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    Name:: Job Safety Analysis (Jsa) Worksheet

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    jonathan camba

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Name:: Job Safety Analysis (Jsa) Worksheet

    Uploaded by

    jonathan camba
    2 views3 pages

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    3

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2 views3 pages

    Name:: Job Safety Analysis (Jsa) Worksheet

    Uploaded by

    jonathan camba

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    JOB SAFETY ANALYSIS (JSA)

    Page 1 of 3

    Name:

    JOB SAFETY ANALYSIS (JSA) WORKSHEET

    Job Cable Pulling of Fiber Optic Cable from RTU 477 to GOSP-3
    Title/Description: Telecommunication Room

    REQUIRED PROTECTIVE EQUIPMENTS


    Safety Helmet Safety Helmet Cotton Hand Electrical Hand
    ☐ ☐ ☐ ☐
    Class G Class E Gloves Gloves
    Safety Glass Safety Glass Latex Coated Anti Vibration
    ☐ ☐ ☐ ☐
    Clear Dark Hand Gloves Gloves
    Welding Helmet Welding/Heat
    Face shield ☐ ☐ ☐ Ear Plugs ☐
    Mask Resistant Gloves
    Disposable
    FRC Clothing’s ☐ E-arc Clothing ☐ ☐ Ear Muffs ☐
    Coverall
    Gum Boots Metatarsal
    Steel Toe Shoes ☐ ☐ ☐ Welding Boots ☐
    Steel toe Guard
    Blasting Airline
    Dust Mask ☐ Cartridge Mask ☐ ☐ Welding Apron ☐
    Hood
    Self-retracting
    SCBA ☐ Full Body Harness ☐ ☐ Reflective Vest ☐
    lifeline
    Personal Gas Multi-Gas
    Hard Barricade ☐ Soft Barricade ☐ ☐ ☐
    Detector Detector
    Warning Chemical Dry CO2 Fire
    ☐ Fire Blanket ☐ ☐ ☐
    Signages Powder Fire Ext. Extinguisher
    Others (Specify) ☐

    REQUIRED TOOLS, HEAVY EQUIPMENTS AND MACHINERIES

    Crane Boomtruck

    Lifting tackles Portable Diesel Generator

    Grinders Hand Power drill

    Double Cab Pickup


    SN Critical Steps Hazard(S) Controls/Recommended Action Responsibility
    List the Specific There may be more hazards in each Identify the PROPER and SPECIFIC controls and SPECIFIC PPE Person or Parties
    Critical Steps step. List all hazards needed. Prioritized Engineering Controls Responsible in
    Identify the Possible Stop Work Trigger Task Actions
    1 Mobilization of
    Equipments
    and Materials
    to the Jobsite

    2 Cable Pulling

    5 Housekeeping

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