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Plant II
SPECIAL
REQUIREMENT
S:
SN
1
2. Excavation Permit
Yes
No
POTENTIAL HAZARDS
Plant -2
HAZAR
D RANK
Crane Positioning
4. Method Statement
Yes
No
5. Gas Test
Yes
STATU
S
Yes
No
REMARKS
No
RECOMMENDED ACTION OR
PROCEDURE
REVISED
3. Safety / Critical
Bypass
Yes
No
NEW
DATE
(Closed):
18.5.2016
JSA NO.:SEN-AR-310
AREA:
1. Exemption Permit
Yes
No
Ground Preparation
DATE (Issued):
FM-PS02-113-07
Inspection of crane
FM-PS02-113-07
FM-PS02-113-07
FM-PS02-113-07
FM-PS02-113-07
RECOMMENDED P.P.E.:
HAZARD
PPE
Toxic Gas
Chemical
Acid
Fall
Dust
Heat / Cold
Exposure
control
Spill
Flying
Particles
Communication
SCBA /
Breathing Air
Hose
Chemical
Suit
Chemical
Suit
Safety
Harness
Mask
Thermal
Suits
Barriers
Container /
Showers
Face
Shield
Radio/
Walkie-talkie
Site control
Flag man
/Watch man
ERT Standby
IC Signature
Yes
No
If you answer NO for any of the questions, then what remedial action
?will you take BEFORE starting work
Are you aware of, and do you have the correct PPE?
Do you have the right tools, and are they in good conditions?
Is there a hot surface around and adequate protection has been considered?
Team leader / Work Group supervisor (I.D# & Sign):
FM-PS02-113-07
POTENTIAL HAZARDS
1.
2.
3.
4.
2.
3.
4.
5.
6.
7.
8.
HAZARD RANKING:
NOTE: Xerox copies of old JSA not allowable. Verify Revision prior to use.
FM-PS02-113-07