Weeks Marine Inc - JSA

• Conducted on

  Date
• Location
  Address

• Prepared by

Job Task Being Conducted

• Brief Job description

• Provide Picture of Task

  Media

• Select job type

  Select Has exposure to hazardous and harmful products High Risk New established job Infrequently performed jobs Other Job done frequently

  • Has exposure to hazardous and harmful products
  • High Risk
  • New established job
  • Infrequently performed jobs
  • Other
  • Job done frequently

• Describe Job Type

PPE Selection

• Selected PPE need to Perform Task

  Select Hard Hat Work Vest Gloves (ANSI Cut Level 3) Safety Glasses Safety Boots Hearing Protection Respirator

  • Hard Hat
  • Work Vest
  • Gloves (ANSI Cut Level 3)
  • Safety Glasses
  • Safety Boots
  • Hearing Protection
  • Respirator

• Have you been fit tested to wear a respirator

  Yes

  No

  N/A

Tools Required for Task

• Select Tools Need for Task

  Select Chain Fall Come Along Cutting Tourch Impact Gun Ladder Extension Cord Hammer Portable Lighting Other Other Hand Tools (i.e. wrench, screwdriver, etc)

  • Chain Fall
  • Come Along
  • Cutting Tourch
  • Impact Gun
  • Ladder
  • Extension Cord
  • Hammer
  • Portable Lighting
  • Other
  • Other
  • Hand Tools (i.e. wrench, screwdriver, etc)

• Has Chain Fall been inspected & deemed safe to use

  Yes

  No

  N/A

• Yes

  No

  N/A

• Has come along been inspected and deemed safe to use

  Yes

  No

  N/A

• Yes

  No

  N/A

• Has Hot Work Permit been Completed

  Yes

  No

  N/A

• Has The Ladder been inspected for damage & missing rungs

  Yes

  No

  N/A

• Has extension cord been inspected & Deemed safe to use

  Yes

  No

  N/A

Tasks, Hazards and Preventive Measures

• 1) Break a job down into smaller tasks
  2) Click + to add a "Job Step" and fill in the relevant information
  3) Identify the potential hazards for each task
  4) Determine preventive measures and controls to overcome these hazards

Job Step

• Enter job step description

• Potential risk or hazard identified while task is being performed (select all that apply)

  Select Chemical (Toxic, Flammable, Corrosive) Explosion (Chemical Reaction, Over Pressurization) Electrical (Shock, Short Circuit, Fire, Static, Loss of Power) Ergonomics (Strain, Sprains, Human Error) Excavation (Collapse) Fall (Slip, Trip) Fire Mechanical (Mechanical Failure, Stuck between objects) Noise Struck by Objects Extreme Temperature Visibility (lack of lighting, Obstructed vision) Weather Other

  • Chemical (Toxic, Flammable, Corrosive)
  • Explosion (Chemical Reaction, Over Pressurization)
  • Electrical (Shock, Short Circuit, Fire, Static, Loss of Power)
  • Ergonomics (Strain, Sprains, Human Error)
  • Excavation (Collapse)
  • Fall (Slip, Trip)
  • Fire
  • Mechanical (Mechanical Failure, Stuck between objects)
  • Noise
  • Struck by Objects
  • Extreme Temperature
  • Visibility (lack of lighting, Obstructed vision)
  • Weather
  • Other

• Enter other potential risk/s identified

• Rate risk/ hazard of job step

  Extremely High Risk

  High Risk

  Moderate Risk

  Low Risk

• Hazard Control Measures

  Select Engineering Controls Administrative Controls Personal Protective Equipment Other

  • Engineering Controls
  • Administrative Controls
  • Personal Protective Equipment
  • Other

• List Engineering Controls

• List Administrative Controls

• List Personal Protective Equipment

• List other controls implemented

Name & Signature

• Name and Signature

  Sign