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JOB SAFETY ANALYSIS (JSA) FORM

Job Location/Site: Task/Activity: UT TEST OF WELDED JOINTS Work area Equipment No:
Emergency situation /Evacuation

JSA NO: JOB NO: Other: Date:

Gas Leak / Fire /Any Emergency: In case of emergency, all works must be stopped, equipment must be switched off
and left in safe condition. All personnel shall reach the nearest muster point considering the wind direction (upward or cross-ward)

Personal Protective Equipment: (Minimum requirement: safety shoes / hard hat / coveralls/dust mask / gloves used as required)
Additional PPE:

Eye Protection (specify) Other (e.g. fire retardant coveralls, breathing apparatus, etc.) Hearing Protection __________________________________________________ Fall Protection __________________________________________________ Rubber footwear and gloves if in damp area __________________________________________________

SL.N O

ACTIVITY STEPS

HAZARDS INVOLVED

CONTROL MEASURES

Work Permit

Gas test

Unauthorized commencement of Authorized work permit holders shall ensure obtaining and maintaining valid work works permits. May result in exposing people and/or The supervisor responsible for this activity has to check the PPE of his staff to ensure potential to harm or danger. 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 and their essential precautionary measures. May found toxic gas or H2S gas leak or Carryout gas test by QP Authorized gas tester time to time. extreme oxygen limit in air All groups working in different area shall have certified H2S personal gas monitor

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SL.NO ACTIVITY STEPS HAZARDS INVOLVED CONTROL MEASURES

Removing of Panit

Toxic fumes. Environment hazard. Skin Problem. Fire Paint over existing facilities Missed use of thinner or other products Fall hazards

Obtain gas test. Proper disposal of empty cans / cotton rags / gloves / roller etc. Skilled painting supervisor Avoid keeping unused paint cans in open atmosphere Paint should not be mixed on ground with out arranging wooden ply or tarpaulin. Ensure availability of MSDS. No hot work shall be allowed in area Use proper PPE Use al product in their own cans or use good labelling procedure. Al materials must be covered while not in use. Supervisor to insure that fire extinguisher available at work site and storage area . Provide approved scaffold with scaff tag Use fullbody harness if work at height. Provid scaffolding. Proper check of Materials/ products Take care of around existing facilities Remove tools equipment and rubbish from worksite and maintain a clean work environment. Arrange housekeeping on daily and every shift bases Supervisor shall conduct tool box meeting in this regards

UT TEST

Fall hazards Missed use of products Touching to the Existing facilities Slips trips and falls due to poor housekeeping

Housekeeping Clean up worksite

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