FORMAT NO:INT902

Al Tayer Development | Al Rawdat – Abu Dhabi Rev. No. 1

Date: 20/04/16
JSA Page 1 of 4
(Job Safety Analysis)
NO JSA!! NO WORK!! Date:

wJob Details Resources Required Work Permits Required

Location / Department / Job Name: Technicians skills
Hot works Confined Space
Electricians Welder
Duct Fabricator Plumber Lifting Others Specify

Insulator Rigger Electrical (LOTO)

Suspended Man basket
Pipe fitter Others
Formwork (casting/striking)
Specific Location of task:- Plant / Equipment / Power tools Emergency Contact Numbers:-

Task In charge:- Hazardous materials / chemicals Male Nurse:-

Number of technicians:- Location of First Aid box:

Description of Works: - Contact Names & Numbers

Before work starts, the following must be in place

Induction Supervision Test Certificates Communication Drinking Water Risk Assessment Permit To Work Area Lighting

SELECT SELECT CONTROLS

HAZARDS ( Tick to identify the controls in place)

Adequate
Fall from Risk Access Edge Secure Guards for
Access Ladder Work Fall Arrestor Life Lines
height Assessment Handrail Protection Ladder Openings
Platform

Manual Risk Mechanical Wrong

Check Weight Access Route Training Team Lifting Right Method Others
Handling Assessment Aids method

Risk Colour code Guards in Proper Proper Cable

Power tools Check Cable Ventilation Dust extraction
Assessment inspection tag place Positioning Scaffold Protection

Risk Permit to Warning Check plug

Electricity Training Tag out Lock out Check Cable Others
Assessment work Signs tops

SELECT SELECT CONTROLS

HAZARDS ( Tick to identify the controls in place)
 FORMAT NO:INT902
Al Tayer Development | Al Rawdat – Abu Dhabi Rev. No. 1
Date: 20/04/16
JSA Page 2 of 4
(Job Safety Analysis)
NO JSA!! NO WORK!! Date:

Confined Risk Permit to Gas Communicati Access/egres

Survey Monitoring Air supply Rescue System
Space Assessment work Detection on s

Use Adequate Jumping

Risk Clean Access House Check oil Access/egres
Trip and fall Pedestrian Work manholes / Others
Assessment route keeping spills s
way Platform trenches

Lifting
Risk Check Examination /
SWL Tag Lines points / Banks man Load stability Packing Pieces
Assessment Lifting gear Inspection
hooks

Loading/unl Check
Lifting Weather Ground Exclusion Communicati Spreader Check
oading Ground Others
operations condition conditions zone on Beams outriggers
vehicles conditions

Compressed Risk Cylinder Cylinder Permit to Flash Back Warning Hose/pipe Pressure
No smoking
Gas Assessment storage Trolley Work Arrestors Signs check Gauges

Fall from Risk Don’t use in Check Secure Over Ladder anti
Others Others Others
ladder Assessment edges stability Ladder Reaching skid shoe

Check
Risk Access Edge Weather Ground Adequate
Scaffold Scaffold Tag Overhead Out riggers
Assessment Ladder Protection condition condition Work Platform
works

Industrial Risk Warning Examination /

SWL Load stability Route survey Speed Limits Banks man Secure Load
Vehicles Assessment devices Inspection

Chemical
Risk Controlled Respiratory Fume
Chemical Check Label Training resistant Ventilation Others
Assessment access equipment extraction
Hand Gloves

Emergency
Emergency ABC Fire CO2 Fire Assembly
Fire Response Fire Blanket Fire Hose Fire Exit
Plan Extinguisher Extinguisher point
Training

SELECT SELECT CONTROLS

HAZARDS ( Tick to identify the controls in place)
 FORMAT NO:INT902
Al Tayer Development | Al Rawdat – Abu Dhabi Rev. No. 1
Date: 20/04/16
JSA Page 3 of 4
(Job Safety Analysis)
NO JSA!! NO WORK!! Date:

Risk Check slope / Access /

Excavation Shoring Barricade Others Others Others Others
Assessment repose angle egress

Welding / Risk Permit to Welding Welding face Fume Barricade hot Leather
Training Ventilation
Hotworks Assessment Work screens shield extraction work zone apron / gloves

Risk Permit to Warning Guard shaft Proper Adequate

Fall Arrestor Life Lines Access / egress
Assessment Work boards openings Scaffold Work Platform

Shafts / Floor Overhead Opening

Training Ventilation Task light Others Others Others Others
Openings Protection guards

Wash Waste
Biological Environment Waste
Survey rooms / Pest control management Waste Skip Others Others
Hazard Assessment removal
Toilets / Recycling

Others
Others Others Others Others Others Others Others Others Others
(Hazard)

Eye
Safety Helmet Hand Gloves Coveralls Face Shield Hi vis Jacket Safety Shoe Ear Protection Safety Harness
protection
PPE

Respiratory Breathing
Dust mask Fall Arrestor Others Others Others Others Others
Equipment Apparatus

Any Others Observations

and actions taken:

Task Hazard Analysis

Name: Signature:
Prepared BY
Cross checked by (random)
Name: Signature:
Engineer-Project/Site/SM/CM
Cross checked by (random)
Name: Signature:
Safety Team
THIS LIST OF HAZARDS AND CONTROLS ARE NOT EXHAUSTIVE
 FORMAT NO:INT902
Al Tayer Development | Al Rawdat – Abu Dhabi Rev. No. 1
Date: 20/04/16
JSA Page 4 of 4
(Job Safety Analysis)
NO JSA!! NO WORK!! Date:

QHSE TOOL BOX TALK –TOPICS COVERED

1. J.SA &Approved MSRA requirements

2.

3.

Name of Trainer: Signature:____________ Date:

Sl. Emirates ID No. /

Name Designation Signature
No Subcontractor

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ALL-GC-INT003-FRM-008 Document Issue Level – 2