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G
E Reported by: bp Contractor:
N
E Duration Classification Health
R Observer: Safety
A
L Partner: Environmental
REACTIONS OF PEOPLE
Adjusting PPE Applying Lockout
Changing Position Changing Tools
Hiding or Dodging Performing Lockouts
Stopping Work Rearranging Job
POSITIONS OF PEOPLE
Absorbing Caught in, on, or between
Electricity Falling
Inhaling Striking against
Struck by
PROCEDURES
Emergency Plan Lone Workers
Reviewed Standards inadequate
Standards Not Established Standard not maintained
ORDERLINESS
Absorbing Benches & toolboxes
Emergency exits Halls & passageways
Leaners Material storage
Stairs and platforms Standards not
established/understood
PERMITS
Was a lift team used to plan the lift? Who is in charge? Note to Auditor: Assess the quality and completeness of the Lifting
Operations Permit based upon response to questions above.
_________________________________
How did you complete the JSA for this job?
How will you prevent others from entering the area during
the lift?