JOB SAFETY ANALYSIS FORM

Main Activity: Hydro test of Pipes /Equipment Plant & Location:-

Date: Day1 Day2 Day3 Day4 Day5 Day6 Day7
Permit Nos. (Day 1-
7)
Sr.N Sub Activities Hazards Control Measures
o. List the tasks required to (Both Existing as well as potential) List the control measures required to eliminate or minimize the risk of injury arising from the identified Hazard.
perform the activity in the Against each task list the Hazards that could cause
sequence they are carried injury/damage to people, equipment or the
out environment.

Health hazard due to exposure to HC/toxic

1 Preparing for hydro test (blinding
gas and Ensure equipment is positively isolated from all HC (process) connections.
connection pump/hoses) Ensure line or equipment is free from HC/toxic gas i.e. check LEL and H2S.
Injury due to use of improper tools Use standard job specific tools and PPEs
Use OF Water Ensure Blinds used area of correct rating to withstand hydro test pressure
2 Avoid threaded connections and plugs. Check for all fittings before hydro test includes gaskets
Check for pump hoses for any kind of damage. Only one person will check for leakages
Barricade the area of hydro test. Do not allow too many person around during pressurization

Injury due to failure of fittings used for hydro

test

JSA Format No. 9112-000-HSE-006-00004/ Ver-2

Injury due to fall from height (if applicable)
Refer and comply to Work at Height JSA (this will apply to all sub activities)
Be clear about the hydro test pressure; do not pressurize beyond hydro test pressure
Hydro test
Use standard and calibrated gauges only.
Raise the pressure slowly and steadily
Property damage due to overpressurisation Use certified hoses
Electric machine must be certified by competent authority and have valid certificate
All Electric connection to be crosschecked for loose fittings etc. Earthling of the equipment must be done
LEL must be checked in the area periodically.
DCP cylinder to be kept ready for use

Fire/electrical hazard due to no flame proof

equipment and/or diesel operated engine

(Note: 1. JSA to be done by issuer and acceptor of work permit. In case required, representative from other discipline can also join the team for JSA.
2. JSA to have approvals*(Managers) for Hot Jobs, confined space entry & Work on equipment in service
3. Minimum one hand written job specific information to be included every day by the issuer & requestor. In case of no additional information, write-“No
change from above” in the Remarks.
 Equipment damage Provide adequate venting to avoid equipment going to vacuum during draining
3 Depressurization
Injury during depressurization Keep body away from the fluid path. Open valve slowly
All sub activities (1-3) Physical injury while working Use correct tools. Use mandatory PPEs
4

Note ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………...
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Name & Sig. Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Issuer

Requestor
Remarks:
*App-1 Issuer

*App-1 Requestor

Checklist of common Hazards

This should be used as an aid to identifying the hazards. This is the list for the most common hazards but is not a definitive list.
Mechanical/Equipment Thermal Ignition sources Electrical
Entanglement Hot surface Electricity Electric shock
Shearing Steam Static electricity Static electricity
Crushing Refrigerants Hot work Power failure
Striking Stored Energy Lightening Pressure
Cutting Falling material Sparks Release of energy
Mechanical failure (e.g by overloading) Springs under tension/compression Frictions Implosion
Chemical Counterweights Flames Compressed air
Flammable Radiations Auto ignition Steam
Toxic e.g. ionising radiations (X-rays) Pyrophoric material Hydraulics
Harmful Place of work Vehicles Process
Irritant Obstructions Fork lift Wrong material
Oxidising Access/egress Tankers Missed steps
Pyrophoric Work at height Reversing vehicles Instrument failure
Corrosive Falling objects Speed Interlocks
Dangerous to environment Slip/trip/fall People Control system failure
Dust explosions Housekeeping Unsafe behaviour Alarms
Gases Temperature Human errors Nature
Fumes Ventilation Training/competence Weather
Vapours Confined space Methods of work Winds/Storms/lightening
 JOB SAFETY ANALYSIS FORM
Dusts Hazards of other tasks being done simultaneously. Manual handling (lifting, carrying, pushing and pulling)
Asphyxiates Stress/workload

Biological (e.g. Legionella) Noise/Vibrations/Hot work

JSA Format No. 9112-000-HSE-006-00004/ Ver-2

(Note: 1. JSA to be done by issuer and acceptor of work permit. In case required, representative from other discipline can also join the team for JSA.
2. JSA to have approvals*(Managers) for Hot Jobs, confined space entry & Work on equipment in service
3. Minimum one hand written job specific information to be included every day by the issuer & requestor. In case of no additional information, write-“No
change from above” in the Remarks.