1

Hot Work JSA Example

Job Safety Analysis

Control No: Status: Original Date:

Last Date Closed:

Organization:

JSA Type:
Work Type:
Work Activity: Hot Work Activities
Specific Site:

Personal Protective Equipment (PPE) Selected Comments

Hard Hat Y Required
Safety Glasses Y Required
Fire Resistant Clothing Y
Face Shields Y As required
Hearing Protection
Goggles Y As required
Lifeline/Body Harness
Air Purifying Respirator
Supplied Air Respirator - SCBA
Welding Hood Y
Welding/Pipe Clothing Y For welding jobs
Welding Mask/Goggles Y
Personal Floatation Device
Long sleeve shirt Y Local procedure
Gloves Y Leather
Other
Safety Cones/Barricades Y
Safety Vest Y
Knee Pads
Caution Tape
Back Belt/Support
Substantial leather footwear
Winter Clothing
Safety Footwear Y
Personal Gas Monitor
Long pants Y

Reviewers

This sample JSA is intended for use as an awareness tool only and is not intended to cover all potential risks, hazards, and conditions. A JSA is not a
substitute for compliance with applicable laws, regulations, or Chevron standards. Each contractor is ultimately responsible for the safety of its
employees and its compliance with applicable laws, regulations, and Chevron standards. Changing conditions, such as weather, location, terrain,
equipment, processes, etc., may not be addressed here, but must be addressed by each contractor with its employees before work begins.
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Hot Work JSA Example
Reviewers Name Position Date Approved

Development Team

Development Team Member Name Primary Contact Position

Job Steps

No Job Steps Potential Hazard Critical Actions

High risk work
Complete Non-routine and/or periodic work Complete permit and implement
1
General Work Permit where approved work procedures controls required
do not exist
High risk work
Conduct hazard assessment Ensure qualified personnel
Non-routine and/or periodic work
2 & conduct hazard assessment &
where approved work procedures
write JSA(s) write JSA(s)
do not exist
High risk work Ensure plan describes in detail the
Non-routine and/or periodic work activities, tasks and sub-tasks
3 Create a written work plan
where approved work procedures required to complete a specific
do not exist scope of work
Ensure equipment to be worked
on is cleaned of all
flammable/combustible materials
Ensure combustible materials that
cannot be removed are covered
Conduct Job Site/Equipment
with flameproof material.
Preparation (e.g., isolation, Flammable vapors (% LFL)
Ensure oily surfaces and oil spills
depressurization, purging, Toxic gases/vapors
4 are rinsed and covered with at
flushing, sealing all drains, etc) Oxygen deficient/enriched
least 25 mm of sand.
(separate JSA(s) may be required As determined during Step 2
Ensure trash, oily rags, grass,
to address specific job)
weeds, etc are removed.
Ensure pressure relief valves on
pipelines and vessels adjacent to
the work area are properly piped
or vented to the safe area.
Ensure gas testing performed in
surrounding area for a distance of
15 meters (50 feet)
Ensure LFL is 0%
Flammable vapors (% LFL)
Ensure no residues of combustible
Toxic gases/vapors
5 Initial Gas Testing liquids present.
Oxygen deficient/enriched
Ensure all potential areas are
As determined during Step 2
tested (e.g., adjacent to welded
seams, plates, etc)
Determine follow-up gas testing
requirements
Ensure all identified requirements
Finalize & Issue
6 As determined during Step 2 and controls have been
Hot Work Permit
implemented before signing permit

This sample JSA is intended for use as an awareness tool only and is not intended to cover all potential risks, hazards, and conditions. A JSA is not a
substitute for compliance with applicable laws, regulations, or Chevron standards. Each contractor is ultimately responsible for the safety of its
employees and its compliance with applicable laws, regulations, and Chevron standards. Changing conditions, such as weather, location, terrain,
equipment, processes, etc., may not be addressed here, but must be addressed by each contractor with its employees before work begins.
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Hot Work JSA Example
Ensure the following topics are
covered:
Scope of work
Conditions and requirements listed
Inadequate communication to all
7 Conduct Safety Briefing on permits and JSA(s).
personnel involved
Potential hazards and controls
Emergency response
requirements
Minimum PPE required
Wear proper PPE, including
welding helmet and respiratory
protection if applicable.
Ensure continuous gas testing
Begin Hot Work occurs, if required
Fire
(e.g., welding, cutting, etc.) Ensure fire extinguisher is readily
Flammable vapors (% LFL)
8 (separate JSA(s) may be required available
Toxic gases/vapors
to address specific job tasks within Ensure fire watch is available, if
Oxygen deficiency
this step) required
Ensure welding/cutting equipment
is in good working condition
Ensure barriers are set-up contain
any flying debris
May include but not limited to:
Change in scope of work
Work Stoppages (permit Ensure Permit Issuer re-evaluates
Change in entire work crew
9 cancellations, extensions, and permit requirements and controls if
Change in site conditions
revalidations) any work stoppages occur
Failure to conduct gas testing
Issue with permits
Job site not left in safe, clean,
and/or orderly condition Ensure Permit Issuer reviews job
Adequate time has elapsed for the site prior to signing off on job
10
Work Completion Fire Watch to verify condition of Retain permits and supporting
the job site documentation in accordance with
Work performed does not meet requirements
required scope and specifications
Assess any changing conditions,
11 such as weather, traffic etc
Update hazard and critical actions

This sample JSA is intended for use as an awareness tool only and is not intended to cover all potential risks, hazards, and conditions. A JSA is not a
substitute for compliance with applicable laws, regulations, or Chevron standards. Each contractor is ultimately responsible for the safety of its
employees and its compliance with applicable laws, regulations, and Chevron standards. Changing conditions, such as weather, location, terrain,
equipment, processes, etc., may not be addressed here, but must be addressed by each contractor with its employees before work begins.