JSA Sample
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SAUDI PETROCHEMICAL COMPANY (SADAF)PROCEDURE NO:SHEM 08.10Attachment 48
REVISION:00 DATEMay 9, 2014
SUBJECT : JOB SAFETY ANALYSIS PAGESee bottom
JOB SAFETY ANALYSIS(TANK)
Area: EDC ( ALL)Job Description: Internal Inspection tesyinhtttTTesttestinghhhhhhHydrotestingHydrotesting testing)New JSA
Job Location: 33TK27 / 33TK13 TanksApplicable SHEM 08Revised JSA
Maintenance Manager: Department: SAP: Date: Use additionalsheetsif necessaryJSA No.06A
AttachmentsYesNo. of Pages2
NoJob StepsPotentialHazardsRisk Rating1/2/3/4*Steps toreduceHazard(Control/Mitigation)Action Completion byRemainingRisk 1/2/3/4*Remarks
1Pre-entry 1) Entry without valid permit.2) Improper ventilation.3) Existence of Process Gas.4) Slips & Trips, Unsafe manual handling.
11)Obtain valid work permit as [per SHEM 08.10.2) Assure proper ventilation is done (0 LEL)3) Gas test to be conducted.Concern MTC supervisor.Concern AXIS Permit Reciever.OP Issuer.
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2Entry for inspection1)Trips and Slips, Unsafe access.2) Falling / Hitting object.3) Flash Hazard.
11) Wear All required PPE and full body harness if needed as per SHEM 08.08 2) Use safe flash light inside the confind space.3) Use Camera without flash.4) LEL=0, Toxic=0, O2=20.8%.Concern MTC supervisor.Concern K-kem AXIS Permit Reciever.OP Issuer.
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Risk Rating: 1 Major; 2- Significant; 3 Minor; 4 Insignificant.
Review Team: Name
ID#:Dept.Sign:Date:Other Team Members :NameID#:Dept.Sign:Date:
Maintenance Manager/ Supervisor
Other Team Members: Names
Operations Manager / Supervisor:safety
EHS Representative
Maint.
Approval by Dept. Senior Manager Unplanned lifting activity Remaining Risk at Significant (2) level activity
Permit Issuer:I have reviewed and agreed with all steps of this JSA.
Approval by M-RAC Chairman Major Risk (1) activity
Permit Acceptor:I have agreed with all steps of this JSA and briefed all my team menmbers on the precaution requirements.
Risk Rating: 1 Major; 2- Significant; 3 Minor; 4 Insignificant.
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