Doc. No.

: JSA006
JOB SAFETY ANALYSIS FOR Date: April 15, 2013
AIR LEAK TEST Revision: Rev_00

Client: Work Supervisor:

Project: Date: Weather:
Task/Activity: Work Procedure: QTP-125
Location: Other Critical Procedures:
1. Risks Assessment Matrix

1. Determine Likelihood – What is the possibility that the effect will occur? 2. Determine Consequence What will be the expected effect?
Criteria Description Consequence
Description
/Impact level
Expected to occur in most
Certain Effect is a common result – No effect – or so minor that effect is acceptable
circumstances. Insignificant
Will probably occur in Effect is known to have occurred at this site Low financial loss
Likely First aid treatment only; spillage contained at site.
most circumstances. or it has happened Minor
Effect could occur at the site or I’ve heard of Medium financial loss
Possible should occur at some time Medical treatment; spillage contained but with outside
it happening Moderate
Effect is not likely to occur at the site or I help. High financial loss.
Likely Could occur at some time
have not heard of it happening Major Extensive injuries; loss of production; Major financial loss
May occur only in
Rare Effect is practically impossible. Critical Death; toxic release of chemicals; Huge financial loss
exceptional circumstances
3. Determine the Risk Score 4. Record Risk Score on Worksheet
Note – Risk scores have no absolute value and should only be used for comparison
Consequence and discussion.
Insignificant Minor Moderate Major Critical
16 – 11 –
Rare 25 – Low 23 – Low 20 – Low Score Action
Moderate Moderate
17 – 12 – Do not commence work. Report to your Supervisor
Unlikely 24 – Low 21 – Low 7 – High Extreme
Likelihood

Moderate Moderate /Manager.

18 – 13 – Do not commence work until additional identified controls,
Possible 22 – Low 8 – High 4 – High High
Moderate Moderate which will lower the risk to moderate or low are put in place
19 – 14 – 2– Establish the work specific risk controls before commencing
Likely 9 – High 5 – High Moderate
Moderate Moderate Extreme task/s
15 – 3– 1–
Certain 10 – High 6 – High Low Risk considered acceptable with continuous monitoring.
Moderate Extreme Extreme

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 Doc. No.: JSA006
JOB SAFETY ANALYSIS FOR Date: April 15, 2013
AIR LEAK TEST Revision: Rev_00

2. Hazard & Risks Management

Task Breakdown Risk Risk to be Risk
Possible Safety or Asses’t Elim’d by Asses’t Responsible
Control measure or procedure to be put into place to control risk
Environmental Risk(s) BEFORE Hierarchy AFTER Employee
N0. Description/Hazard
Controls Of Control Controls

Hierarchy of Control Risk Elimination Legend: A – Elimination, B – Substitute, C – Isolation, D – Mechanical, E – PPE
(Elimination being MOST EFFECTIVE control measure to PPE being the LEAST effective control measure)

1 Site induction  Not understanding 13 C  All site ARL employees and visitors will do ARL and Client 20
 Meeting regarding client site safety induction prior to the commencement of work on all sites.
safety and job Manager and
requirements i.e.  Regular toolbox meetings are also required to discuss:
procedures Supervisor, All
Response to issues and review SWMS and procedures for amending as
employees
incident /injury / necessary for improvement
material spills etc.  Site OHSE issues
2 Site Access  Personal injury 13 C  Always walk on dedicated walk ways and traffic no-go 17
due to moving zones
vehicle:  Wear high visibility vest 17
 Crush injuries  Signal drivers before proceeding around mobile equipment
 Walk around tank 13  Notify findings to supervisor of leaks. Take care when 17
for any Potential walking in water or wet areas/ carry out SPSA. All employees
Hazards before  Ensure all workers associated with this work fully
testing roof and understand the requirements of the JSA before
check tank dia. commencing any hammer testing.
and plan for 1 or 2
watchers as
required
3 Manual Handling  Lifting heavy 5 A,D  Make into smaller and lighter loads 16
loads/objects  Lift loads that are within employees lifting capabilities. 12
 Handing personnel 8 B,D,E  Follow Manual Handling procedure by using mechanical 8 All employees
equipment/tool devices or team lifting principles
bags from vehicle  Wear safety glasses, gloves and steel capped boots 8
to job location

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 Doc. No.: JSA006
JOB SAFETY ANALYSIS FOR Date: April 15, 2013
AIR LEAK TEST Revision: Rev_00

Task Breakdown Risk Risk to be Risk

Possible Safety or Asses’t Elim’d by Asses’t Responsible
Control measure or procedure to be put into place to control risk
Environmental Risk(s) BEFORE Hierarchy AFTER Employee
N0. Description/Hazard
Controls Of Control Controls

Hierarchy of Control Risk Elimination Legend: A – Elimination, B – Substitute, C – Isolation, D – Mechanical, E – PPE
(Elimination being MOST EFFECTIVE control measure to PPE being the LEAST effective control measure)

4 Confined Space  Possible Gases 4 A Gas Test is required prior to entry. 11

 Loneliness 11 D ARL staff authorized to enter the confined space those are 22
permitted to work in confined space after training.
 Testing should not be carried out without the hole watcher 22
who should have two way radio communications with
All employees
emergency services in place.
 A proper ventilation of fume to be observed. If no
ventilation or ventilation system is present, operator must
still use a mask or respirator as required and take rest
brakes at intervals ensuring there is no risk to health.
5 Testing Procedure  Check Vacuum box & 13 A  Replace any damaged hose with the new one. 21
air hose
 Crack hose, 8 A,E  Use proper PPE including safety goggles. 21
high pressure air Inspector /
impinge on eyes Technician
 Soap water on floor
& welds
 Slip/trip/fall 8 A,C  Walk carefully, use slip resistance safety boots. 16
6 Slips/Trips/Falls  Personal injury 8 A,C,E  Ensure Work Zones are free from obstacles 12
 Death  IF obstacles cannot be removed provide barricades and 12
 Broken Bones signage 12
All employees
 Cuts and  Report slip and trip hazards immediately to ARL site supervisor
Abrasions who will report inadequate lighting to client for rectification.

Page 3 of 5
 Doc. No.: JSA006
JOB SAFETY ANALYSIS FOR Date: April 15, 2013
AIR LEAK TEST Revision: Rev_00

Task Breakdown Risk Risk to be Risk

Possible Safety or Asses’t Elim’d by Asses’t Responsible
Control measure or procedure to be put into place to control risk
Environmental Risk(s) BEFORE Hierarchy AFTER Employee
N0. Description/Hazard
Controls Of Control Controls

Hierarchy of Control Risk Elimination Legend: A – Elimination, B – Substitute, C – Isolation, D – Mechanical, E – PPE
(Elimination being MOST EFFECTIVE control measure to PPE being the LEAST effective control measure)

7 Environmental  Incorrect disposal 5 A,C  Use provided waste disposal bin(s) if provided by client 16
Waste of waste product,  Dispose of at an accredited waste facility and file waste 12
 Solid and liquid equipment and disposal receipt in appropriate file.
All employees
 Contamination of 3  Report environmental incident immediately to ARL site 12
landfill or supervisor who will communicate to the client for rectification
waterway and reporting to EPA.
8 Incident Reporting  Non reporting of 5 A  Training should include: 8
Incident or injury  Incident reporting procedure
 Injury/incident  Regular toolbox meetings to discuss injury and incident
All employees
becomes worse reporting procedures
 Incident not  Report injury/incident immediately to ARL site supervisor who 16
managed effectively will communicate to client – if required.
9 Site Paperwork  Non completion of 5 A  Know contract requirements 8
 Site Check Sheets paperwork  Site filing system in place and understood by site employees 12
 Correspondence Management
 No drawings  Required site records in place before commencing on site 12
 Drawings
 No check sheets  Appropriate employees for task 8
10 Other Possible
Risk/Hazards
11 Required PPE Hard Hat, Safety
Shoes, Safety
Glasses, Long
Sleeve Shirts &
Long Pants

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 Doc. No.: JSA006
JOB SAFETY ANALYSIS FOR Date: April 15, 2013
AIR LEAK TEST Revision: Rev_00

JSA Prepared By: Position: Date:

JSA Approved By: Position: Date:
Name of Workers: Signature: Date:

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