XJob Safety Analysis

Complete Daily (Before Beginning Work or for Pre-Job Analysis)

Job Information
Attachment 4-1
Page 1 of 2
Date: Site ame: Site o:
Site A!!ress: S"per#isor:
Project Personnel
Name: Company: CPR/First
Aid
Name: Company: CPR/First
Aid
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Emergency Procedures
$ist telep%one n"mbers an! atta&% !ire&tions to t%e site:
Are 911 systems functional with cell phone use? Yes No
ower Rescue Procedures to !e used:
Fire "epartment: #n $ouse Crew %ther
Am!ulance: elephone Co:
&ocal $ospital: Police:
'(acuation Point: )tility Co:
Job'(ask for (o!ay or Pre-Job Analysis
Chec* which is !ein+ performed:
&ine and Antennas ower ,or*/'rection Ci(il/Concrete 'lectrical
Crane %perations Critical &ift - #f yes. you must complete a Critical &ift Permit/ Rooftop ,or*
Controlled "escent - #f yes you must su!mit this 01A 2in lieu of a permit3 to the 'ricsson P4 and recei(e appro(al prior to performin+ the descent
%ther 5 "escri!e 0o!/#ssues:
Job/Tasks/Steps Potential Hazards Preventive Measures/Ne Procedures
Re( - " - 16/17/69

Job Safety Analysis
(Job )*pos"res)
!ttac"ment #$%
Page & o' &
$a8ards #dentification: 2#tems chec*ed !elow relate to e9istin+ conditions. or may !e a result of site operations3
P%ysi&al +a,ar!s +ealt% +a,ar!s
Falls from ele(ations 'lectrical
1lips. rip. or falls )nder+round utilities
:ehicle raffic 'le(ation/1ite errain
%ther
$eat 1tress Cold 1tress
$i+h Noise 2;<7 d=A3 Chemical '9posure
1ilica '9posure 2Concrete Cuttin+3
'4'/RF &iftin+ $a8ards
%ther:
(-) +a,ar! Control .eas"res
Personal Prote&ti#e
)/"ipment'.onitoring
)/"ipment
Inspe&tions Inspe&tions Safety Program'(raining
$ard $at 1afety >lasses
$earin+ Fall Protection
>lo(es RF 1uits
RF 4onitors
ools/'?uipment Ri++in+
$ouse*eepin+ a+ &ines
>round Fault Protection
>in Poles $oists
ail+ate 4eetin+ @ in51 1i+n
&oc*out/a+out '9ca(ation &o+
Permit 1ystem 2$oistin+ Personnel. Confined 1pace.
'9ca(ation. Critical &ifts. Controlled "escents etc/3
RF rainin+
Complete for Ci#il Work
1/ "escri!e type and depth of e9ca(ations:
A/Ca(e5in control measures to !e used if e9ca(ation will !e +reater than 7 feet and personnel are enterin+ the trench:
1lopin+ =enchin+ 1horin+ rench 1hield/=o9 &adder in rench at @ feet
B/ "escri!e ele(ation/site terrain/en(ironmental concerns or ha8ards:
@/ "escri!e ha8ards with site/(ehicle access 2i/e/ !oom and cranes/electrical lines3 and stora+e of materials:
7/ "escri!e the type of electrical concerns or ha8ards:
Complete for (o0er'1ooftop Work (2all Prote&tion 3 4sing S"spen!e! Personnel Platform)
ype of ower/Rooftop: ype of Antenna =oom:
Fall protection to !e used:
Full =ody $arness "ou!le &e+ or wo &anyards Rope >ra! Ca!le >ra!
Retracta!le &ifeline Anchora+e 1traps Ropes "escenders
N%': Controlled "escents and 1uspended Positionin+
Anchora+es used to support suspended positionin+ ri+s shall !e independent of any anchora+e !ein+ used for attachment of a PFA1 and shall !e capa!le of
supportin+ at least 7.666 pounds per employee attached/
Ropes and straps 2we!!in+3 used in suspension and descent ri+s shall !e made from synthetic fi!ers/ 1uspension and descent lines or systems and all
necessary slin+s. connectors and friction de(ices shall ha(e a minimum !rea*in+ stren+th of 7.666 pounds/ All lines shall !e protected a+ainst !ein+ cut or
a!raded/ 'ach employee on a suspended positionin+ ri+ shall !e protected !y a PFA1/
1/ $as each employee inspected his or her fall protection e?uipment? Yes No
A/ "escri!e the fall protection system to !e used for the Co! includin+ Controlled "escent Applications:
B/ "escri!e the fall protection system to !e used when accessin+ antenna !ooms or performin+ tower erection:
@/ $oistin+ '?uipment to !e used:
1uspended Personnel Platform 24an!as*et3 Crane/=oom ruc* >in Pole
7/ $as a 1uspended Personnel Platform Permit !een completed?
1e#ie0s an! Signat"res
S"perinten!ent'2oreman $o0er-tier S"b&ontra&tor S"per#isor
ame Signat"re ame Signat"re
Comments:
Re( - " - 16/17/69