PMT/Contractor JSA Form - 1/12/2008

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JOB SAFETY ANALYSIS WORK SHEET

Pipeline Rehabilitation New D / M / Y Contractor: Br C.A.T International Co Ltd
JSA # 019
Rev. 01 2010 – Khursaniyah Date 1 / Mar / 2018
KRT-3
✘ Revised Contract # 6600029321 / B.I # 10-000913

JSA Function Name Badge# Job Title Mobile Phone #

CAT Site Supv./ Frmn. Joseph thoma 8210507 Site Foreman 0505295501

CAT Project Engineer Majdi Bannoura 8210699 Project Engineer 0555037286

CAT HSE Manager Muhammad Ihtisham 8232295 HSE Manager 0504638022

SAPMT Safety Advisor Carlos M. Cayabyab 8874458 Safety Advisor 0554754784

SAPMT Representative Elvin Roland Delicano 8906936 Site Superintendent 0533693633

Proponent Rep. (OPS) Operation Representative

DESCRIPTION OF TASK: Trench Excavation, Backfilling, Berming & Construction of ROW

Work Location/ (Area then station numbers): KRT-3 Km 75 to 138
Prepared by/ Signature: (Contractor) Reviewed By/ Signature: (SAPMT) Approved By/ Signature: (Client)

Project Engineer ______________ Safety Advisor ____________ Project Engr. ____________

Majdi Bannoura Signature Carlos M. Cayabyab Signature Signature

Project HSE Manager ______________ SAPMT Supt. ____________

Muhammad Ihtisham Signature Signature Operation Rep. ____________
Signature

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Reference GIs & SAES:

Work Permit GI. 2.100, Gas Testing Procedure using 3 in 1 Gas Monitor G.I. 2.709, Traffic and Vehicle Safety G.I. 6.030, Mobile Heavy Equipment Operator Testing and Certification G.I.
7.025, Street and Road Closure; Excavations, Reinstatement and Traffic Controls G.I. 1021.000, Fire Fighting Training Company Personnel G.I. 1783.001, Safety Spectacles G.I. 8.002,
Protective (Safety) Footwear G.I. 8.005, Environmental Conservation Policy Implementation G.I. 2.714.

Safety Equipment:
Required Hard Hat, Safety Glasses, Leather Gloves, Safety Shoes, Firefighting equipment, Hand Tools, Heavy Equipment,

Item
SEQUENCE/ POTENTIAL HAZARDS HAZARD CONTROLS ACTION BY
BASIC STEPS

1. Work Site Preparation. 1. Miss communication / understanding 1.0 Issuer and receiver shall conduct Joint Site Inspection (JSI) prior to any1 Permit Issuer and
work activities. Receiver
1.1 Obtain Work Permit as per G.I. 2.100.
1.2 Toolbox talks to address activities planned for the day, including hazards CAT Supervisor
identified, control measures implemented. and Safety Officer
1.3 Rescue plan to be clearly communicated with the work force.
(SAPMT &
2. Danger to existing A/G & U/G 2.0 Obtain from operation the as built drawing of the work site, to identify Operations to
facilities ALL existing A/G & U/G facilities. Monitor and Verify)
2.1 If necessary, obtain countersign on work permit from the concern
Department / personnel such as POD (Power, Electrical), Communication
(IT) etc.
2.2 Keep Heavy Equipment at least 3 meters away from the existing
facilities.
2.3 Place plastic drums filled with water every 2 meters along A/G pipeline
sections.
2.4 Underground facilities shall be identified by metal detector.
2.5 Warning signboards, barricades, beacon lights must be installed as
precautionary measures

3. Gas release, fire and other 3.0 Gas test shall be conducted prior to and during work activities by Saudi
emergencies Aramco Operation Certified Gas Tester as per G.I. 2.709.
3.1 Provide adequate and inspected portable fire extinguisher & other
firefighting equipment.
3.2 Emergency Response Plan / Procedure shall be followed by ALL affected
Personnel and sub-contractors in case of any emergency.
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3.3 Work location shall have a designated Assembly Area in case of any
emergency.
3.4 Conduct gas test regularly, see to it that there’s no indication / signs of
any toxic gases in the area.
3.5 Safety Orientation must be conducted to personnel prior to assign in the
job site.
3.6 Provide appropriate respiratory protection equipment for any confined
space entry.

4. Personal Injury 4.0 Provide / use complete P.P.E to all personnel.

4.1 Provide necessary tools / equipment.
4.2 Use the right tools for the right job.
4.3 Ensure all tools / equipment are correctly inspected & color coded by a
competent / qualified person.
1. Struck by vehicle / Trailers/ Heavy 1.0 Install barricade & safety warning signboard as per GI 1021 at
Equipment reasonable distance.
1.1 Driver accessories (mirrors are inspected so that drivers can see
CAT Supervisor and
movement all around the vehicle, together with reversing alarms to alert
Safety Officer,
other vehicles and pedestrians to their presence.)
Secure the area against
2. 1.2 Qualified spotter / flagman shall be assigned with reflective safety vest.
traffic. Operation &
1.3 All drivers and pedestrians shall know and understand the routes and
SAPMT
traffic rules on site. Use standard road signs to give direction and speed
(follow-up)
limit where appropriate.
1.4 Traffic Flow plan must be communicated to all Operators, Flagmen,
Spotters and workers at site.
3. Mobilization of 1. Traffic hazards 1.1 Obtain Hot Work Permit as per G.I. 2.100. CAT Supervisor and
Equipment at site a. Injury to personnel 1.2 Install sufficient barricades and warning sign boards at a reasonable Safety Officer,
b. Vehicle mishap distance.
1.3 Assign trained / competent flagman/ spotters to assist and monitor the Operation &
operation of vehicle / heavy equipment and as well as in the surrounding SAPMT
of the personnel. (follow-up)
1.4 Follow standard procedures on Traffic and Vehicle safety as per G.I.
6.030.
1.5 Ensure that periodic maintenance of all heavy equipment vehicles are
applied and must be equipped with audible back-up alarm, beacon light
and supplied with safety gears (such as fire extinguishers, safety belt,
etc…).
1.6 Only certified operators with valid licenses and inspection stickers on
equipment are allowed at the work site.
1.7 Work Permit Receiver and Safety officer must validate the inspection of
all heavy equipment and all of checklist documentation as per SMS.
1.8 Ensure Driver accessories (mirrors are in good condition.) this can help
drivers to see all around. Together with reversing alarms to warn
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pedestrians and other drivers of his presence.

1.9 Try to limit reversing to a minimum by introducing a one way system.
1.10Traffic Flow plan must be communicated to all Operators, Flagmen,
Spotters and workers at site.

2.0 ALL tools or equipment shall be properly inspected, color coded,

maintain in good condition and appropriate for the job.
2. Property damage 2.1 Unnecessary material shall be removed prior to start the activity.
2.2 Equipment should be barricaded to avoid damages.

3.0 Assign trained / competent flagman / spotters equipped with safety vest
and flags to control the traffic flow.
3. Serious injury due to maneuvering 3.1 Only certified operators with valid SAG License and SA-Approved
certificate for the intended heavy equipment to operate are allowed to
work at site.
3.2 Operator / driver must ensure to maintain a proper communication with
the flagman / spotter.

4.0 Install goal post to warn the operators of the hazard of overhead power
line.
4. Striking the existing facilities. 4.1 Install warning signs “caution above power lines” at both sides.
(such as Power lines) 4.2 Keep heavy equipment to maintain required distance away from existing
facilities.
4.3 Keep not less than 3 meter distance from A/G Pipelines.
4.4 Place water barrels at 2 meter intervals along A/G Pipeline sections.

5.0 Assign qualified spotter to assist the operator and monitor the activities.
5.1 Secure the area with barricades.
5. Improper Loading / Offloading of 5.2 Only competent person will allow to perform the task.
Material and Heavy Equipment. 5.3 Traffic Flow plan must be communicated to all Operators, Flagmen,
Spotters and workers at site.
5.4 Assign certified Rigger to rig all loads and materials.

6.0 Ensure correct P.P.E is worn at all times during any manual handling.
6.1 Ensure correct procedures are followed when lifting material, tools etc.
6. Improper Manual Handling
Exposing the existing 1. Danger to U/G facilities 1.0 Obtain Cold Work Permit as per G.I. 2.100.
pipeline & other 1.1 Obtain from operation the as built drawing of the work site, to CAT Supervisor and
4. underground facility Identify all existing U/G facilities. Safety Officer,
using hand tools (Hand 1.2 If necessary, obtain countersign on work permit from the concern
excavation only) for Department / personnel such as POD (Power, Electrical), Communication Operation &
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(IT) etc.
1.3 Underground facilities shall be identified by metal detector.

2. Back injury to personnel 2.0 Only qualified and competent personnel shall perform the work.
2.1 Ensure foreman has introduce the procedure on having a proper job
rotation to perform the activities to avoid overexertion.
SAPMT
sand Removing
(follow-up)
3. Defective tools or equipment 3.0 Ensure all tools and equipment are properly inspected & color coded by
competent / qualified personnel.
3.1 Ensure that ALL defective tools and equipment’s shall be discarded and
remove from site.

4. Weather hazards 4.0 Stop any activities when weather is not suitable to work.
5. Excavation more than 4 1. Miss communication / 1.0 Issuer and receiver shall conduct Joint Site Inspection (JSI) prior to any
feet Understanding work activities. CAT Supervisor and
1.1 Obtain Cold Work and Confined Space Entry Permit as per G.I. 2.100. Safety Officer,

2. Asphyxiation 2.0 Continuous atmospheric test for Oxygen, H2S and other hazardous gases Operation &
in the excavation using 3 in 1 Gas Tester as per G.I. 2.709. SAPMT
2.1 Saudi Aramco Certified Gas Tester shall conduct the gas test. (follow-up)
2.2 Only authorized personnel shall enter the excavation.
2.3 Personnel entering the excavation shall sign the confined space entry log
sheet.
2.4 Designated standby man shall be stationed in the entrance / exit of the
excavation.
2.5 Fire watch shall be in place during any hot work activity.

3. Fall 3.0 Entire excavation shall be properly barricaded and appropriate warning
sign in every side shall be installed.
3.1 Safe means of egress shall be located in excavation and adequate
ladders to be placed were personnel travel no more than 7.5 meters
shall be provided. Access ladder shall be secured & extend 3 feet above
the surface of the excavation.
3.2 Maintain three points of contact and avoid to carry any materials on your
hands while climbing the ladder.

4. Sidewall collapse / Cave-in 4.0 Use shoring, benching or sloping whichever is applicable as per SA
Construction Safety Manual.
4.1 Spoil or excavated materials must be 2 feet away from the edge of the
excavation.
4.2 Keep only the needed personnel.
4.3 Ensure Daily Inspection Checklist shall properly completed and signed by
the competent person at site.
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4.4 Maintain safe distance of heavy equipment from the edge of the
excavation.
1. Miss communication / 1.0 Issuer and receiver shall conduct Joint Site Inspection (JSI) prior to any
Understanding work activities. CAT/ Operation
1.1 Obtain Hot Work and Confined Space Entry Permit as per G.I. 2.100. SAPMT (follow-up)

2. People and property struck by 2.0 Keep away unnecessary personnel in the working area.
Heavy equipment 2.1 Maintain safe distance from the existing pipeline or any A/G or U/G
utilities.
2.2 U/G utilities shall be adequately protected from damage.
2.3 Pedestrian barricades shall be placed no less than 1meter from the edge
of the excavation.
2.4 Heavy Equipment not permitted within 2 meter of an excavation.
2.5 Proper warning signs to be in place.
2.6 Frequent housekeeping inspections to be done by competent person.
2.7 Trained and competent spotter in orange vest shall direct the heavy
equipment operator.

3. Incompetent heavy equipment 3.0 Only Saudi Aramco certified heavy equipment operator shall perform the
Excavation by heavy
6. operator work activity as per G.I. 7.025.
equipment
a. Injury to personnel 3.1 Heavy equipment operator shall have a valid SAG License and Saudi
b. Damage to equipment Aramco Certificate.
and facilities 3.2 Heavy equipment operator shall not leave the heavy equipment running
unattended.
3.3 Heavy equipment shall have a valid inspection sticker.

4. Heavy equipment not in good 4.0 Heavy equipment shall be inspected in a regular basis by a competent
Condition person or mechanic as per the manufacturer’s recommendation.
4.1 Heavy equipment operator shall ensure that any defect found during
inspection shall be reported for immediate repair.
4.2 Heavy equipment operator shall complete the Daily Inspection Checklist
prior to use/operate.

5. Heavy equipment falling 5.0. Heavy equipment operator shall maintain safe distance from edge of the
excavation to prevent from falling.
5.1. Trained and competent spotter in orange vest shall direct the heavy
equipment operator.
7. Partial backfilling with 1. Weather condition 1.0 Conduct joint site inspection by PTW Issuer & Receiver. CAT Supervisor and
sweet sand for the 1.1 No activities will allow during adverse weather condition. Safety Officer,
existing pipe, Backfill to 1.2 Secure hot work permit & a confined space entry permit if trench is 4 Operation &
the level of ground & feet or deeper. SAPMT
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2. Traffic hazards 2.0 Certified / competent operator must be used as per GI-7.025.
2.1 Assigned trained/competent flagmen/spotter to assist and monitor the
operation of heavy equipment and dump trucks.
2.2 Only operators with valid SAG license and SA-Approved Certificate for
the heavy equipment intended to operate are allowed to work at site.
2.3 Ensure that periodic maintenance of all heavy equipment vehicles are
applied and must be equipped with audible back-up alarm and supplied
with safety gears (such as fire extinguishers, safety belt, etc…).
Berming. (follow-up)
2.4 Operator / driver must ensure to maintain a proper communication with
the flagman / spotter.
2.5 Traffic Flow plan must be communicated to all Operators, Flagmen,
Spotters and workers at site.

3. Eye injury 3.0 Proper use of PPE on site.

4. Excessive dust emission 4.0 Effective dust control measures (e.g. wetting of top soil by water spray)
to be implemented.
8. Heavy Equipment 1. People struck by equipment 1.0 Assign trained flagman/ spotters to assist and monitor the operation of CAT Supervisor and
Operation vehicle / heavy equipment and as well as in the surrounding of workers. Safety Officer,
1.1 All workers must wear appropriate Personal Protective Equipment. Operation &
SAPMT
a. Loading and un- 1.2 Heavy Equipment must be equipped with backup alarm.
(follow-up)
loading of filling 1.1 Flagman /spotter shall be equipped with safety vest & proper flags
materials (Sand during operation.
etc. 1.3 Only SA certified operators with valid licenses and inspection stickers on
b. Grading / the heavy equipment are allowed to work at site as per G.I. 7.025.
leveling 1.4 Sleeping or resting under any heavy equipment is strictly prohibited.
c. Ground 1.5 Heavy equipment shall not be left running unattended.
compacting 1.6 Other personnel are not allowed to ride in heavy equipment.

2. Equipment failure. 2.1 Daily inspection/check by operator will be observed.

2.2 Preventive maintenance by mechanic will be observed.
2.3 Ensure that periodic maintenance of all heavy equipment vehicles are
applied and recorded.
2.4 Heavy equipment must be equipped with / supplied with safety gears
(such as fire extinguishers, safety belt, audible back-up alarm, horn,
head/signal/beacon lights, tires, NO oil/crude leak, NO damage mirrors
etc…).
2.5 Safety Officer and Work Permit Receiver must validate the inspection of
all heavy equipment and applicable checklist documentation as per SMS.

3.1 Only operators with valid SAG license and SA-Approved Certificate for the
3. Accidentally hit the existing facilities
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(such as buried facilities, power heavy equipment intended to operate are allowed to work at site as per
lines) G.I. 7.025.
3.2 Install barricade & safety warning signboard at reasonable distance.
3.3 Ensure all U/G utilities have been traced and exposed.
3.4 Install warning / caution signs, goal posts on overhead power lines /
cables in both sides of the road with sufficient distance away from the
facilities.
1. Uncontrollable release of 1.1 Obtain Hot Work Permit as per G.I. 2.100.
contaminated water to the 1.2 Ensure the depressurization is done at a safe and slow rate.
environment. 1.3 Do not depressurize by loosening flanges; use the depressurizing valves
and piping.
1.4 Precautions shall be taken to ensure containment of ALL substances. No
liquids to be disposed of utilizing any nearby units of drainage system.
1.5 Identify all requirements for disposal (consent for discharge, return to CAT Supervisor and
Safety Officer,
De-watering / release of shore, etc.) and liaise with the operation personnel.
9. Operation &
contaminated water 1.6 Safe systems of work shall be implemented for de-watering operations SAPMT
and personnel shall be advised of the system prior to work (follow-up)
commencement.
1.7 Personnel shall ensure that there are no conflicting activities ongoing
during the de-watering stage which can have a direct impact on the
actual operation.
1.8 De-watering areas shall be barricaded off & warning signs shall be
erected to warn and prevent access of other personnel.
1. Environmental Hazards 1.0 Obtain Hot Work Permit as per G.I. 2.100.
a. Oil spill from equipment 1.1 Remove all installed barricades and signboards.
b. Contaminated waste 1.2 Remove all tools, equipment and other materials that are not needed.
1.3 Clean / remove all debris.
1.4 Provide dip tray to contain the oil spill from heavy equipment.
1.5 Ensure that the work site is returned to its original good condition.
1.6 Contaminated waste to be disposed of at Saudi Aramco approved CAT Supervisor and
10. Housekeeping.
facilities. Safety Officer
2. Injury due to sharp or heavy edges 2.0 Provide complete and appropriate PPE to all personnel.
2.1 First aid kit shall be provided and ensure that the log is properly
maintained at site.

3. Slip, trips and falls 3.0 Keep all material in proper place.
3.1 Ensure work place is clear from any obstruction.

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# Recommendations/Notes Assigned to Mobile Phone #

All site personnel to wear the required minimum PPE’s such as safety helmet, safety glasses, FRC, gloves, and
1 CAT/ Operation & SAPMT
safety shoes at site.

2 Conduct Tool Box Safety Meeting prior to start the work activity. CAT/ Operation & SAPMT

3 Explain to key personnel the purpose of the JSA and enforce the implementation of content. CAT Project Engineer

4 Use the JSA to identify hazards and list the precautions on the work permit. CAT Safety Supervisor

5 Garbage’s shall be disposed properly on a daily basis. CAT Safety Sup. & Frmn.

If an injury or near miss occurs, the JSA shall be reviewed immediately to determine whether changes are CAT HSE Manager / Safety
6
needed in the job procedures. Supervisor

Identify safe location for emergency assembly area, rest shelter, vehicle and heavy equipment parking areas CAT Safety Supervisor / Safety
7
at site, Toilet and Watch Facility. Officer

CAT Safety Supervisor / First

8 First Aid kit shall properly monitor by the competent first aider at site.
Aider

L6.09 Safety Officers Report and Tool-Box Attendance Sheet and L6.10 Job Safety Log Forms must be used at CAT Safety Supervisor / Safety
9
site. Officer

CAT Safety Supervisor / Safety

10 Emergency Contact personnel must be posted at site.
Officer

CAT Safety Supervisor / Safety

11 Work activities must be stopped due to adverse weather condition.
Officer

CAT Safety Supervisor / Safety

12 STOP Work Authority signages must be installed in all locations.
Officer

Emergency Response Procedure Office/Name Designation Emergency Contact

Number

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1. Dial 911 from the nearest telephone or from your mobile       (03-673-0911). Saudi Aramco
2. When reporting an emergency speak slowly, calmly, distinctly, in a  clear voice and give N/A 911
Telephone
information in the following sequence:
3. States there is an emergency or disaster at your location and specify your location. Northern Area (RT) 013-673-0911
4. Tell Your Name_____ and your Badge # ______. Aramco Emergency Tanajib 013 378 0911
5. Tell about emergency or disaster like you see a fire, car accident, major injury, etc. at Khursaniyah 013 679 0911
the following location: _________. Jacques Karim Contractor Site Supervisor 0553694074
6. Inform that there are _______ (number of) people requiring medical assistance /
attention. Joseph thoma Contractor Site Foreman 0505576453
7. Repeat the above Information and answer questions.  Khurram Shahzad Contractor Site Safety Supervisor 0583856618
8. Do not hang up until the dispatcher repeats the above or asks for more information.
Angelo Camas Contractor Work Permit Receiver 0553938481
M. Imran Contractor Site Safety Officer 0593823060

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