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JSA Blank 2011

This document contains a job safety analysis (JSA) for Rig 22. The JSA lists potential hazards, recommended actions, and responsible persons for various job steps. It also includes criteria for reviewing JSAs, such as ensuring the correct location and date are listed, identifying specific hazards and controls, and discussing stop work authority. Signatures are required from those participating in the JSA and the supervisor approving the analysis.

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Casey Weatherford
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© Attribution Non-Commercial (BY-NC)
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148 views4 pages

JSA Blank 2011

This document contains a job safety analysis (JSA) for Rig 22. The JSA lists potential hazards, recommended actions, and responsible persons for various job steps. It also includes criteria for reviewing JSAs, such as ensuring the correct location and date are listed, identifying specific hazards and controls, and discussing stop work authority. Signatures are required from those participating in the JSA and the supervisor approving the analysis.

Uploaded by

Casey Weatherford
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd

Job Safety

ANALYSIS Rig 22
SEQUENCE OF BASIC JOB STEPS

Job Performed: Title of Person Who Performs Job: Supervisor:


Well Name / Location:

Page

of
Risk Level

New Date: Approved By:

Reviewed By;

Review pages with Criteria, Hazards, Controls & Proper PPE


POTENTIAL HAZARDS RECOMMENDED ACTION Responsible Person

1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13)


List Short Service Employees:

Signature of those Participating in this JSA:

Revised Time: Approved By:

view pages with Criteria, Hazards, Controls & Proper PPE


SWA TENTS

COASTAL DRILLING
JOB SAFETY ANALYSIS WORKSHEET
Potential Hazards Ignition Source Pressure Lifting Overhead Fire / Explosion Spills Slips / Trips Chips / Slivers OtherHazard Controls and Emergency / Contingency Plans Personal Protective Equipment Physical Barriers Safety Equipment Ignition Source Controls Lock out-Tag out Required Work Permits Fall Protection / Open Hole Policy OtherSpill Control / contingency Plan Fire Fighting Emergency Evacuation Procedures Eye Wash / Safety Shower Location MSDS Simultaneous Operations Pinch Points Hot Surface Simultaneous Operations Adequate Lighting Chemical Exposure Hazardous Atmosphere Confined Space Noise Working / Walking Surfaces Environment / Weather Arc / Flash Open Hole Falls Machinery Heat Stress Power & Hand Tools

Safety Equipment Required Hard Hats Safety Shoes Safety Glasses Face Shield Goggles Cotton Gloves Leather Gloves Rubber/Chemical Gloves Chemical apron Work Vest/Life Jacket Full Body Harness Double Lanyard Life Line Safety Cable Safety Barricade Caution Tape Special Clothing Work Permit Respirator Fire Extinguisher Fire Retardant Tarps Lock Out-Tag Out Gas Detector Hearing Protection Adsorbent Pads Containment Pans Proper Tools

COASTAL DRILLING
JOB SAFETY ANALYSIS CRITERIA

Yes

No
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

JSA Review Criteria


Is the JSA written for task being performed? Is the correct date on the JSA? Is the correct location on the JSA? Is the JSA legible? Is the JSA a New or Revised? Has the JSA been approved by the supervisor? (Toolpusher, Driller, Crane Operator) Is the JSA detailed to assure understanding by all employees? Is the JSA thirteen steps or less? Is the JSA behavior based? Was the Supervisor participatioin and Supervisor support for this JSA? Are employee satisfied with the overall quality of this JSA? Was the JSA developed at the work site? Was the JSA prepared immediately prior to performing work? Was the person responsible for each step identified? Are hazards identified specifically? Was the SWA (Stop Work Aughority) discussed? Are the Tents of Operations included? Has the proper PPE (page 2) been identified on the JSA? Has the hazard control been identified?

Supervisor Signature:

Date:

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