JSA -0xx- Site survey

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TASK STEPS
(Number)
1. Permitting work
POTENTIAL HAZARDS
(What could go wrong?)
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HAZARDS CONTROLS
(How can harm be prevented?)
Work condition not safe
Procedures and tasks not clear
Lack of supervisory
Miscommunication
Not correct PPE worn
Equipment not inspected and certified
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2. GT survey
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3. GT Measuring
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Prepared By
Checked By
Approved By
HSE team to assess continuously the conditions
of work in the assigned area
One person to issue work permits
Toolbox talks
Competency of personnel and supervisory for
the activity
Define hierarchy and reporting flowcharts
Define proper PPE to be used for the work
Check inspection certificates of equipment for
the job
Adequate equipment, certified will be used
Competent persons will perform the job
 Wear proper PPE
 Use proper ladders / steps to go on top
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Punch point / hand injuries
Personnel Injury
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Wear proper PPE
Use ear plugs
where high noise
levels
 Use Safety glasses
Wear boots
Adequate equipment, certified will be used
Competent persons will perform the job
 Wear proper PPE
 Use proper ladders / steps to go on top
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Position
Date
PTW system
Tool Box Talk
Certificates
inspection
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Punch point / hand injuries
Personnel Injury
Trip
Falls
Stuck by
Trip hazard
Name
HAZARD PORT
MITIGATION
STATUS
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Suitable PPE
Use ear plugs
where high noise
levels
Use Safety glasses
Utilize safety vests
at all times.
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First aider in place
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Wear boots
Signed
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