDS Review)
  • Restricted Access/ Confined Space
  • Poor Lighting
  • Heat Stress/ Cold Stress
  • Compressed Air
  • Repetitive Motion
  • H2S, Benzene, Other
  • Other Hazards

• PPE (check all that apply)

• Hard Hat

• Hearing Protection

• Safety Glasses

• Monogoggles

• Safety Shoes or Rubber Boots

• Gloves for Specific Hazards

• Nomex or FRC

• Fall Protection Equipment

• H2S Monitor

• Respiratory Protection

• Chemical Suit

• Personal Floatation Device

• Buddy System

• Other

• Facility Access Requirements (check all that apply)

• GNOIEC/GBRIA-ARSC Training

• Site Specific Training

• Vehicle Permit Required

• Vehicle Magnets

• Client Notification Required

• Control Room Check In Required

• Entry or Work Permit Required

• Other

Observations/Conditions (note specifics)

• Construction or other work in progress in the area?

  Yes

  N/A

• Chemical Hazards - Dripping/splashing or puddles?

  Yes

  N/A

• Tripping/Slipping Hazards?

  Yes

  N/A

• Thermal Hazards? (including exposed steam lines)

  Yes

  N/A

• H2S Monitor Required?

  Yes

  N/A

• Wind Direction Checked?

  Yes

  N/A

• Observe Signs for Special PPE Required? DO NOT WORK WITHOUT THIS PPE

  Yes

  N/A

• Confined Space? NEVER ENTER A PERMIT CONFINED SPACE

  Yes

  N/A

• Barricades and Barricade Tape? (observe all)

  Yes

  N/A

• Elevated Work? (100% tie off and buddy system required)

  Yes

  N/A

• Potential Hazards Reported to Client Supervisor?

  Yes

  N/A

• Asbestos/Lead Paint?

  Yes

  N/A

Permits Required

• Hot Work?

  Yes

  N/A

• Confined Space Entry?

  Yes

  N/A

• Safe Work Permit?

  Yes

  N/A

Unit Safety Devices

• Eye Wash Located? (if required)

  Yes

  N/A

• Safety Shower Located? (if required)

  Yes

  N/A

• Understand Area Alarms?

  Yes

  N/A

Energized Equipment

• Ground Fault Protection (GFCI) Required?

  Yes

  N/A

• Lock Out/ Tag Out Required?

  Yes

  N/A

• Electrical Tool/ Cords Inspected?

  Yes

  N/A

• High Voltage Lines Identified?

  Yes

  N/A

• Hot Pipes Need Temporary Insulation?

  Yes

  N/A

• Cords/Leads/Hoses Elevated?

  Yes

  N/A

Work Platforms for Task

• Scaffold Needed/Inspected?

  Yes

  N/A

• JLG/Scissor Lift Required? (operator certification)

  Yes

  N/A

• Ladders Required? (inspected and secured)

  Yes

  N/A

• Additional Comments

• Start Date/Time

  Date

• End Date/Time

  Date

• Employee Signature

  Sign

Post Task Review

• Were there any incidents at the site today?

  Yes

  N/A

• Supervisor Review Comments

• Supervisor Signature

  Sign