Job Safety Analysis Worksheet

Contractor: Connelly & Associates, INC. Date: 6/20/13 JOB Number:

Yes
No
Team Name: Job Name:

Team Leader: JSA team members: Name Initials Name Initials

Description of work: Concrete Coring

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Activity Hazards Risk control measures Who is responsible?
List the tasks required to perform the activity in the Against each task list the hazards that could cause injury when the task is List the control measures required to eliminate or minimize the risk of injury arising from Write the name of the person responsible (supervisor or
sequence they are carried out. performed. the identified hazard. above) to implement the control measure identified.

1.MOBILIZATION TO SITE DRIVING ACCIDENTS ALL VEHICLES TO COMPLY WITH CONNELLY DRILLER / CONSULTANT
DRIVING SAFETY STANDARDS

VEHICLE TO BE FIT FOR PURPOSE AND WELL DRILLER / CONSULTANT

MAINTAINED.

LOADS TO BE SECURE AND NOT TO EXCEED DRILLER / CONSULTANT

VEHICLE SPECIFICATIONS OR LEGAL LIMTS.

DRIVER TO BE LICENCED, TRAINED AND MEDICALLY DRILLER / CONSULTANT

FIT

DRIVER TO BE RESTED AND ALERT DRILLER / CONSULTANT

MOBILE PHONE OR TWO-WAY RADIO TURNED OFF DRILLER / CONSULTANT

WHILE DRIVING

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 PLAN YOUR ROUTE AHEAD OF TIME - reference RM DRILLER / CONSULTANT
Journey Assessment

DRIVER NOT BE UNDER THE INFLUENCE OF DRILLER / CONSULTANT

ALCOHOL, DRUGS OR MEDICATION THAT IMPAIRS
ABILITY TO DRIVE VEHICLE.

2.SET UP WORK SITE AUTO / PUBLIC TRAFFIC NOTIFY ATTENDANT OR SITE MANAGER / OWNER
OF WORK ACTIVITIES AND LOCATION.

WORK LOCATION TO BE BARRICADED OFF; VEHICLE DRILLER / CONSULTANT

AND PEDISTRIAN TRAFFIC MANAGEMENT PLAN AS
REQUIRED

3.SET UP WORK SITE (Cont’d) AUTO / PUBLIC TRAFFIC (Cont’d) HIGH VISIBLE CLOTHING, STEEL CAP BOOTS, LONG DRILLER / CONSULTANT
SLEEVES/PANTS/ HARD HAT / SAFETY GLASSES TO
BE WORN AT ALL TIMES WHILE IN OPERATIONAL
AREAS

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 INSPECT AREA AROUND VEHICLE PRIOR TO DRILLER / CONSULTANT
PUTTING VEHICLE IN MOTION AND USE SPOTTER

UNEVEN OR UNSTABLE GROUND VISUALLY EXAMINE SITE PRIOR TO ENTRY. DRILLER

PLACE TIMBERS UNDER OUTRIGGERS TO SPREAD
LOAD.

UNEVEN OR UNSTABLE GROUND VISUALLY EXAMINE SITE PRIOR TO ENTRY. DRILLER

PLACE TIMBERS UNDER OUTRIGGERS TO SPREAD
LOAD.

ELECTRICAL SPOTTER TO BE EMPLOYED WHEN CONSULTANT

WORKING WITHIN 3 – 6.4 M (10 TO 20 FEET) OF OHE
LINES; POWER COMPANY PERMIT ALSO REQUIRED

UNDERGROUND SERVICES UNDERGROUND SERVICES TO BE LOCATED PRIOR CONSULTANT / SERVICE LOCATOR /

TO BREAKING GROUND BY QUALIFIED SERVICE DRILLER
LOCATOR

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4.CONCRETE CORING IGNITION SOURCES / FIRE & EXPLOSION ENSURE ELECTRICAL EQUIPMENT PROPERLY CONTRACTOR / DRILLER /
GROUNDED AND FITTED WITH EARTH LEAKAGE CONSULTANT
DEVICE. USE NON-ELECTRICAL CORING
EQUIPMENT WHERE POSSIBLE

APPLY WATER AS NECESSARY TO ADDRESS CONTRACTOR / DRILLER /

SURFACE SPARKING POTENTIAL CONSULTANT

AREA TO BE DEEMED FREE OF EXPOLSIVE CONSULTANT / DRILLER

CONDITIONS PRIOR TO WORK

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 ENSURE AREA IS WETTED AT ALL TIMES, CONSULTANT / DRILLER
INCLUDING BIT

HEARING DAMAGE DUE TO HIGH NOISE WEAR APPROPRIATE HEARING PROTECTION (EAR CONTRACTOR / DRILLER /
LEVELS MUFFS OR EAR PLUGS) CONSULTANT

INSPECT ALL HAND TOOLS PRIOR TO USE. IF DRILLER

FAULTY OR INAPPROPRIATE, DO NOT USE UNTIL
REPAIRED OR REPLACED

MOVING / ROTATING EQUIPMENT ALL APPROPRIATE GUARDING TO BE INPLACE DRILLER

PRIOR TO USE

SET-UP ADEQUATE EXCLUSION ZONE – ONLY DRILLER

TRAINED, INDUCTED AND AUTHORIZED PERSONNEL
WITHIN THIS AREA

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 MOVING / ROTATING EQUIPMENT (Cont’d) STAY CLEAR OF ROTATING AUGER / EQUIPMENT – DRILLER
NO HANDS, FEET OR ANY BODY PART TO BE NEAR
ROTATING EQUIPMENT. ROTATION TO STOP FOR
SAMPLING ETC.

USE LONG HANDLED SHOVELS TO CLEAR AWAY DRILLER

CUTTINGS WHEN AUGER HAS STOPPED

WEAR APPROPRIATE PPE INCLUDING LEATHER DRILLER

GLOVES, STEEL CAPPED BOOTS, HARD HAT, AND
SAFETY GLASSES. FULL LENGTH OVERALLS OR
LONG SLEEVE SHIRT AND LONG PANTS - NO LOOSE
CLOTHING, FIRE RETARDENT CLOTHING (FRC)
WHEN APPROPRIATE.

HEARING DAMAGE FROM HIGH NOISE USE HEARING PROTECTION (EAR MUFFS OR EAR DRILLER
LEVELS PLUGS) IF NOISE > 85 dB

VAPOURS AND AIRBORNE PARTCULATES MONITOR AIR CONCENTRATIONS USING PHOTO- CONSULTANT
IONIZATION DETECTOR, LEL METER etc

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 STOP WORK IF HAZARDOUS CONDITIONS DRILLER / CONSULTANT
IDENTIFIED (EXPLOSIVE ATMOSHPERE, O2
DEFICIENT OR ENRICHED ATMOSPHERE) –
REASSESS AND TAKE THE NECESSARY
PRECAUTIONS.

WEAR APPROPRIATE PPE INCLUDING FACE DRILLER / CONSULTANT

SHIELD / SAFETY GLASSES, DUST MASKS OR
RESPIRATORS, LONG SLEEVE SHIRTS AND PANTS,
FRC WHEN APPROPRIATE.

SLIP, TRIP & FALL KEEP WORK AREA TIDY AND CLEAN – INCLUING DRILLER / CONSULATANT
THE REMOVAL OF EXCESS CUTTINGS.

SLIP, TRIP & FALL (Cont’d) STAY AWARE OF FOOTING AND DO NOT RUN DRILLER / CONSULATANT

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 HEAT / COLD STRESS TAKE REGULAR BREAKS ON HOT DAYS OR IF DRILLER / CONSULATANT
FEELING FAINT OR OVEREXERTED

CONSUME ADEQUATE FOOD / BEVERAGES DRILLER / CONSULATANT

(WATER / SPORTS DRINK)

IF POSSIBLE, ADJUST WORK SCHEDULE TO AVOID DRILLER / CONSULATANT

TEMPERATURE EXTREMES

BIOLOGICAL HAZARDS: INSECTS, SNAKES, CAREFULLY INSPECT WORK AREA DURING SITE DRILLER / CONSULATANT
WILDLIFE, VEGETATION INSPECTION TO IDENTIFY HAZARDS

USE INSECT REPELLANT DRILLER / CONSULATANT

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 OPEN ENCLOSURES SLOWLY DRILLER / CONSULATANT

SURVEY SITE FOR PRESENCE OF BIOLOGICAL DRILLER / CONSULATANT

HAZARDS AND MAINTAIN SAFE DISTANCE

WEAR APPROPRIATE PPE INCLUDING LEATHER DRILLER / CONSULATANT

GLOVES, LONG SLEEVES AND PANTS AND SNAKE
CHAPS AS REQUIRED

UNDERGROUND SERVICES PROFESSIONAL CABLE LOCATOR TO LOCATE AND CONSULTANT

IDENTIFY ALL SERVICES IN POTENTIAL DRILLING
AREA.

WORKING AT HEIGHTS NO WORK TO BE CONDUCTED ON RIG AT HEIGHTS DRILLER / CONSULTANT

GREATER THAN 2M (6 FEET) WITHOUT FALL
RESTRAINT / ARREST SAFETY EQUIPMENT.

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 UV EXPOSURE WEAR CORRECT PPE (NECK TO TOE CLOTHING & DRILLER & DRILLER’S OFFSIDER
SUNBLOCK)

WIND BLOWN DUST MINIMIZE DUST FROM DRILLING BY USE OF COVERS DRILLER / CONSULTANT
/ SHIELDS OR WATER WHEN POSSIBLE. WEAR
PROTECTIVE GLASSES OR GOGGLES AS
REQUIRED.

LEAKAGE OF FUEL OIL AND HYDRAULIC HAVE READY ACCESS TO SPILL ABSORBENT DRILLER / CONSULTANT
FLUID MATERIALS TO SOAK UP ANY SPILLED
HYDRCARBONS

LIFTING HEAVY EQUIPMENT DO NOT LIFT OR MOVE HEAVY EQUIPMENT DRILLER

WITHOUT ASSISTANCE

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 USE PROPER BENDING / LIFTING TECHNIQUES BY DRILLER / OFF-SIDER
LIFTING WITH ARMS AND LEGS AND NOT WITH
BACK. KEEP BACK STRAIGHT WHILE LIFTING

TAKE BREAKS IF FEELING FAINT OR OVER EXERTED DRILLER / OFF-SIDER

ALL WORK TO CEASE WHEN FUEL DELIVERING DRILLER / CONSULTANT

TANKER IS ON SITE. WORK CAN ONLY COMMENCE
15 MINUTES AFTER TANKER HAS LEFT SITE AND
SITE IS AGAIN FREE OF EXPOLSIVE CONDITIONS

MUSCLE STRAIN INJURY USE CORRECT MANUAL LIFTING METHODS. DRILLER’S OFFSIDER
WEAR CORRECT PPE.

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 ENTANGLEMENT WITH ROTATING DRILLING STAND CLEAR OF ROTATING EQUIPMENT. DRILLER / CONSULTANT
RODS AND ASSOCIATED EQUIPMENT NO LOOSE CLOTHING TO BE WORN.
DRILLER TO MANAGE SAMPLING.

HANDLING CONTAMINATED MATERIALS / WEAR APPROPRIATE PPE INCLUDING NITRILE DRILLER / CONSULTANT
SOILS / GROUNDWATER GLOVES, SAFETY GLASSES AND NECK TO TOE
CLOTHING.

VAPOURS (Cont’d) WORK UPWIND OF SAMPLING AREA IF POSSIBLE DRILLER / CONSULTANT

5.ANY CHEMICAL USE INJURY OR ADVERSE EFFECTS FROM ALL CHEMICALS TO BE PROPERLY STORED & DRILLER / CONSULTANT
CHEMICAL EXPOSURE LABELLED

CURRENT MSDS TO BE AVAILABLE FOR EACH DRILLER / CONSULTANT

CHEMICAL ON-SITE

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 EMPLOYEES TRAINED ON CHEMICAL HANDLING DRILLER / CONSULTANT

APPROPRIATE PPE FOR HANDLING CHEMICALS DRILLER / CONSULTANT

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