Attachment III
PTW No. : _______________
Date Issued : _______________
Job Safety Analysis (JSA) Worksheet
BINTULU PORT SDN. BHD.
Location :
Date :
New
Page : _______ of _______
Revised
Job / Task Title :
Task Name ( Job / Task Description ) :
Primary Hazard :
Required And / Or Recommended Personal Protective Equipment :
Step
No.
Sequence Of Basic Job Steps
Company / Organization / Applicant :
Hazards (Potential
Incident)
Supervisor :
Who / What
Might Be Harmed
Analysis by :
Control Measures Or Recommended Action
Or Procedure
Reviewed by :
Rev. No. :
Action / Responsible
Party
Acknowledged / Approved by :
Attachment III
PTW No. : _______________
Date Issued : _______________
Job Safety Analysis (JSA) Worksheet
BINTULU PORT SDN. BHD.
..Continuation.
Step
No.
Sequence Of Basic Job Steps
Company / Organization / Applicant :
Hazards (Potential
Incident)
Supervisor :
Who / What
Might Be Harmed
Analysis by :
Control Measures Or Recommended Action
Or Procedure
Reviewed by :
Action / Responsible
Party
Acknowledged / Approved by :
Attachment III
PTW No. : _______________
Date Issued : _______________
Job Safety Analysis (JSA) Worksheet
BINTULU PORT SDN. BHD.
Name List Of Manpower Involved
# All workers involved in this work process have being briefed and shall observe and comply with the requirements of this JSA at all times.
No. Name
1.
I/C Or Passport No.
Citizenship
Designation
Signature
2.
3.
4.
5.
6.
7.
8.
9.
10
.
11.
Note : Please fill in at the appropriate column below i.e. name of company, your name, signature and stamp, and date.
Company / Organization / Applicant :
Supervisor :
Analysis by :
Reviewed by :
Acknowledged / Approved by :
Attachment III
PTW No. : _______________
Date Issued : _______________
Job Safety Analysis (JSA) Worksheet
BINTULU PORT SDN. BHD.
INSTRUCTIONS FOR COMPLETING JOB SAFETY ANALYSIS WORKSHEET
Job Safety Analysis (JSA) is an important accident prevention tool that works by finding hazards and eliminating or minimizing them before the job is performed and before they have a chance to become
accidents. Use your JSA for job clarification and hazard awareness, as a guide in new employee training, for periodic contacts and for retraining of senior employees as refresher on jobs which run
infrequently, as an accident investigation tools and for informing employees of specific job hazards and protective measures. Set priorities for doing JSA's : Jobs that have a history of many accident s , job
that have produced disabling injuries, job with high potential for disabling injury or death, and new jobs with no accident history
Step
No.
Sequence Of Basic Job Steps
Hazards (Potential Incident)
Who /
What
Might Be
Harmed
Control Measures Or Recommended
Action Or Procedure
Action /
Responsible Party
Break the job down into steps. Each of the steps of a
job should accomplish some major task. The task will
consist of a set of movements. Look at the first set of
movements used to perform a task and then
determine the next logical set of movements.
For Example;
The job might be to move a box from a conveyor in
the receiving area to a shelf in the storage area. How
does that break down into job steps? Picking up the
box from the conveyor and putting it on a hand truck
is one logical set of movements, so it is one job step.
Everything related to that one logical set of
movement is part of the job step.
The next logical set of movement might be pushing
the loaded hand truck to the storeroom. Removing the
boxes from the truck and placing them on the shelf is
another logical set of movements. And finally,
returning the hand truck to the receiving area might
be the final step in this type of job. Be sure to list all
the steps in a job. Some steps might not be done each
time- checking the casters on a hand-truck.
Identify the hazard associated with each step.
Examine each step to find and identify
hazards actions, conditions and possibilities
that could lead to an accident. It's not enough
to look at the obvious hazards. It's also
important to look at the entire environment
and discover every conceivable hazard that
might exist.
Be sure to list health hazards as well , even
though the harmful effect may not be
immediate A good example is the harmful
effect of inhaling a solvent or chemical dust
over a long period of time. It's important to
list all hazards contribute to accidents, injuries
and occupational illness. In order to do JSA,
you must identify potential and existing
hazards. That's why it's important to
distinguish between a hazard, an accident and
an injury. Each of these terms has a specific
meaning.
HAZARD - A potential danger. Oil on the
floor is a hazard.
ACCIDENT An unintended happening that
may result in injury, loss or damage.
INJURY The result of an accident. A
sprained wrist from the fall would be an
injury.
Parties
expose to
the hazard.
Using the first two columns as a guide, decide what
actions are necessary to eliminate or minimize the
hazards that could lead to an accident, injury or
occupational illness. Among the actions that can be
taken are :
1-engineering the hazard out. 2-providing personal
protective equipment. 3-job instruction training. 4good housekeeping. 5-good ergonomics (position
the person in relation to the machine or other
elements in the environment in such a way as to
eliminate stresses and strains). List recommended
safe operating procedures on the form, and also list
required or recommended personal protective
equipment for each step of the job. Be specific. Say
exactly what needs to be done to correct the hazard,
such as "lift" using your leg muscles. Avoid
general statements like "be careful". Give a
recommended action or procedure for every hazard.
If the hazard is a serious one, it should be corrected
immediately. The JSA should then be changed to
reflect the new conditions.
Workers involved in
the job.
Company / Organization / Applicant :
Supervisor :
Analysis by :
Reviewed by :
Acknowledged / Approved by :
Attachment III
PTW No. : _______________
Date Issued : _______________
Job Safety Analysis (JSA) Worksheet
BINTULU PORT SDN. BHD.
Typical Example Of Completed Job Safety Analysis
Location :
Storage Godown No 1
Page : ___1____ of ___2____
Job / Task Title :
Task Name ( Job / Task Description ) :
Banding Pallets
Strapping a box to a pallet
Primary Hazard :
Required And / Or Recommended Personal Protective Equipment :
1- Cuts to the body parts (hand, fingers legs, etc.)
1-Hand Gloves 2-eye Protection
Step
No.
1.
Sequence Of Basic Job Steps
2.
Date :
09.09.04
New
Revised
Rev. No. :
01/2004
3-Long Sleeve 4-Safety Shoes.
Hazards (Potential
Incident)
Cart positioned too close to
pallet (strike body & legs
against cart or pallet
Who / What
Might Be Harmed
Bander
Control Measures Or Recommended Action
Or Procedure
Leave ample space between cart and pallet to
feed strapping - have firm grip on strapping
gun.
Action / Responsible
Party
Bander & supervisor
Withdraw strapping and bend end back about
3".
Sharp edges of strapping
(cut hands, fingers & arms)
Bander
Bander & supervisor
3.
Walk around load while holding strapping with
one hand.
Projecting sharp corners on
the pallet (strike feet on
corners)
Bander & other
workers passing
by
Wear gloves, eye protection & long sleeves keep firm grip on strapping - hold end
between thumb & forefinger - watch where
stepping.
Assure a clear path between pallet and cart pull smoothly - avoid jerking strapping.
4.
Pull and feed strap under pallet.
Splinters on pallet
(punctures to hands and
fingers)
Sharp strap edges (cuts to
hands, fingers and arms)
Bander
Wear glove - eye protection - long sleeves.
Point strap in direction of bend - pull strap
smoothly to avoid jerks.
Bander & supervisor
Position portable banding cart and place
strapping guide on top of boxes.
Company / Organization / Applicant :
Supervisor :
Bander & supervisor
Bander
Analysis by :
Reviewed by :
Acknowledged / Approved by :
