SAFE WORK METHOD STATEMENT

Title & Description of Work: Suck water from PIV pit PTW No.:

Work Location/
Work Executed by FETH-FFS Preparation Date 4-Tháng 11-24
Area:

Tools/ Equipment’s: Fire Truck, Hand tool Materials:

Authorization to
No. Briefly describe each critical work step Hold Point
Continue

1  Mobilization of tool, material and fire truck to working location.

Work Execution:
 Inform PO, SSV before starting work.
2  Remove cover for PIV pit
 Connect hose from fire truck to pit and from fire truck to ditch
 Carry out suck water from PIV pit to drain
 Re-install cover for PIV pit

3  Housekeeping.

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 1 of 02
 Position Name Signature Date Company

Requestor MAI VAN MINH 4-Nov-24 FETH

NSRP Discipline Supervisor HOANG HUY DUNG 4-Nov-24 NSRP

NSRP Discipline Leader (High Risk)

NSRP Discipline Section Manager (High Risk)

Appointed Task Supervisor

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 2 of 02
 JOB SAFETY ANALYSIS

Title & Description of Work Suck water from PIV pit

Work Executed by FFS-FETH Preparation Date 4-Nov-24

Work Location/ Area Applied for PTW No.

RISK x NSRP Standard Control Sheet

LEVEL High Medium Low Hot Works Non Naked Flame

What can cause it go to If it does go wrong.

What can go wrong?
wrong? What can be done to prevent it going to What can be done to
(Potential Negative
No. ( List cause – Condition/ wrong? minimize the Action by
Consequences)
Action) (Preventive Actions) negative
consequences?

1. Mobilization of tool, material and tool to working location.

Call JOC at 6700/

6701 or
1.1.1.1. Use corect and proper hand flove. 02378738541 for Task Supervisor
1.1 Finger pinch 1.1.1 Poited object
1.1.1.2. Identify/ avoid pinch point. medical emergency Workers
respone

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 3 of 02
 1.1.2.1. Reques gas test before enter to
1.2.1. Enter to working place process unit/ workplace prior PTW
without conduct gas revalidation.
Call JOC at 6700/
test/hazardous gas 1.1.2.2. Use proper PPE as required.
presence. 1.1.2.3. Identify the excavation route and 6701 or
02378738541 for Task Supervisor
1.2 Expose to hazardous gasses. the nearest assembly points.
medical emergency Workers
1.2.2.1. Provide gas detector and ensure
1.2.2. No personal gas functional. respone
detector with 1.2.2.2. Task supervision shall ensure the
execution team. gas deetector always switch on
while working inside the plant.
2. Work Execution:

 Inform PO, SSV before starting work.

 Remove cover for PIV pit
 Connect hose from fire truck to pit and from fire truck to ditch
 Carry out suck water from PIV pit to drain
 Re-install cover for PIV pit
2.1 Flying object/Personal injury and 2.1.1.1 Ensure the access and egress are
respiratory not obstruction. Call JOC at 6700/
2.1.1.2 All unwanted material must be 6701 or Task Supervisor
2.1.1 Slips, trip & falls
removed from site. 02378738541 Workers
2.1.1.3 Firefighters will barricade the emergency respone
sucking area by the traffic cone
2.1.2 Contact with sharp 2.1.2.1 Before lifting, call for everyone to Call JOC at 6700/ Task Supervisor
edge of the pit cover be out of line of fire. In this case, 6701 or Workers
the path of the pit cover 02378738541
movement. emergency respone
2.1.2.2 Maintain safe distance of the shin
from the sharp edge. Use levers to

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 4 of 02
 lift the pit cover, if feasible
2.1.2.3 If levers are not feasible, then
consider using gum boots for the
activity which will provide some
protection to the shin.
Call JOC at 6700/
2.1.3.1 Suppervisor must conduct START 6701 or
before start the job. 02378738541 Task Supervisor
2.1.3 Pinch point
2.1.3.2 Use hand gloves. emergency respone Workers
2.1.3.1. Use correct tools.

2.1.4.1 If there is significant vegetation

around the pit covers, before
approaching such an area,
advance a long stick or lever
noisily such that any reptile would
move away
2.1.4.2 Before removing the pit cover, tap Call JOC at 6700/
2.1.4 Snakes, scorpions, it 3-4 times with the suction 6701 or
Task Supervisor
dead carcass in & wrench, so that any reptile inside 02378738541
Workers
around the pit cover the water will move away from the emergency respone
opening
2.1.4.3 Do not lean near the open edge
since any reptile would try to
make its way out immediately
upon opening the pit cover
2.1.4.4 Do not touch any dead carcass.
Report & use discretion
Call JOC at 6700/
2.1.5 Noise lead causing 6701 or Task Supervisor
2.1.5.1 Use correct and proper ear plug.
tinnitus/ Deaf ear 02378738541 Workers
emergency respone

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 5 of 02
2.2 2.2.1.1 Park the fire truck & cars on the
road edge.
2.2.1.2 Erect barricades & install traffic
cones at least 5 meters on either side of
the parked fire truck
2.2.1.3 Keep the hazard lights on to warn
the incoming traffic especially during the
2.2.1 Struck by vehicles night times or at sharp road bends
causing injuries 2.2.1.4 Do not park the vehicles on the
road junctions or turns. Park some
distance away if the PIV is on the road Call JOC at 6700/
Irritation of skin eye and impact turning such that the road visibility of 6701 or Task Supervisor
to heath other road users is not blocked. 02378738541 Workers
2.2.1.5 If full road closure is required, this emergency respone
requires the road closure certificate prior
approval from HSSE&S
2.2.2.1 Secure the end of the hose at the
ditch.
2.2.2.2 Gradually increase the pressure
2.2.2 Injury to people around
2.2.2.3 If using branch man, Keep the
and Operation interruption
pump discharge pressure low to start with
& then increase with consent of the branch
man
Spills/ leak to environment 2.2.3 Acute- breathlessness, 2.2.3.1 As much as possible remain Call JOC at 6700/ Task Supervisor
pollution nausea, Chronic- cancer due upwind & stay away from the exhaust 6701 or Workers
to Diesel emission from the plume. 02378738541
fire truck 2.2.3.2 Consider turning off the engine emergency respone
while the pump is not engaged

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 6 of 02
 2.2.4 Environmental pollution 2.2.4.1 Inspection Fire truck and fire pump
due to oil leaking before start the job.

3. Housekeeping

3.1.1.1. Conduct housekeeping during

HSSE supervision/
working time.
Task supervision shall
3.1.1.2. Arrange materials, equipment
3.1.1 Un-Used material left conduct site survey
Environment effect/ Operation properly; save space for peorm the
3.1 in workplace poor and choose properly Task Supervision
impact. task.
housekeeping location to put the
3.1.1.3. Collect all tools, materials,
equipment materials
equipment after complated, return
before mobilixation.
clean area.

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 7 of 02
 Position Company Date Name Signature

Person who prepare JSA FETH

MAI VAN MINH

Requestor (Low/ Medium) / Task

Supervisor (High Risk) FETH MAI VAN MINH

NSRP Discipline Owner NSRP HOANG HUY DUNG

Permit Issuer NSRP LE ANH DUC

Division Manager
(HSSE)
High Risk Work If no SCS available
Asset Owner Section
Manager/ DSL

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 8 of 02
 What can go wrong? What can cause it to go What can be done to prevent it If it does go wrong. What can
(Negative Consequence) wrong? (List from going wrong? be done to minimize the Action by
Causes- Condition/Action) (Preventive Actions) negative consequences?
LMRA

Document No.: NSRP-HSE-HS-PD-003 Title: Job Safety Analysis Form

Date: 5th December 2022 Rev. No.: 10 Page 9 of 02