JOB SAFETY ANALYSIS
Ref: – JSA-…….
Facility / Site: CPF

Location within Site: Chemical storage
area
Task Description: Visual inspection and ultrasonic thickness measurement on pressure vessels
Permit No: 25459
REQUIRED REFERENCES
Have the relevant Procedures, Standards, Guidelines,
or Safe Work Practices been reviewed?
Permit Type: COLD
Date: 21.05.2019
JSA REVIEW
Yes
N/A
Pending confirmation by the Task Leader of site conditions, I agree that the attached JSA identifies the
significant Task Steps, Hazards, and Controls.
JSA REVIEWER (Supervisor or Designate):
RISK ASSESSMENT
Must existing Procedures or Work Practices be
modified to perform this work?
Yes
No
After mitigation, are there any hazards that continue to
present a potentially significant risk? (Scenario-Based
Risk Assessment required)
Yes
No
Name / Signature: HBIB BOUSABBEH
Company: MSBI
WORK SITE VERIFICATION
The Work Team has assessed the worksite conditions and confirms:
 The JSA addresses the applicable hazards and necessary controls.
PPE REQUIRED DURING THIS TASK
 The Team has the appropriate resources (people and equipment) to do the job safely.
HARD HAT
SAFETY GLASSES
 Others that could be affected by the work have been informed.
SAFETY SHOES / BOOTS
FACE SHIELD
GOGGLES
TASK LEADER:
Name / Signature:
FALL PROTECTION
FALL RESTRAINT
Company:MSBI
COMPLETE THE SECTION BELOW IF THIS JSA IS NOT PART OF A PERMIT PACK
GLOVES:
Work Team Declaration:
I acknowledge that I have reviewed the attached JSA, I understand my roles
and responsibilities, and I will comply with the instructions for this task.
COTTON
LEATHER
IMPACT PROTECTION
Dust mask
Work clothes
OTHER PPE (specify):
OTHER (specify):
Name (print):
Name (print):
TASK STEPS
(Number)
POTENTIAL HAZARDS
(What could go wrong?)




Procedure or task unclear
Miscommunication
Workers involved in the tasks are not
competent
Incorrect tools or PPE
2- Preparation of pressure
vessel surface, conduct
ultrasonic thickness
measurement on pressure
vessels


Wire brush failure causing hand injuries
Slip or fall
3- Housekeeping



Slips trips and falls
Unsafe access
Obstacles in work area
1- Work permit in place
Name
HAZARDS CONTROLS
(How can harm be prevented?)
 PTW signed by authorised person.
 Ensure correct PPE available for task
 Carry out toolbox talk
 Clear access to work zone.
 All workers involved are competent and
They understand the scope of the work and
the hazards/risks associated with the
task.
 Clean and arrange the work area.
 Be careful when used wire brush and
equipment
 Wear adequate PPE’s
 Equipment pre-use check
 Wash your hand after handling and
before eating
 Do not expose to extreme heat
 Make sure that all equipment are stored
in the correct place
HAZARD PORT
MITIGATION STATES
 MSBI Emergency
 Response plan
 MSBI Emergency
response Plan
 First Aid kit in place



Keep work area tidy and clean
Regular Housekeeping and keep all
area free from hazards
Position
Prepared By
Area Supervisor
Checked By
Area HSSE Supervisor
Approved By
PTW Coordinator
Date


Signed
MSBI Emergency
response Plan
First Aid kit in
place
Spill kit in place