JOB SAFETY ANALYSIS (JSA) FORM
Job Location/Site: JSA NO:11
Task/Activity: ERECTION AND DISMANTLING OF SCAFFOLDING PCR NO :
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PCR NO:
Work Area: Permit N0: Date:
Gas Leak / Fire /Any Emergency: In case of emergency, all works must be stopped, equipment must be switched off
Emergency situation /Evacuation and left in safe condition. All personnel shall reach the nearest muster point considering the wind direction (upward or
cross-ward)
SL.
WHO IS AT
NO ACTIVITY STEPS o INVOLVED CONTROL MEASURES
RISK
1 Morning tool box ●People Not Understanding What ● People ● Make Sure Everyone Is Involved With The JSA/JHA Discussion And
Meeting And JHA
Discussion The Plan Or Hazards Are; People Understands; Encourage Everyone To Ask Questions And Participate.
● Equipment
Afraid To Ask Questions Don't Make Anyone Feel For Speaking Up Or Questioning
●Presence Of H2S gas and Toxic ● Facility ●Try To Identify These Types Of things In Your Work Areas Before
gas In Work Areas ● Environment Starting the work; Clear Carefully Work Areas By gas testing and
●Presence of chemical or flammable ●daily site inspection
items
2 Work Permit
● Unauthorised commencement of ● People ● Authorised work permit holders shall ensure obtaining and maintaining
works valid work permits.
● Equipment
● May result in exposing people ● The supervisor responsible for this activity has to check the PPE of his
● Facility
and/or potential to harm or danger. staff to ensure that all required items are available and properly used.
● Environment ● Inform all people regarding permit conditions before work starts.
● Supervisors must conduct daily toolbox talk about nature of work and
associated potential hazards e~and their essential precautionary
measures.
3 Gas test
●May found toxic gas or H2S gas leak ● People ● Carryout gas test by QP Authorized gas tester time to time.
or extreme oxygen limit in air Environment
● All groups working in different area inside station shall have H2S
PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
Page 1 of 4
JOB SAFETY ANALYSIS (JSA) FORM
SL.NO
ACTIVITY STEPS HAZARDS INVOLVED WHO IS AT RISK CONTROL MEASURES
personal gas monitor(certified)
4 ● Mobility restriction, access ● People ● Survey the area and confirm safe location of temporary of material prior
Scaffolding
Preparation of obstruction, congestion in the work to hauling.
● Equipment
area if hauling/storing of material in
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work/Hauling of ● Provide temporary holding area at location that will not congest/obstruct
materials not properly planned and ● Facility
coordinated. plant access or restrict mobility of other activities.
● Nearby existing facilities if any ● Obtain necessary permit
subject to physical damage during ● Provide temporary holding area at location that will not congest/obstruct
material hauling
site access or restrict mobility of other activities.
● Scaffold rack is a must for holding scaffolding material. No pipes,
couplers will be stored on the ground or anytime scattered on the
ground.
● Observe extra caution in mobilizing material at site
5 ● Erection & Use ● Damage to onsite detectors ● People ● Take extreme care during erection and override it if needed.
of Scaffolding /switches / transmitters etc
● Facility
● Equipment
●
6 ● Fall of objects / Tools. ● People ● Provide guardrail & toe board to prevent falling of tools /objects
● Facility ● Don’t keep the unnecessary materials on the scaffold platform
● Equipment ● Hand tools to be tied with permanent structure or person
● If required barricade the area during erection work.
7 ● Accidental Fall of Person ● People ● The Scaffolder must use Safety Harness/full body harness to prevent
accidental fall
●
8 ● Unstable Scaffold ● People ● The scaffold must be inspected, certified & tagged bythe competent
person confirming its suitability
● Facility
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PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
JOB SAFETY ANALYSIS (JSA) FORM
SL.NO
ACTIVITY STEPS HAZARDS INVOLVED WHO IS AT RISK CONTROL MEASURES
● Equipment
9 ● Weak Scaffold ● People ● The scaffold tag must indicate the maximum load that itcan bear
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● Facility
● Equipment
10 ● Damaged Scaffold ● People ● The scaffolding is to be inspected at least weekly for any damage due
to weather condition (rain, high windetc) or other unsafe conditions.
● Facility
●
● Equipment
11 ● Modified Scaffold ● People ● In case of any modification, addition in the scaffold, ithas to be re-
inspected & certified
● Facility
● Equipment
12 ● Improperly Supported Scaffold ● People ● Ensure Scaffold is securely supported on a rigid groundand not on
process piping / vessel or equipment
● Facility
13 ● Incomplete Scaffold ● People ● Do not use if green Tag is missing
● Facility
● Do not use if red tag is available.
14 ● Old Scaffolding ● Doubtful Integrity ● Do not use if it does not have valid inspection tag attached
15 Housekeeping Slips trips and falls due to poor ● People ● Remove tools equipment and rubbish from worksite and maintain a
Clean up worksite housekeeping
clean work environment.
● Environment
● Arrange housekeeping on daily and every shift bases
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PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
JOB SAFETY ANALYSIS (JSA) FORM
SL.NO
ACTIVITY STEPS HAZARDS INVOLVED WHO IS AT RISK CONTROL MEASURES
● Facility ● Supervisor shall conduct tool box meeting in this regards
● Equipment
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Project Engineer HSE/QA/QC Manager Project Manager
PREPARED BY: REVIEWED BY: APPROVED BY:
Page 4 of 3
PJ247/JSA-11-REV-0 ERECTION AND DISMANTLING OF SCAFFOLDING
