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INSTALLATION/FACILITY LOCATION JOB ACTIVITY DESCRIPTION OF ACTIVITY POWER BRUSH & TOUCH UP PAINTING
NOTE 1. A valid Permit to Work, including the associated Isolation/ByPass Certificate(s) as necessary, is required for all work. 2. Personnel carrying out the work shall be fully familiar with the written Work/Operating Procedures developed for the job. The Work/Operating Procedures shall describe, in step-by-step instructions, the correct method of executing the specified work. 3. Prior to commencement of work, the task-specific JHA shall be discussed amongst all personnel involved in the execution; and requirements contained therein shall be fully understood by all involved personnel.
JOB STEP
POTENTIAL HAZARD
POTENTIAL IMPACT
INHERENT RISK L S R
CONTROL BARRIERS
RESIDUAL RISK L S R
RESULT
Failure will cause damage to equipment and can cause harm to personnel.
Monitoring
Body injury
ACCEPTABLE
ACCEPTABLE
Site safety
ACCEPTABLE
Housekeeping.
Monitoring
ACCEPTABLE
RISK ASSESSMENT - LEGEND L - LIKELIHOOD CATEGORY LOW 1 MEDIUM 2 HIGH 3 DEFINITION Remote Possible Probable S - SEVERITY CATEGORY LOW 1 MEDIUM 2 HIGH 3 DEFINITION No Damage Minor Damage Major Damage R RISK RATING H M L 3 2 1 L 6 4 2 M LIKELIHOOD 9 6 3 H RESULT 6-9 3-4 1-2 UNACCEPTABLE TOLERABLE ACCEPTABLE
SEVE RITY
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JHA NO TYPE OF EQUIPMENT MANUFACTURER CERTIFICATE NUMBER(S) TAG.NO PRECISE WORK SITE
ENDORSED BY NAME DESIGNATION SIGNATURE DATE /2/13 Partner Construction Manager/Supervisor NAME DESIGNATION SIGNATURE DATE /2/13 Partner Safety & Health Manager/Officer NAME DESIGNATION SIGNATURE DATE /2/13 MOKHTAR PCSB Construction Supervisor Representative (CSR) NAME DESIGNATION SIGNATURE DATE /2/13 PCSB Safety & Health Officer NAME DESIGNATION SIGNATURE DATE /2/13 Production Supervisor/Maintenance Supervisor
TOOL BOX REVIEW - WORK ACTIVITY PARTICIPANTS POSITION SIGNATURE PERFORMED JOB BEFORE? Name Signature Date Time
/2/13
DATE
/2/13
RISK ASSESSMENT - LEGEND L - LIKELIHOOD CATEGORY LOW 1 MEDIUM 2 HIGH 3 DEFINITION Remote Possible Probable S - SEVERITY CATEGORY LOW 1 MEDIUM 2 HIGH 3 DEFINITION No Damage Minor Damage Major Damage R RISK RATING H M L 3 2 1 L 6 4 2 M LIKELIHOOD 9 6 3 H RESULT 6-9 3-4 1-2 UNACCEPTABLE TOLERABLE ACCEPTABLE
SEVE RITY
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