SiteSafety

JOB SAFETY ANALYSIS

Gilco Contracting, Inc.

Supervisor / Foreman

Job Number

Todays Date

Time (Hour)

Minute

Consider the following, check the items applying to the job and review with the work crew.

SPECIAL CONDITIONS

Cold Work

Lockout / Tagout Job

Hot Work

Confined Space

Entry

Other (Explain)

PERSONAL PROTECTIVE EQUIPMENT

Normal PPE

Protect. Clothing:

Hard hat

Face Shield

Safety Glasses w/side shields

Respirator: Type

Monogoggles w/retainer

Hearing Protection (Ear Plugs)

Safety Toed Boots / Shoes

Fall Protection

Work Gloves

Seat Belts

Gloves - Type:

Burning Goggles

Add'l Foot Prot.:

Welding Shield

Other (Explain)

TOOLS

Current Inspection

Qualification Required

Proper Tools for the Job

Extension Cords / Power Cables

Good Tool Condition

Other (Explain)

EMERGENCY INFO EQUIPMENT LOCATION

Fire Hydrant

Fire Extinguisher

Extension Cords / Power Cables

Wind Direction:

Other (Explain)

WELDING

Welding Leads in Good Condition

Water Hose

Combustibles

Fire Blanket

Spark Containment

Fire Wrench

Welding Screens (Personal Protection)

Sewer Covers

Grounding

Other (Explain)

ELECTRICAL

Locked and Tagged

GFCI Test

Try Start / Stop Switch

Assured Grounding / Chasis Ground

Other (Explain)

LIFTING

Motorized Equip.:

Proper Rigging Practices

Properly Inspected

Manual Lifting

Man. Lift Equip:

Overhead Obstructions

Properly Inspected

Other (Explain)

ACCESS

Scaffold Properly Inspected

Personnel Basket (Inspected and Approved)

Ladder Tied Off

Properly Inspected

Areial Lift

Other (Explain)

EQUIPMENT

Back Up Alarms

Leaks

Windows

Tires

AC / Heat

Other (Explain)

POTENTIAL RISKS

Injection (Puncture)

Inadequite Lighting

Flammable / Combustible

First Opening of Equipment

Ingenstion (swallowing)

Mech: Isolation Devices

Inhalation (breathing)

Process Isolation Devices

Absorption (through the skin)

Line or Equipment Cleared

Falls

Noise

Pinch Points

Poor Access / Egress

Slip-Trip Potential

Poor Housekeeping

Heat Stress

Sharp Objects

Hot / Cold Surfaces or Materials

Electrocution

Other (Explain)

OTHER / MISCELLANEOUS

Barricades

Overhead Work

Signs

Other Crews Working in Area

Hole Cover

Knowlegable in use of Specific Tools

Handrail

Other (Explain)

If this is a LO/TO job, has the equipment been isolated and drained?

Has a joint walk throughbeen performed?

Are Locks / tags installed?

Comments

Employees have read and understand the JSA Job Safety Analysis