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7/17/2019 Blank jsa http://slidepdf.com/reader/full/blank-jsa 1/1 JOB SAFETY ANALYSIS Location /System Date JSA: Site Visited Task Description JSA Team Is an MOC required Yes No X Are there any Y2K Issues Yes No X Has consideration been given to weather conditions Yes No X Are written rocedures avai!ab!e Yes Ha"ard #$$ect %H#&' (robabi!ity%(& )*is+%*& ,* -igni$ies residua! ris+ a$ter contro! .easures in !ace -#/0#NC# O1 A-IC 3O -4#(- HA5A*6- I6#N4I1I#6 H# ( * CO**#C4I7# M#A-0*#- 8 * #COMM#N6A4ION- H#%*,& (, *, ACC#(4 -A1#4Y #/0I(M#N4 *#/0I*#6 -a$ety hard hat or+ vests 1ace shie!d Hearing rotection ;oc+ out -a$ety boots -a$ety Harness arricades 7esse! entry er.it 4ag out -a$ety g!asses 1ire e'tinguishers *oe o$$ area< Hot wor+ er.it ;i$ting recaution =ogg!es 1ire watch Cotton =!oves -ca$$o!ding 6ust8Che.ica! Mas+ 1ire resistant c!othing 1ire b!an+et ;eather =!oves Che.ica! resistant g!oves =as 6etectors CH#CK;I-4 (*OM(4- NO4#: Chec+!ist is not co.rehensive< (*OC#-- 1;0I6 *I-K > 1!a..ab!e? 4o'ic? Corrosive? (ressure? 4e.erature? 1oa.ing? ;-A8(yrohoric -ca!e? Hydrates? -and 8 6ebris? a'? Inventory 7o!u.e? -yste. -tatus I-O;A4ION HA5A*6 *I-K > Iso!ation standard? (ast (er$or.ance? Integrity (rob!e.s? (roo$ o$ va!ve integrity? I.act o$ wor+ on iso!ation? (ossib!e to .onitor (ressure ui!d 0 Migration $ro. other syste.s? -coe $or reverse $!ow? -coe $or b!oc+age? 4raed ressure? ;oca! #-6 $aci!ities? 4i.e to initiate #-6? 4i.e to shutdown8b!owdown AC4I7I4Y 4Y(# *I-K > rea+ing Contain.ent? Hot or+? Heavy ;i$t? Con$ined -ace #ntry? 6ri!!ing8e!! Oerations? #'!osive Hand!ing? 6iving? *adiograhy? #!ectrica!8High 7o!tage? Overboard or+ -ca$$o!ding? Manua! Hand!ing? ater @etting8-and !asting? I.act on -a$ety -yste.s? Handovers? 0se o$ Hand too!s? Non>routine tas+? -IMO(- HA5A*6 4Y(# *I-K > 1a!!ing $ro. height? 1a!!ing ob@ects? Co!!ision? Access8#gress? Moving Machinery? Noise? Che.ica! e'osure? eather Conditions? 1u.es86ust? I!!u.ination? Co.etence o$ ersonne!? Ha"ard to #nviron.ent? 1!aring 8 hydrocarbon gas re!ease? -i!!age 8 Oi! to sea? -i!!age 8 che.ica!? aste .anage.ent 8 ha"ardous waste? 4raed between? #.issions to at.oshere 3-A 4ea. ;eader: 6ate : -ite -uervisor #ndorse.ent : 6ate :
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JOB SAFETY ANALYSIS FORM
Transcript of Blank jsa
7/17/2019 Blank jsa
http://slidepdf.com/reader/full/blank-jsa 1/1
JOB SAFETY ANALYSIS
Location /System Date JSA: Site Visited
Task Description
JSA TeamIs an MOC required Yes No X Are there any Y2K Issues Yes No X Has consideration been given to weather conditions Yes No X Are written rocedures avai!ab!e Yes
Ha"ard #$$ect %H#&' (robabi!ity%(& )*is+%*& ,* -igni$ies residua! ris+ a$ter contro! .easures in !ace
-#/0#NC# O1 A-IC 3O -4#(- HA5A*6- I6#N4I1I#6 H# ( * CO**#C4I7# M#A-0*#- 8 * #COMM#N6A4ION- H#%*,& (, *, ACC#(4
-A1#4Y #/0I(M#N4 *#/0I*#6
-a$ety hard hat or+ vests 1ace shie!d Hearing rotection ;oc+ out
-a$ety boots -a$ety Harness arricades 7esse! entry er.it 4ag out
-a$ety g!asses 1ire e'tinguishers *oe o$$ area< Hot wor+ er.it ;i$ting recaution
=ogg!es 1ire watch Cotton =!oves -ca$$o!ding 6ust8Che.ica! Mas+1ire resistant c!othing 1ire b!an+et ;eather =!oves Che.ica! resistant g!oves =as 6etectors
CH#CK;I-4 (*OM(4- NO4#: Chec+!ist is not co.rehensive< (*OC#-- 1;0I6 *I-K > 1!a..ab!e? 4o'ic? Corrosive? (ressure? 4e.erature? 1oa.ing? ;-A8(yrohoric -ca!e? Hydrates? -and 8 6ebris? a'? Inventory 7o!u.e? -yste. -tatus
I-O;A4ION HA5A*6 *I-K > Iso!ation standard? (ast (er$or.ance? Integrity (rob!e.s? (roo$ o$ va!ve integrity? I.act o$ wor+ on iso!ation? (ossib!e to .onitor (ressure ui!d 0 Migration $ro. other syste.s? -coe $or reverse $!ow? -coe $or b!oc+age? 4raed ressure? ;oca! #-6 $aci!ities? 4i.e to initiate #-6? 4i.e to shutdown8b!owdown AC4I7I4Y 4Y(# *I-K > rea+ing Contain.ent? Hot or+? Heavy ;i$t? Con$ined -ace #ntry? 6ri!!ing8e!! Oerations? #'!osive Hand!ing? 6iving? *adiograhy? #!ectrica!8High 7o!tage? Overboard or+
-ca$$o!ding? Manua! Hand!ing? ater @etting8-and !asting? I.act on -a$ety -yste.s? Handovers? 0se o$ Hand too!s? Non>routine tas+? -IMO(- HA5A*6 4Y(# *I-K > 1a!!ing $ro. height? 1a!!ing ob@ects? Co!!ision? Access8#gress? Moving Machinery? Noise? Che.ica! e'osure? eather Conditions? 1u.es86ust? I!!u.ination? Co.etence o$ ersonne!? Ha"ard to #nviron.ent? 1!aring 8 hydrocarbon gas re!ease? -i!!age 8 Oi! to sea? -i!!age 8 che.ica!? aste .anage.ent 8 ha"ardous waste? 4raed between? #.issions to at.oshere
3-A 4ea. ;eader: 6ate : -ite -uervisor #ndorse.ent : 6ate :
