JOB SAFETY ANALYSIS (JSA) FORM

Job Location/S8ite: JSA NO:11

Task/Activity: ERECTION AND DISMANTLING OF SCAFFOLDING PCR NO :

PCR NO:
Wk Area: Permit N0: Date:
Gas Leak / Fire /Any Emergency: In case of emergency, all works must be stopped, equipment must be switched off
Emergency situation /Evacuation and left in safe condition. All personnel shall reach the nearest muster point considering the wind direction (upward or
cross-ward)

SL.
WHO IS AT
NO U STEPS o INVOLVED CONTROL MEASURES
RISK

1 Morning tool box People Not Understanding ● People Make Sure Everyone Is Involved With The JSA/JHA Discussion
Meeting And JHA What The Plan Or Hazards Are; ● Equipment And Understands; Encourage Everyone To Ask Questions And
Discussion People Afraid To Ask Questions ● Facility Participate. Don't Make Anyone Feel For Speaking Up Or Questioning
● Presence Of H2S gas and ● Environment Try To Identify These Types Of things In Your Work Areas Before
Toxic gas In Work Areas Starting the work; Clear Carefully Work Areas By gas testing and
Presence of chemical or daily site inspection
flammable
5 items
4
2
p
2 Work Permit Unauthorised ● People Authorised work permit holders shall ensure obtaining and
commencement of works ● Equipment maintaining valid work permits.
May result in exposing people ● Facility The supervisor responsible for this activity has to check the PPE
and/or potential to harm or danger. ● Environment of his staff to ensure that all required items are available and properly
used.
Inform all people regarding permit conditions before work starts.
Supervisors must conduct daily toolbox talk about nature of work
and associated potential hazards e~and their essential precautionary
measures.
3 Gas test May found toxic gas or H2S ● People Carryout gas test by QP Authorized gas tester time to time.
gas leak or extreme oxygen limit in Environment All groups working in different area inside station shall have H2S
air personal gas monitor(certified)
PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
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 JOB SAFETY ANALYSIS (JSA) FORM
SL.N WHO IS AT
ACTIVITY STEPS HAZARDS INVOLVED CONTROL MEASURES
O RISK

4 Mobility restriction, access ● People Survey the area and confirm safe location of temporary of
Scaffolding obstruction, congestion in the work ● Equipment material prior to hauling.
Preparation of area if hauling/storing of material
work/Hauling of ● Facility Provide temporary holding area at location that will not
properly planned and coordinated. congest/obstruct plant access or restrict mobility of other activities.
materials
Nearby existing facilities if Obtain necessary permit
any subject to physical damage Provide temporary holding area at location that will not
during material hauling congest/obstruct site access or restrict mobility of other activities.
Scaffold rack is a must for holding scaffolding material. No pipes,
couplers will be stored on the ground or anytime scattered on the
ground.
Observe extra caution in mobilizing material at site
5 Erection & Damage to onsite detectors People Take extreme care during erection and override it if needed.
Use of Scaffolding /switches / transmitters ETV Facility

Equipment

6 Fall of objects / Tools. People Provide guardrail & toe board to prevent falling of tools /objects
Facility Don’t keep the unnecessary materials on the scaffold platform
Hand tools to be tied with permanent structure or person
If required barricade the area during erection work.
Equipment

7 Accidental Fall of Person People The Scaffolder must use Safety Harness/full body harness to
prevent accidental fall
8 Unstable Scaffold People The scaffold must be inspected, certified & tagged bythe
Facility competent person confirming its suitability

Equipment
9 Weak Scaffold People The scaffold tag must indicate the maximum load that itcan bear
Facility

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 JOB SAFETY ANALYSIS (JSA) FORM
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ACTIVITY STEPS HAZARDS INVOLVED CONTROL MEASURES
O RISK

Equipment
10 Damaged Scaffold People The scaffolding is to be inspected at least weekly for any damage
Facility due to weather condition (rain, high windetc) or other unsafe conditions.

Equipment
11 Modified Scaffold People In case of any modification, addition in the scaffold, ithas to be
Facility re-inspected & certified

Equipment
12 Improperly Supported People Ensure Scaffold is securely supported on a rigid groundand not
Scaffold Facility on process piping / vessel or equipment

13 Incomplete Scaffold People Do not use if green Tag is missing

Facility

Do not use if red tag is available.

14 Old Doubtful Integrity Do not use if it does not have valid inspection tag attached
Scaffolding

15 Housekeeping Slips trips and falls due to poor ● People ● Remove tools equipment and rubbish from worksite and maintain a
Clean up worksite housekeeping ● Environment clean work environment.
● Facility ● Arrange housekeeping on daily and every shift bases
● Equipment ● Supervisor shall conduct tool box meeting in this regards

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 JOB SAFETY ANALYSIS (JSA) FORM
SL.N WHO IS AT
ACTIVITY STEPS HAZARDS INVOLVED CONTROL MEASURES
O RISK

Project Engineer HSE/QA/QC Manager Project Manager

PREPARED BY: REVIEWED BY: APPROVED BY:

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PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING