SKC ENGINEERS AND CONTRACTORS PRIVATE

LIMITED
JOB SAFETY ANALYSIS [JSA] FORM
Project JSA SKC-JSA-103
Name Number
Date
Location Client
Activity BACKFILLING AND COMPACTION [GENERIC]
Equipment
Work Mechanical Equipment
Details
Description

Check all applicable anticipated or potential hazards

Work At Height [Scaffolds, ladders, roofs,
 Electrical [ Live ]  Heavy Equipment Lifting  etc...]
 Electrical [ Isolation ]  Traffic Patterns [ Mobile Equipment / Pedestrian ]  Underground Tank Removal / Disposal

 Hot Work  Temporary Pumping & Transfer Facilities  Demolition

 Confined Space Entry  Extreme Weather  Exposed Handling of Petroleum Products

 Equipment Handling & Dismantling  Pile Driving / Drilling Equipment  Mobile Equipment

 Excavation  Bore-hole Drilling / Test Pit Excavation  Drilling, Grinding, Cutting

Stored Pressure Systems [ e.g. - Propane, NH3
 ]
 Pressure Testing  Work in Hazardous Areas

 Radiography / X-ray Testing  Overhead Power-lines  Other:

Tools, Equipment, Interfaces, or Job Aids needed to perform Work Upgraded PPE needed to address Potential Risks identified in this
Task JSA

Reviewed By Organization Position Date

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 JOB SAFETY ANALYSIS [JSA] FORM

Sequence of Basic Job Potential Hazard Responsibility

Control Measures
Identify potential risks [safety, process safety, Personnel directly
Steps environmental, reliability, and business
Explain critical actions to prevent/ manage potential
responsible to
List key and critical job steps risks.
Inefficiencies]. supervise the task
1. Backfilling and  Slips, Trips & Falls  Clear walkways, work areas of equipment,
Compacting Soils tools, construction debris and other
materials. HSE Officer
 Mark, identify, or barricade other
obstructions
 Handling Heavy Objects  Observe proper lifting techniques
 Obey sensible lifting limits [27.2 kg max. per
person] HSE Officer
 Use mechanical lifting equipment [hand
carts, trucks] to move large, awkward loads
 Struck by or Against Heavy  Wear reflective hi-vis vests when exposed to
Equipment, flying Debris or Protruding vehicular traffic.
Objects  Isolate equipment swing areas
 Make eye contact with operators before
approaching equipment
 Barricade or enclose the work area
 Restrict work area entry to authorized HSE Officer
personnel only
 during construction activities
 Wear hard hats, safety glasses with side
shields, and steel-
 toe safety boots
 Understand and review hand signals
 Vibration  Rotate compaction tasks to minimize worker
exposure to equipment vibration.
Site Engineer
 Use compactors with vibration dampening
devices
 High Noise Levels  Use hearing protection when exposed to
excessive noise
levels [greater than 85 dBA over a 10 hour
work period] HSE Engineer
 Access noise level with sound level meter if
possibility exists that level may exceed
85dBA TWA [Time Weighted Average]
 High Ambient Temperature  Monitor for Heat Stress
 Provide Fluids to prevent worker dehydration Site Manager
 Establish Work and Test Schedule.
 Low Ambient Temperature  Monitor for Cold Stress Site Manager
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 JOB SAFETY ANALYSIS [JSA] FORM

Sequence of Basic Job Potential Hazard Responsibility

Control Measures
Identify potential risks [safety, process safety, Personnel directly
Steps environmental, reliability, and business
Explain critical actions to prevent/ manage potential
responsible to
List key and critical job steps risks.
Inefficiencies]. supervise the task
 Establish Work and Test Schedule.

Safety Process Information Regarding this JSA

Prepared by Position Date

Person[s] Carrying Out This Process On The Actual Work-Site

Names: Signed Date

Verified by Position Date

Use back of the sheet if additional names and signatures are required in this section of JSA.

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