Gordie Howe International Bridge
Section I: Enter general information about the site and job task.
Section II: Determine whether any of these operations apply to the job task to be performed. Make note of any special training,
permit, certification, and risk assessment requirements.
Section III:
1.
Break the job down into steps and be as specific as possible. List each job step in a new row of column A (Activity/Step).
Number each step consecutively. Each step of a job will accomplish some major task (which may consist of a set of
movements). Each step description defines an action, but does not describe hazards or precautions. Cleanup and stowing of
equipment at the completion of work is considered a step. Add additional rows to the table as needed, or if completing the JSA
on paper, print additional copies of the sheet to accommodate all job steps.
2.
Determine the hazards associated with each job step and write them in column B (Hazards). Hazards as associated with each
Activity/Step will be identified and numbered as associated with the respective step. Equipment, personnel, and the activities
that are required to complete each step will be considered. Each step to find and identify hazards that could lead to an accident
will be examined. The preparer will verify that all hazards are listed, including environmental and health hazards.
3.
List any control measures that will be taken to ensure that step is done safely in column C (Control Measures). Use the control
measure examples and hierarchy provided to trigger your thinking about different types of controls and their effectiveness at
reducing risk. Controls toward the top of the table tend to be more effective at minimizing the severity and/or likelihood of an
event than the controls toward the bottom of the table. Do not use general statements such as “be careful”.
If this job involves a Life Critical Operation, continue to step 4. Otherwise, repeat steps 2-3 for each of the job steps identified,
then proceed to step 8.
4.
Considering the hazards involved and the control measures that will be in place, determine the worst credible severity of an
incident that could result from this job step. Use the severity table provided. Write the severity number in column D (Severity).
5.
Considering the hazards involved and the control measures that will be in place, determine the likelihood that an incident will
result from this job step. Use the likelihood table provided. Write the likelihood number in column E (Likelihood).
6.
Multiply the severity number by the likelihood number and enter the product in column F (Risk).
7.
Consider the risk rating against the thresholds provided in the Overall Risk Ratings.
i.
Very low and low risk ratings of 1-3. This level is generally considered acceptable provided that all control measures are
applied.
ii.
Medium risk ratings of 4-6. Additional control measures must be considered to determine whether it is practical to further
reduce the risk. If additional control measures will be implemented, write them in the Control Measures column on the
same line or a new line below. Rescore the Severity, Likelihood, and Risk taking into consideration this additional corrective
action.
iii. High and Very High risk ratings of 8-24. Additional control measures must be implemented where practical to further
reduce the risk. Write additional Control Measures in the column on the same line or a new line below. Rescore the
Severity, Likelihood, and Risk taking into consideration this additional corrective action. If the risk rating cannot be reduced
further to a medium or low then the Site Construction manager must approve the activity by signing off the JSA.
8.
Repeat steps 2-7 for each of the job steps identified.
Section IV: Provide the name, company, and title of those who prepared and reviewed/approved this form in the signature box
provided. The Site/Construction Manager must review and approve any line items that have a High or Very High risk rating before
the job may proceed. Additional space is provided for crew members to sign the JSA if desired.
Page 1 of 8
Health, Safety, and Environmental
Gordie Howe International Bridge
CONTROL MEASURE EXAMPLES TABLE (Column C)
Most Effective
Controls
Elimination
(Remove the hazard altogether)
Substitution
(Replace the material/process with a
less hazardous one)
Examples
 Make connections at ground level before erecting a
 Remove a dangerous machine from service
structure to eliminate work at height
 Provide power outlets to avoid trailing cords
 Use latex rather than oil-based paints
 Reduce energy, such as speed, force, amperage, pressure, and temperature
 Use water-based detergents instead of organic solvents
Engineering/Isolation
 Ventilation
 Isolate hazardous energy sources
 Secondary containment
(Design effective control measures to
 Machine guarding
 Interlocks
 Barriers
protect people and the environment)
 Enclosures
 Platforms and guardrails
 Improve lighting
 Circuit breakers
 Exclusion zones
Warning
 Signs
 Horns
 Labels
 High visibility paint
(Alert people to the hazards)
 Backup alarms
 Beepers
 Tags
Administrative
 Work rotation to minimize exposure
 Training and supervision
(Provide training, procedures, etc.)
 Inspect safety equipment
 Good housekeeping practices
PPE
 Safety glasses
 Fall harness and lanyards
 Respiratory protection
(Personal protective equipment)
 Hearing protection
 Gloves
 High visibility vests
SEVERITY TABLE (Column D)
LIKELIHOOD TABLE (Column E)
Least Effective
Severity Level
People
 Fatality(ies)


Critical /
Catastrophic
6


 Long-term, life-altering injury
Major
Moderate
Minor
4
2
1
or illness resulting in
permanent total or partial
disability
‒ Examples: amputation
including bone, severe
disfigurement, paralysis,
loss of
limb/organ/vision/hearin
g
 Injury or illness that requires
medical treatment or results
in temporary disability or loss
of function
‒ Examples: deep
laceration, object
embedded in eye, bone
fracture, concussion,
dislocation, injury
requiring surgery
 Injury or illness requiring first
aid treatment only
‒ Examples: minor cuts,
bruises, sprains, strains,
abrasions, irritation,
inflammation, object in
eye removed by flushing











Impact On
Environment / Community
Long-term (multi-year) impacts
to air, surface/ground water, or
soil; OR
Legal liability for related
consequences (such as
remediation); OR
Widespread areas including
offsite area or community
affected; OR
Adverse publicity/media
coverage
Lasting up to one year, impacts
to air, surface/ground water, or
soil; OR
Offsite area/community
affected; OR
Notice of violation, citation, or
fine from regulatory authority;
OR
Likely adverse publicity/media
coverage
Temporary, up to one month,
impacts to air, surface/ground
water, or soil limited to the
project site; OR
Breach of regulatory
requirement or limit; OR
Events that are reportable to
regulatory authorities; OR
Potential adverse publicity /
media coverage
No direct impact to air, surface /
ground water, or soil; OR
Effects restricted within
buildings or containment
structures; AND
No adverse publicity / media
coverage
Likelihood
Level
Equipment / Property
 Extensive losses of high
value
equipment/property; OR
 Losses exceeding
$1,000,000; OR
 Major unplanned impact
on project budget and
schedule
Probability
Expected to
occur in most
circumstances
Very
Likely
4
 Losses of equipment that
cannot be readily
replaced; OR
 Losses exceeding
$100,000; OR
 Significant unplanned
impact on project budget
and schedule
Likely
Possible
Unlikely
1 in 1,000
The event
might occur
1 in 10,000
Highly unlikely
but may occur
in exceptional
circumstances
1 in
1,000,000
2
 No impact on equipment
functionality.
 Minor, cosmetic damage;
OR
 Repair costs easily
covered by normal project
operating budget
Strong
possibility the
event will
occur
3
 Loss of equipment that
can be readily replaced;
OR
 Losses exceeding $10,000;
OR
 Minor impact on project
budget
Chances of
Occurrence
1 in 100
1
Risk Matrix (Column F)
Severity
Likelihood
Critical (6)
Major (4)
Moderate (2)
Minor (1)
Unlikely (1)
Possible (2)
Likely (3)
Very Likely (4)
6
4
2
1
12
8
4
2
18
12
6
3
24
16
8
4
Page 2 of 8
Very Low 1
Low
2-3
Overall Risk Ratings
Medium
High
4-6
8-18
Very High
24
Note: The Site/Construction Manager must personally review any items
with a High or Very High residual risk score, and approve by signing this
form.
Health, Safety, and Environmental
Gordie Howe International Bridge
Company:
BNA
Contract No.:
JSA Title:
Use of Aerial Lifts “Man Lifts”
Building:
Work Scope/Description:
SECTION I - GENERAL INFORMATION
New
or Revised
Area:
Date: 03/17/2020
Site Wide
Specific Location:
Plant Tools & Equipment Required:
Use of Aerial Lifts “Man Lifts”
General PPE, Pre-Inspected Harness and SRL or Lanyard
Primary Emergency Contact
Phone:
Name:
Secondary Emergency Contact
Phone:
Name:
SECTION II - DOES THIS JOB REQUIRE ANY OF THE FOLLOWING OPERATIONS?
 = Requires formal/special training
= Requires certification or Competent/Qualified Person designations
= Requires a permit/form/report
∆ = Life Critical Operations = Requires Risk Assessment
Refer to the approved site-specific Project HSE Plan for specific requirements on applicable operations.
Aerial Lifts   ∆
Confined Space   ∆
Dismantling and Demolition 
Electrical Hazards   ∆
Excavation/Trenching   ∆
First Line Breaks   ∆
Grating, Floor Plate, Guardrail Removal
Hazardous Energy Control   ∆
∆
Hazardous Materials
Asbestos  
Benzene 
Crystalline Silica  
Cadmium  
Hexavalent Chromium 
Hydrogen Sulfide
Lead  
Hazardous Waste Operations 
Heavy Equipment   ∆
Hot Work 
Loading/Unloading Material ∆
Noise Exposure 
Powered Industrial Trucks   ∆
Respiratory Hazards 
Roof Work   ∆
Scaffolding   ∆
Site/Vehicle Traffic  ∆
Steel Erection  ∆
Work at Height (> 6 ft)   ∆
Rigging & Cranes   ∆
SECTION III - JOB SAFETY ANALYSIS
A
ACTIVITY/STEP
1.
2.
Ensure adequate personal
protective equipment is available
Before operating an aerial lift,
perform a pre-operational inspection.
RISK ASSESSMENT
B
HAZARDS


Inadequate PPE or incorrect usage of
appropriate PPE may result in property
damage, injury, illness or fatal injury.
Slip/Trip/ Falls
Page 3 of 8
C
CONTROL MEASURES
D
SEVERITY

Operator must be trained and
certified to wear PFAS and to
operate an aerial lift

Harness/ lanyard or SRL to be
inspected by user prior to use. Take
out of service if found defective.

A fall protection harness and 6-foot
lanyard or SRL is required for use
within aerial lift. Minimum of 19’
floor level to basket clearance
when using 6’ Lanyard. SRL IS THE
RECOMMENDED PERSONAL FALL
ARREST SYSTEM
Check operating and emergency
controls, safety devices (such as
outriggers and guardrails), personal
fall protection gear, wheels and

E
LIKELIHOOD
F
RISK
Health, Safety, and Environmental
Gordie Howe International Bridge
tires and other manufacture
specified items. Look for possible
leaks (such as air, hydraulic fluid,
and fuel-system) and loose parts.
Document findings Refer to the
Inspection Report – General Line
Equipment.
See above
3.
4.
Check the work area where the lift
will be used.
Operating the aerial lift
•
Un- even terrain
•
Fall from heights

Pinch points

Sharp objects or edges

Overhead power lines

Tip over

Ejections from the lift platform

Tripping hazard inside of the basket

Overloading the basket capacity

Fall from heights

Slip/trip/fall
Page 4 of 8

Look for level surfaces that won’t shift.
Check the slope of the ground or floor;
do not work on steep slopes that exceed
slope limits listed by the manufacturer.
Look for hazards such as holes, drop-offs,
bumps and debris and overhead power
lines and other obstructions.

Warn people in work areas; utilize cones,
barricades or caution tape to keep
bystanders at a safe distance from the
job. If working near traffic is involved a
safe work-zone setup must be utilized
with cones, barricades and signs.

Use spotter where needed

Position the lift away from traffic,
building overhangs, and power lines.

Fall Protection Plan to be filled out when
working
Use 3 point contact, facing basket when
climbing in and out of basket


Don the harness and lanyard. Enter the
bucket and attach lanyard to a
designated lanyard anchorage point.
100% tie off at all times

Always close lift platform doors and hook
chains.

Secure all tools. Use tool nets around
basket if necessary.

Do not climb or lean over guardrails, nor
stand on the railing

Operator shall remain in basket at all
time while performing work
Health, Safety, and Environmental
Gordie Howe International Bridge

Dropping objects to lower level

Never exceed the posted lift capacity
(including, worker, material and tools).

Never use the lift as a crane or hoist to
lift or lower material.

Travel at safe speed

Always look in the direction of travel of
the bucket when operating the lift; never
run the boom or bucket into conductors,
cables, poles, trees, etc.

Never operate the lift when the boom is
elevated in a working position with an
operator in the bucket.
Maintain a minimum clearance of 10
meters (33 feet) from energized lines.
See above
5.
Overhead dangers; power lines
and electrical equipment.

Electrocution


Page 5 of 8
Verify line in de-energized before
working within in 33 feet or work within
10 meters (33 feet) of overhead power
lines will be performed under an
approved, Working Near Energized
Power Lines Permit.
Health, Safety, and Environmental
Gordie Howe International Bridge
A
ACTIVITY/STEP
B
HAZARDS
Page 6 of 8
C
CONTROL MEASURES
D
SEVERITY
E
LIKELIHOOD
F
RISK
Health, Safety, and Environmental
Gordie Howe International Bridge
Page 7 of 8
Health, Safety, and Environmental
Gordie Howe International Bridge
SECTION IV – APPROVALS AND SIGNATURES
HSE Incident Alerts related to similar jobs have been reviewed and considered in the development of this JSA.
Name
PREPARED BY
Company
Position
Name
APPROVALS
Position
Signature
Superintendent
HSE Representative
Site/Construction Manager
High (8-18) and Very High (24) Overall Risk Rankings
require review and approval by the
Site/Construction Manager
Name
REVIEWED BY CREW
Company
Page 8 of 8
Signature
Health, Safety, and Environmental