Job Safety Analysis

TRS-HS-FRM-0001

Instructions for completing Job Safety Analysis (JSA) form

Section I -Enter general information about the site and job task.

Section II - Determine whether any of these operations apply to the job task to be performed. Make note of any special training, permit, certification, and risk
assessment requirements.

Section III - Identify any human/organizational factors that could impact the ability to perform the work safely.

1. Break the job down into steps - Be as specific as possible. Write each job step in a new row of column A (Activity/Step). It’s a good idea to leave an extra row
between steps in case you need them later. Add additional rows to the table as needed, or if completing the JSA on paper, print additional copies of the
sheet to accommodate all job steps.

2. Determine the hazards associated with each job step and write them in column B (Hazards). Use the examples of hazards provided below to trigger your
thinking about different types of hazards and energy sources.

3. List any control measures that will be taken to ensure that step is done safely in column C (Control Measures). Use the control measure examples and
hierarchy provided to trigger your thinking about different types of controls and their effectiveness at reducing risk. Controls toward the top of the table
tend to be more effective at minimizing the severity and/or likelihood of an event than the controls toward the bottom of the table. If this job involves a Life
Crucial Operation, continue to step 4. Otherwise, repeat steps 2-3 for each of the job steps identified, then proceed to step 8.

4. Considering the hazards involved and the control measures that will be in place, determine the worst credible severity of an incident that could result from
this job step. Use the severity table provided. Write the severity number in column D (Severity).

5. Considering the hazards involved and the control measures that will be in place, determine the likelihood that an incident will result from this job step. Use
the likelihood table provided. Write the likelihood number in column E (Likelihood).

6. Multiply the severity number by the likelihood number and enter the product in column F (Risk).

7. Consider the risk rating against the thresholds provided in the Overall Risk Ratings.

i. Very low and low risk ratings of 1-3. This level is generally considered acceptable provided that all control measures are applied.

ii. Medium risk ratings of 4-6. Medium risk requires a planned approach to control the hazard and applies additional controls if required. Action taken must
be documented on the risk assessment form.

iii. High and Very High-Risk ratings of 8-24. For all high and very high risk, Column G (Additional control measures) must be implemented to further reduce
the risk to a medium or low level. Such activities shall not be proceeded until applying additional control measures. The Construction Director/Manager or
facility Manager must personally review the activities with a High or Very High residual risk score and approve additional control measures by signing off
the JSA.

8. Repeat steps 2-7 for each of the job steps identified.

Section IV - Provide the name, company, and title of those who prepared and reviewed/approved this form in the signature box provided. The Construction
Director/Manager or facility Manager must review and approve the additional control measures that have a High or Very High-Risk rating before proceeding the task.
Additional space is also provided for crew members to sign the JSA if desired.

Reference Table in completing Section III – Job Safety Analysis (Column B – Hazard)

Biological & Electrical Chemical Gravity/Height Mechanical & Motion

Environmental
Arc Flash Air Emissions Equipment Being Thrown Off/Under
Altitude Tipping/Collapsing Equipment
Buried Utilities Chemical Products
Animal Bite/Sting Excavation/Trench Disintegration of Moving
Damage to Leads/Cables ● Carcinogenic
Components
Blood-Borne Pathogens Falling Objects
Damage to Switches ● Combustible/Flammable
Driving/Vehicle Traffic
Contaminated Food/Water Floor Openings/Edges
Energized Circuits/Conductors ● Explosive
Ejection of Workpiece/Debris
Insect-Borne Disease Grating Removed
Inadvertent Energization ● Toxic
Entanglement
Pests Inadequate Support
Lack of Isolation/Grounding ● Corrosive
Friction
Poisonous Plants Lack of Access Ladders/Stairs
Missing/Damaged Insulation ● Reactive
Movement/Shifting
Precipitation Suspended Load
Overhead Lines Client/Process Chemicals
Moving Parts
Temperature/Humidity Unstable/Insecure Materials
Overload of Circuits Lack of Containment
Pinch/Crush Points
Unsanitary Conditions Work Above/Below Others

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Weather Stored Energy Leakage/Spills Work at Height/Fall Hazards Projectiles

(Batteries/Capacitors)
Wind/Turbulence Material Incompatibility Walking/Working Surface Rotating Equipment
Water Near Electrical
Pressure Produced/Disturbed by Work ● Slippery Sharp Edges, Corners, or Points
Conductors
Abrasive Blasting ● Asbestos ● Uneven Shearing
Work Environment
Compressed Gases ● Lead ● Obstructed Stored Energy
Cluttered
(Springs/Accumulators)
High Pressure Fluid ● Silica ● Steep
Confined Space
Striking
Pressure Testing ● Welding Fumes ● Moving/Swaying/Pitching
Damaged Tools/Equipment
Trapped Between Equipment
Pressure Washing/Blasting ● Dust ● Insufficient/Unstable
Entrapment and Fixed Structures
Radiation Water Discharges Ergonomic
Erosion Unexpected/Uncontrolled
Intense Light Wastes Generated Awkward Movement
Hazardous Atmosphere
Postures/Movement
Lasers ● Hazardous
● Oxygen Rich/Deficient
Excessive Force/ Exertion
Microwaves ● Non-Hazardous
● Contaminants
Heavy/Awkward Load
Naturally Occurring Sound
Ignition Sources
Radioactivity Radioactive Repetitive Motion
Continuous Noise
Material Inadequate Ventilation
Same Position
Intermittent Noise
X-Rays Poor Lighting/Glare
Vibration
Extreme Noise
Restricted Access/Egress
Impact Noise
Runoff

Reference Table in completing Section III – Job Safety Analysis (Column C – Control Measure)

Most Effective Controls Examples

Elimination ⮚ Make connections at ground level before ⮚ Remove a dangerous machine from service
erecting a structure to eliminate work at height
(Remove the hazard altogether) ⮚ Provide power outlets to avoid trailing cords

Substitution ⮚ Use latex rather than oil-based paints

(Replace the material/process ⮚ Reduce energy, such as speed, force, amperage, pressure, and temperature
with a less hazardous one)
⮚ Use water-based detergents instead of organic solvents

Engineering/Isolation ⮚ Ventilation ⮚ Isolate hazardous energy ⮚ Secondary containment

sources
(Design effective control ⮚ Machine guarding ⮚ Barriers
measures to protect people and ⮚ Interlocks
⮚ Enclosures ⮚ Improve lighting
the environment)
⮚ Platforms and guardrails
⮚ Circuit breakers
⮚ Exclusion zones

Warning ⮚ Signs ⮚ Horns ⮚ Labels ⮚ High visibility paint

(Alert people to the hazards) ⮚ Backup alarms ⮚ Beepers ⮚ Tags

Administrative ⮚ Work rotation to minimize exposure ⮚ Training and supervision

(Provide training, procedures, ⮚ Inspect safety equipment

etc.)
⮚ Good housekeeping practices

Least Effective PPE ⮚ Safety glasses ⮚ Fall harness and lanyards ⮚ Respiratory protection

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(Personal protective ⮚ Hearing protection ⮚ Gloves ⮚ High visibility vests

equipment)

Reference Table in completing Section III – Job

Reference Table in completing Section III – Job Safety Analysis (Column D –Severity)
Safety Analysis (Column E – Likelihood)

Severity Level Impact On Likelihood Probability Chances of

Level Occurrence
People Environment / Community Equipment / Property

Critical / 6 Single / ⮚ Long-term (multi-year) impacts to ⮚ Extensive losses of high Very 4 Expected to occur 1 in 100
Catastrophic Multiple air, surface/ground water, or soil; or value equipment/property Likely in most
fatalities circumstances
⮚ Widespread areas including offsite ⮚ Loses exceeding $1,000,000;
area/community affected; or or

⮚ Some adverse publicity/media ⮚ Major unplanned impact on

coverage project budget and schedule

Major 4 Injury or illness ⮚ Lasting (up to one year) impacts to ⮚ Losses of Likely 3 Strong possibility 1 in 1,000
resulting in air, surface/ground water, or soil; or equipment/property that the event will
permanent cannot be readily replaced; occur
⮚ Offsite area/community affected; or
total or partial or
disability ⮚ Events that are reportable to ⮚ Losses exceeding $100,000;
regulatory authorities; or or

⮚ Potential for adverse ⮚ Significant unplanned

publicity/media coverage impact on project budget

Moderate 2 Injury or illness ⮚ Temporary (up to one month) ⮚ Loss of equipment that can Possible 2 The event might 1 in 10,000
resulting in impacts to air, surface/ground be readily replaced; or occur
medical water, or soil limited to the project
⮚ Losses exceeding $10,000;
treatment or site; or
or
temporary
⮚ Breach of regulatory requirement or
disability/loss ⮚ Minor impact on project
limit; and
of function budget
⮚ No potential for adverse
publicity/media coverage

Minor 1 Injury or illness ⮚ No direct impact to air, ⮚ No impact on equipment Unlikely 1 Highly unlikely but 1 in
requiring first- surface/ground water, or soil; or functionality may occur in 1,000,000
aid treatment exceptional
⮚ Effects restricted within buildings or ⮚ Minor, cosmetic damage; or
only circumstances
containment structures; and
⮚ Repair costs easily covered
⮚ No potential for adverse by normal project operating
publicity/media coverage budget

Reference Table in completing Section III – Job Safety Analysis (Column F – Risk)

Risk Matrix Overall Risk Ratings

Severity Likelihood Very Low Low Medium High Very High

Unlikely Possible Likely Very Likely 1 2-3 4-6 8-18 24

1 2 3 4

Critical - 6 6 12 18 24 High and Very High-Risk ratings of 8-24.

Additional control measures must be implemented to further reduce the High

Major - 4 4 8 12 16 and very high risk to acceptable level.

Note: The Construction Director/Manager or Facility Manager must personally

review the activities with a High or Very High residual risk score and approve
Moderate - 2 2 4 6 8
suitable additional control measures by signing the JSA.

Minor - 1 1 2 3 4

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Section I – General Information

Emergency Procedures

Emergency Contact Name Emergency Contact Phone Number

Primary Contact Samy Ahmed Primary Contact 0501251976

Secondary Contact M.A.Haq Nisar Secondary Contact 0500132567

Details

Program Number. Company Name Al Kifah precast Company

Project Name The Red sea developing Company Date 02-02-2021

JSA /Risk Assessment Title Concrete Placement Category ☒ New ☐ Revised

Specific Location precast manufacturing company Building N/A

Plant Tools & Equipment Required Concrete Pumps, Concrete Truck Mixers, Concrete Vibrators, Plate Area N/A
Compactors, Hand Shovels, Wheelbarrows, Slump Test Apparatus,
Temperature Gauge, Measuring Tape, Cubes for Sampling

Work Scope/Description Concrete Placement

Section II – Does this job require any of the following operations?

✔ = Requires formal/special training ■ = Requires certification or Competent/Qualified Person designations

 = Requires a permit/form/report ∆ = Life Crucial Operations = Requires full Risk Assessment

Description Yes Description Yes

Aerial Lifts ✔ ∆ ☐ Cranes - Critical lift ✔  ■ ∆ ☐

Confined Space ✔  ■ ∆ ☐ Hot Work ✔  ☐

Dismantling and Demolition ■ ☐ Loading/Unloading Material ∆ ☒

Electrical Hazards ✔  ■ ∆ ☐ Noise Exposure ✔ ☒

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Excavation/Trenching ✔  ■ ∆ ☒ Powered Industrial Trucks ✔ ■ ∆ ☐

First Line Breaks ✔  ■ ∆ ☐ Radiation Area Work ✔  ■ ☐

Grating/Floor Plate/ Guardrail Removal  ∆ ☐ Respiratory Hazards ✔ ☐

Hazardous Energy Control ✔  ■ ∆ ☐ Roof Work ✔  ■ ∆ ☐

Hazardous Materials ✔  ■ ☐ Scaffolding ✔ ■ ∆ ☐
Asbestos & Lead Work

Hazardous Materials ✔ ■ ☐ Site/Vehicle Traffic ∆ ☒

Crystalline Silica & Cadmium

Hazardous Waste Operations ✔  ☐ Steel Erection ■ ∆ ☐

Heavy Equipment ✔ ■ ∆ ☒ Work at Height (> 6 ft) ✔ ■ ∆ ☐

Rigging, & Cranes ✔ ■ ∆ ☐ Other       ☐

Section III – Job Safety Analysis Risk Assessment (Post Control Measures)
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J)

Activity/Step Hazards Control Measures Severit Likelihood Risk Additional Control measures Severity Likelihood Risk

y
Excavation Issue the work permit from 04 01 4
authorized personnel
Excavation beyond the area
/ limits Excavation area to be marked before
to start of excavation competent
person

Provision of adequate barricade by

Concrete or PVC-Web

Provide means of proper access &

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egress

Post safety signs, use blinking

warning lights in the night
Cave In/ edge & wall Provide proper mean of access & 4 2 8
collapse & engulfment egress inside trench

Edge shall be protected by benching

& shoring depends upon class of soils
Formwork and steel Fatigue/ heat exhaustion/ Ensure the provision of welfare 1 03 3
reinforcement cramp/ heat stroke & poor facilities such as; rest shelter,
weather conditions alternative staff shift, provide
drinking water & toilet in order
prevent from heat stress
Untrained or incompetent Brief all personnel before activity, 2 2 4
entry follow site instructions by site
supervisors

Provide Induction to all site

personnel, safety briefing before
start of job to be ensured

Trained people to be used for

unloading the frame.

Carpenters instructed to carry out

shutter bolting activity using 3
persons to hold the shutter frame in
vertical position

Make provision of craft-based

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training which

Operator should have valid driving

license

Concrete placement and Uninspected Equipment Ensure equipment inspection before 4 2 8

pouring concrete pump, concrete to mobilize on site, Use TRSDC forms
vibrator etc. and checklist, ensure daily inspection Consult with the relevant 4 1 4

of equipment before to use, do not department, Scan the area if

use defective equipment, ensure to required, mark the area to be
rectify or remove from the site excavated, brief the personnel for the
activity, supervise and monitor the
activity continuously
Operator should stand in position; if 6 2 12
this is impossible a spotter must be
Electrocution
used (Don’t rely on depth of
perception with high voltage wire)

Apply thumb Rule: for every one feet

of vertical drop, stay back from base
edge min. 01-feet that shall be
equal/greater than one feet of
vertical drop

Remove all staff from discharge area

Don’t walk backward and stay out of

the path of the boom

Always assume all wires are live in

order to prevent from electric shock

Never work in manner that boom

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over the electrical wires

Maintain safe clearance distance

from obstructions and point of
concrete pouring
Rotating/Moving parts of Don’t exceed the maximum weight 2 3 6
machinery allowed to hand from boom of
concrete pump

Verify that outrigger pads are not

sinking before and after concrete
pump is in boom.
Falling from height Only approved ladder to be used, 4 2 8
Person to ascend and descend facing
towards ladder and firmly having the
grip of the ladder.

Use of full body harness with proper

hooking arrangement.

Only approved standard ladder to be

used.

Only inducted workers shall be

deputed at the work place.
Skin inflammation , eyes Use of the PPE like Hand gloves and 2 3 6
irritation, safety goggles.

hand injury etc Proper housekeeping/stacking of

material in an isolated area.

Scaffolds / staging to be made as per

the scheme.

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Work shall be carried out by a

competent person under proper
supervision of foremen / in charge.
Cut Injury due to sharp Unloading at a distance of 1 meter 2 2 4
edges from the pit.

Head injury Designated location for the storage

of the reinforcement rods.
Fall of material
Use of safety shoes, gloves, helmet
Wire piercing in the finger
and reflection jacket.

Concrete Casting, finishing Movement of Concrete 4 1 4

and curing Trucks
Ensure induction of all drivers /
operators, Brief before start of
activity, ensure training in regular
intervals, Follow site traffic rules and
regulations, park in the designated
area, do not overtake in blind points,
use flagman on site and avoid
reversing without flagman

Not following Speed Limit Ensure induction of drivers before to 3 3 9

or Using Mobile phone move on site, Conduct awareness
during driving training, and Follow speed limits, site
rules and regulations, safety briefing

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to be ensured before to start of

activity. Stop vehicle at safe place to
answer the call ( if necessary )
Collision of equipment Assign flags man, barricade the area, 2 3 6
ensure proper supervision of the
activity, coordinate the nearby
activity,
Improper Parking of trucks Ensure safe parking on site for the 2 3 6
truck, vehicles and ensure access for
equipment and people near to the
activity, ensure to assign flagman,
install safety sings,
Entanglement with rotating Ensure all safety guard must be in 2 2 4
elements and Poor place
maintenance of equipment
Ensure preventive / regular
maintenance of equipment, use daily
equipment inspection checklist, do
not use defective equipment, and
Remove defective equipment from
the site for service.
Oil leak / oil spill Use drip tray or resistant sheet 3 2 6
during refueling, ensure preventive
maintenance, provide spill kit in
nearby location, ensure emergency
contact numbers and emergency
response team
Fire into plan or machinery Ensure provision of firefighting 2 3 6
equipment, Inspect regularly, train

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site people for the use of fire

extinguishers, Ensure updated
emergency response plans, ensure
provision of emergency contact
numbers,

2 2 4
2 2 4
Failure of Equipment Ensure preventive maintenance of 2 3 6
equipment, use equipment checklists
before to operate for the day activity,
Do not stay near to equipment
radius, use flagman
Slip, Trip and Fall Monitor site continuously, remove all 2 2 4
unnecessary material and people
from the area, Ensure emergency
exits, train people for emergency
response, brief employees for the
activity, ensure updated emergency
response plans, team and contact
numbers.
Concrete Spill Use drip tray or resistant sheet 2 3 6
underneath of concrete pump.
Ensure availability of spill kits,
maintain emergency contact
numbers, brief site personnel for
environmental emergency response,
and ensure to update environmental

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emergency response team.

2 2 4
Lack of emergency Ensure provision of emergency 2 2 4
response equipment, Ensure to have
emergency response team at site,
Moreover updated emergency
contact numbers to be available at
site.
2 3 6
High Noise Use ear plugs / ear muffs, post safety 2 2 4
signs, brief personnel before the
activity, train personnel in regular
intervals
Note: Insert additional rows or print additional sheets as necessary to accommodate all job steps.

Section IV – Approval and Signatures

Prepared bys Company Position

M.A.Haq Nisar Al Kifah Precast Company Safety Officer

A.B Soomro Al Kifah Precast Company

Reviewed and Approved by Company Position

Khalid Mumtaz Al Kifah Precast Company Supervisor/Engineer

HSE Representative

High and Very High residual risk rating (8-24)

Note: All High and Very High residual risk ratings (8-24) require review and approval by Construction Director/Manager or Facility Manager before starting work to ensure that the additional controls are adequate to execute the task safely.

Reviewed and Approved by Company Position

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Construction Director/Manager or Facility Manager

Reviewed by Crew Company Position

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