JOB SAFETY ANALYSIS WORKSHEET

JOB DESCRIPTION:
Prudent Saudi Arabia Ltd. DATE: JSA NO.: ________

JOB SAFETY ANALYSIS Job location (Plant):
NEW
REVISED

JOB LOCATION (Plant): AREA:

BASIC STEP POTENTIAL HAZARDS RECOMMENDATIONS RESPONSIBILITY STATUS

Use appropriate PPE.

Ensure the correct MCBs
Electrical hazard power is turned off.
1. Isolation Accidental tripping Check the power supply in all OPERATOR (SEC)
of wrong MCB racks Power terminals.
First Aid/ Emergency
Preparedness
Wear appropriate PPEs.
Correct body posture.
Injury to personnel
Good communication while
/ hand during the
dismantling the equipments.
dismantling.
Use right tool for the right
Accident / Incident
job.
may happen due
Hands to be always clear of
2. Dismantle to falling of tools. PRUDENT
any adjacent Bur/ sharp
Damage to other
edges.
components and
Use the appropriate hand
/or personal injury
gloves for the job.
by unskilled
Use skilled manpower.
manpower.
First Aid/ Emergency
Preparedness
Wear appropriate PPEs.
Correct body posture.
Use the appropriate hand
Injury to hand. gloves for the job.
Splinter caused by Use skilled manpower
PRUDENT
3. Drilling / Making Cut-out drilling may short Adequate supervision
the other First Aid/ Emergency
components. Preparedness.
Limit splinter falls onto
electronic components by
creating temporary barriers
P16002-JSA-R0 Page : 1 Prudent Saudi Arabia Ltd
Dammam, Saudi Arabia.

4. Install new PLC / Panel AC
5. Termination IFM / Field Cables
6. Electrical Power Up
7. Loop Check
8. General
Injury to personnel
Proper body posture
/ hand during the
Use the appropriate PPEs &
assembly.
tools for the job.
Accident / Incident
Adequate supervision
may happen due PRUDENT
First Aid/ Emergency
to falling of tools.
Preparedness
Module may get
Align module properly before
damaged due to
applying pressure.
wrong insertion
Short circuit Use approved documents &
Cable damage due drawings.
to wrong Tool box meeting should be PRUDENT
connection conducted with working crew
prior to job execution.
Ensure the correct MCBs
power is turned ON.
Electrical hazard Use double insulated tools.
Tripping hazard Use SEC approval hand tools PRUDENT / SEC
& power tools.
Use skilled manpower
Adequate supervision
Continuity Tester / Calibrated
Multimeters to be used while
Electrical hazard
checking loops.
Tripping hazard PRUDENT
Communication between the
all products as per the
standards.
Use inspected full body
harness.
During the light or low
illumination use clear safety
glass.
PPE Failure PRUDENT
Wear good conditions leather
gloves.
Use chin strap for and hat.
Inspect all power & hazard
tools with SEC.

P16002-JSA-R0 Page : 2 Prudent Saudi Arabia Ltd

Dammam, Saudi Arabia.
REQUIRED AND/OR RECOMMENDED P.P.E.:____________________________________________________________________
______________________________________________________________________________________________________

All recommendations suggested in JSA have been implemented at site:(Maintenance Supervisor)

Prepared by: JSA Team Leader Acknowledged by: Operation/Shift Supervisor
Name:__________________ Signature:________ Badge #: _______
Name:______________ Signature:__________ Badge#: __________
JSA Team Members
Department Signature Reviewed and acknowledged by Operation Manager In case of
Name ID # Date
Medium / High Risk (Critical Activity).

Name:______________ Signature:__________ Badge#: __________

Approved by Maintenance Superintendent Comment:

.

Name:_____________________ Signature:__________ Badge #:________ .

Approved by Maintenance Manager in case of Medium / High Risk .

(Critical Activity). .
.
Name:_____________________ Signature:__________ Badge #:________

P16002-JSA-R0 Page : 3 Prudent Saudi Arabia Ltd

Dammam, Saudi Arabia.
 INSTRUCTIONS FOR COMPLETING THE JOB SAFETY ANALYSIS FORM

Job Safety Analysis (JSA) is an important incident prevention tool that works by Select a job to be analyzed. Before filling out this from, consider the following:
finding hazards and eliminating or minimizing them before the job is preformed, The purpose of the job-What has to be done? Who has to do it? The activities involved: How
and before they have a chance to become accidents. Use JSA for job clarification is it done? When is it done? Where is it done?
and hazard awareness, as a guide in new employees training, for periodic contacts
and for retraining of senior employees, as a refresher on jobs which run In summary, to complete this form you should consider the purpose of the job, the activities
infrequently, as an incident investigation tool, and for informing employees of it involves, and the hazards its presents. If you are not familiar with a particular job or
specific job hazards and protective measures. operation, interview an employee who is. In addition, observing an employee performing
the job, or walking through the operation step may give additional insight into potential
Set priorities for doing JSAs: jobs that have a history or many accidents, jobs that hazards. You may also videotape the job and analyze it. Heres how to do each of the three
have produced disabling injuries, jobs with high potential for disabling injury of parts of Job Safety Analysis
death, and new jobs with no accident history.
RESPONSIBLE
SEQUENCE OF BASIC JOB STEPS POTENTIAL HAZARDS RECOMMENDED ACTION OR PROCEDURE
PERSON
Examining a specific job by breaking it A hazard is a potential danger. The purpose Using the first two columns as a guide, decide Who is responsible? Write
down into a series of steps of tasks, will of the Job Safety Analysis is to identify all what actions or procedures are necessary to the person (receiver)
enable you to discover potential hazards hazards, both those produced by the eliminate or minimize the hazards that could responsible (Supervisor /
employees may encounter. environment or conditions and those lead to an accident, injury, or occupational Work Permit Issuer receiver
connected with the job procedure. illness. / contractor) to implement
Each job operation will consists of a set the control measures
of steps or tasks. To identify hazards, ask yourself these Begin by trying: identified.
questions about each step: 1. Engineer the hazard out: 2. provide guards,
For example: 1. Is the danger of the employee striking safety devices, etc.; 3. provide personal
The job might be to move a box from against, being struck by, or otherwise making protective equipment; 4. Provide job
conveyor in the receiving area to a shelf injurious contact with an object? instruction training; 5. Maintain good
in the storage area. To determine where 2. Can the employee be caught in, by or housekeeping; 6. Insure good ergonomics
a step begins or ends, look for a change between objects? (positioning the person in relation to the
of activity, change in direction or 3. Is there potential for slipping, tripping, or machine or other elements in such a way as to
movement. falling? improve safely).
4. Could the employee suffer strains from List the recommended safe operating
Picking up the box from the conveyor pushing, pulling, lifting, bending, or twisting? procedures. Begin with an action word. Say
and placing it on a hand truck is one 5. Is the environment hazardous to safety exactly what needs to be done to correct the
step. The next step might be to push and/or health (toxic gas, vapor, mist, fumes, hazard, such as, lift using your leg muscles.
the loaded hand truck to the storage dust, heat, or radiation)? Avoid general statements such as be careful.
area (a change in activity). Moving the List the required or recommended personal
boxes from the truck and placing them Close observations and knowledge of the job protective equipment necessary to perform
on the shelf is another step. The final is important. Examine each step carefully to each step of the job.
step might be returning the hand truck find and identify hazards; the actions, Give a recommended action or procedure for
to the receiving area. conditions and possibilities that could lead to each hazard.
an accident. Compiling an accurate and Serious hazards should be corrected
Be sure to list all the steps needed to complete list of potential hazards will allow immediately. The JSA should then be changed
perform the job. Some steps may not you to develop the recommended safe job to reflect the new conditions.
be performed each time; an example procedures needed to prevent accidents. Finally, review your input on all three columns
could be checking the casters on the for accuracy and completeness. Determine if
hand truck. However, if the step is the recommended actions or procedures have
generally part of the job it should be been put in place. Re-evaluate the job safety
listed. analysis as necessary.

P16002-JSA-R0 Page : 4 Prudent Saudi Arabia Ltd

Dammam, Saudi Arabia.