JOB SAFETY ANALYSIS

JSA Number :  NEW  REVISED Page No. :

Job being analyzed: Concrete work of Temporary Facilities
Department/Section doing JSA Members :
JSA
HES & Construction Job Performers :
Normal Approvals Name Signature Date General job
Job by : requirements/Common Personal
Protective Equipment.
Job Supervisor : 1. The following Personal
Protective Equipment shall be
worn--------------------------------:
Additional Approvals(Determined by Job Supervisor in correlation with DECV HSE Manager)
Approved coveralls, safety
Name Signature Date
Discipline Supervisor (DECV) glasses, safety helmet, safety
shoes and gloves, ear plugs and
HSE Representative (DECV) dust masks.
Others(List Below)

2. Permit To Work

Approval required for hazardous work detailed in the DECV work permit procedure.
Changing conditions and emergency procedures
Stop work. Switch of equipment. Supervisor directs personnel to nearest and safest muster point wind direction. Supervisor counts all
employees. Missing employees are reported to DECV HSE Dept. When all clear is given check with DECV HSE before returning to work.

EMERGENCY TELEPHONE NO. HSE MANAGER: Y.I.KIM

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 JOB SAFETY ANALYSIS Date:
WORK ACTIVITY :
Page: _____ of _____
MS AND JSA NO :

S.CON.CONSTRUCTION Mgr
DECV CONSTRUCTION Mgr.
SUPERVISOR APPROVAL:
CRITICAL QUESTIONS:
BASIC JOB STEPS
JSA PREPARED BY:
DECV HSE Sign. :
Everyone Ready/Capable To Work?  Potential Spill/Gas Release Addressed?  Worst Case Discussed? 
POTENTIAL INCIDENTS OR HAZARDS WAYS TO ELIMINATE OR CONTROL HAZARDS

REQUIRED SAFETY EQUIPMENT

Hard Hats Goggles Safety Harness Hearing Protection Barricades Other (List):___________________________________
Safety Shoes Face Shield Cotton Gloves Flame Resistant LEL Monitor _____________________________________________
Safety Glasses Work Vests Leather Gloves Clothing H2S Monitor _____________________________________________
Fire Extinguisher

APPLICABLE SAFE WORK PRACTICES/SPECIAL PRECAUTIONS

Hot Work Permit Special Pre-Job Safety Discussions Confined Space Entry Permit Pollution Prevention Measures
Energy Isolation Review Emergency Action Plans Use of Specialized PPE Redundant Protection Measures
Written Procedure Site/Job Orientation Overhead/Underground Utility Lines Simultaneous Operations

POTENTIAL HAZARDS
Lifting Hazards Short Service Elec. Shock/ Flash (includes utility lines) Dropped/Falling Low Lighting Ionizing
Fall Potential Employees Haz. Chemical Exposure (includes H2S) Objects Breathing Hazard Radiation
Skin Irritants Water/Drowning Hazard Sharp Edges or Hot/Cold surfaces Tripping/Slipping Environmental
Confined Mech. Equip. Hazards Pinch/Crush/Striking Hazards Excavation Hazard Extremes Other:_________
Spaces Fire/Explosion Potential Potential Release of Energy Confined spaces Vehicle Operations ________________
Elev. Load/Work High Noise Levels Elevated load or work ________________

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 SCOPE : Concrete
JOB SAFETY ANALYSIS/RISK ASSESSMENT Works

SEQUENCE OF BASIC RESPONSIBLE

ITEM POTENTIAL HAZARDS HAZARDS CONTROL
ACTIVITY STEPS PARTY

1) Injury to personnel 1) Equipment for loading and unloading will be 1) Construction

due to improper checked prior to mobilization. Ocular inspection
1 Mobilization of equipment handling of will be done prior to unloading and area will be
and materials equipments and cleared of materials and/or personnel during
materials unloading.
1) Traffic accident 1) Defensive and responsible driving must be 1) Construction
followed.
Flagman to assist all drivers.

2) Slips , trips and 2) Proper handling and organizing of materials. 2) Construction

falls Proper housekeeping shall be done to prevent
accidental slips, trips and falls.

3) Dust inhalation, 3) Wear proper PPE

eye injury, ear Eye protection must be worn during woring.
damage, head Personnel awareness must be very high. 3) HSE
injury, pinch points
2 Concrete Works
4) Equipment 4) Equipment must be in good condition
malfunction Proper maintenance of equipments must be 4) Construction
done

5) Concrete burns, 5) Competent personnel will be assigned to

personnel being critical jobs 5) Construction
struck by concrete
Helper to assist concrete hoseman.
hose
6) Construction
6) Electrocution 6) Equipment must be in good condition
Proper maintenance of equipments must be
done

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 1) Injury to personnel 1) Equipments for loading and unloading will be 1) HSE /
due to improper checked prior to mobilization Construction
handling of Ocular inspection will be done prior to unloading
equipments and and area will be cleared of materials and/or
materials personnel during unloading.
3 Demobilization
2) Construction
2) Slips , trips and 2) Proper handling and organizing of materials
falls Proper housekeeping shall be done to prevent
accidental slips, trips and falls.

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 ID # NAME TRADE SIGN
1
2
3
4
5
6
7
8
9
10

Declaration note: I/We had explained and fully understood content of Step by Step JSA.I/We fully comply with the content of this JSA. If
condition exists and we change steps or sequence of the steps, we will notify to the supervisor and include/update in the JSA.

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