Form No:

JOB SAFETY ANALYSIS DOC. No. Rev

Project Project Facilities JSA Reference No.
Approved Method Statement
Contractor Contractor who performing the Job Reference:
Sub-Contractor Work location
Geotechnical Survey Work (Cutting of Asphalt, Hand
Description of Excavation, Drilling of Boreholes, Thermal resistivity Area Classification GREEN FIELD BROWN FIELD
Activity /JSA Title & Electrical Resistivity Tests)

S.No JSA Participants’ Name: Position Signature Contractor’s Review & Approval
1 Reviewed By

2 Name:
3 Contractor HSE Manager
4 Approved By

5 Name:
6 Contractor Project Manager:
Note: Contractor’s JSA participants team shall comprise of discipline engineers, supervisors and safety personnel
Hazards, Risks &Control Measures provided in this JSA shall be communicated to all personnel involved in this job execution, and shall sign the communication sheet - (responsibility supervisor /foreman)
PCD PMT Review PCD Safety Review Area Authority Approval Verified & Issued By:

Name: Name: Name: Name:

Position: Position: Safety Engineer Position: PCD Project Manager
Date: Date: Date: Date:

CHECK (✓ ) REQUIRED PPE, SAFETY EQUIPMENT AND CONTROLS REQUIRED

Hard Hats  Welding gauntlets  Respirator  Signs  Life Jacket/Work Vest  Permit to Work 
Safety Glass /Goggles  Face Shield  Air Supplied Hood  Barricades  Life Rings  Gas Test 
Safety Shoes/Boots  Hearing Protection  SCBA  Fire Extinguishers  Other PPE (Specify)  CSE 
Safety gloves  Full Body Harness  Rescue Equipment  Spill Control   Isolation / LOTO 
Other Gloves (Leather/PVC)  Self Retracting Lifeline (SRL)     Excav. /Road. Closure. 

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1 Site Preparation i. Accident with vehicles 4 1 2 1 3 12 i. Observe speed limits inside 3 2 6 RGF
(People and Equipment). and pedestrians worksite
ii. Wear seat belts
iii. Mobile phones are not
allowed at all
iv. All vehicles should be
regularly inspected
v. All vehicles/equipment
shall be fitted with Spark
Arrestors
vi. Area shall be barricaded
while the boring operation
is on-going and a
Banksman shall be posted
as required
2 Secure the required work i. No special hazard. 3 1 3 9 i. Joint site inspection of issuer 4 1 4 RGF
permit for drilling, and and receiver.
testing. ii. Conduct gas testing.
iii. Provide proper access to
avoid short cut.
iv. Obtain excavation and road
closure permit prior to
excavation. De-tour signs
and flash lights shall be
installed in road closure
areas.
v. Prior to Asphalt cutting, a
written permission shall be
taken from the area authority
/ proponent.

3 Mark location of test points i. Absorption, inhalation, 1 1 3 3 i. Use PPE: Safety Mask 1 1 1 RGF
with spray paint. ingestion resulting in ii. Adhere to health and safety
injury procedures
iii. Avoidance of direct contact
w / chemical or substances

LEGEND: (P) - People ;(E) – Environment ;(A) – Asset ;(R) - Reputation;(S) – Severity of Consequence ;(L) – Likelihood of Occurrence
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iv. Survey the area with

Calibrated cable detectors,
test pits, as-built drawings
etc. to identify the buried
facilities
4 Vehicle entry to unload i. Fire hazard. 5 1 2 3 15 i. Provide portable fire 1 1 1 RGF
materials. extinguisher.
ii. 5All Vehicles should

have Valid Aramco

inspection sticker and daily
inspection to be done.
iii. Provide certified Fire
Watchman
ii. A collision accident. 5 2 3 15 i. Provide Flag Man. 2 3 6 RGF
ii. Route of vehicles should be
well defined by operations.
iii. Slips, trips and falls 2 3 6 i. Use appropriate PPE: Gloves, 2 2 4 RGF
(personnel injury) safety shoes & safety glasses
and face shield.
ii. Securing all loose items while
loading/unloading
iii. Ensure tidiness of equipment,
buckets and debris etc.
iv. Injury to the back during 4 3 12 i. Use proper lift technique. 3 2 6 RGF
loading/unloading ii. Team Lifting
material (manual iii. Use appropriate PPE:
handling). Gloves, steel toe shoes &
safety glasses
5 Asphalt cutting, Breaking of i. Injury to hand, feet, eye 4 3 12 i. Use appropriate PPE: Helmet, 3 2 6 RGF
Asphalt & face Gloves, safety shoes & safety
in to small pieces and glasses and face shield.
Removal of asphalt debris ii. First aid kit and first aider
from site.
shall be available at site

ii. Loss of hearing capacity. 4 3 12 i. Use hearing protection/ear 1 3 3 RGF

plug or ear muff

LEGEND: (P) - People ;(E) – Environment ;(A) – Asset ;(R) - Reputation;(S) – Severity of Consequence ;(L) – Likelihood of Occurrence
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iii. Body injury due to hose 4 3 12 i. Keep unnecessary personal 2 2 4 RGF

rupture/cutting blade. away from the cutter
machine, in front and sides.
ii. Insure asphalt cutter blade is
securely guarded.
iii. Barricade the area.
iv. Use inspected hoses.

iv. Fire hazard. 5 1 2 1 3 15 i. Properly connected houses, 4 1 4 RGF

tightened, and safety wire
between connections.
ii. Provide portable fire
extinguisher.
iii. Keep all combustible
material out of the area.
iv. Inspected machine to be used.
v. Provide certified Fire
Watchman
v. Heat Stress 2 4 8 i. Ample cold water storage 1 1 1 RGF
should be available.
ii. Schedule the work for the
cooler times of the day.
Established work/rest
rotation for the workers
exposed to heat stress.

6 Hand excavation using hand i. Digger tool- injury 3 3 9 i. Use appropriate PPE: Helmet, 1 1 1 RGF
tools up to 1.20 m below to hand, eye, back Gloves, safety shoes & safety
ground surface. & feet. glasses and face shield.

LEGEND: (P) - People ;(E) – Environment ;(A) – Asset ;(R) - Reputation;(S) – Severity of Consequence ;(L) – Likelihood of Occurrence
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ii. First aid kit and first aider

will be available at site
ii. Respiratory 2 3 6 i. Use Safety Mask. 1 1 1 RGF
problems due to
airborne particle.
iii. Damage to underground 5 1 2 1 3 15 i. Provide underground utility 4 1 4 RGF
utility resulting in injury plan and be careful during
and loss of service. excavation.
ii. Work to be stopped
immediately if WPR /
workers notice any abnormal
condition.
iii. Using calibrated cable / metal
detectors & follow
excavation form.
iv. Discussion with site
representatives prior to
drilling.
v. Provide standby man.
vi. Provide portable fire
extinguisher.
iv. H2S Hazards 5 3 15 i. Conduct Gas test continuously 2 2 4 RGF
ii. Provide H2S monitor to
employees during work.
7 Vehicle entry and positioned i. Vehicle tip over. 5 2 3 15 i. Use base jack for stability. 1 1 1 RGF
on place, ii. Use leakage free jacks
Drilling & sampling. iii. Only authorized persons
should be allowed in the
area.
ii. Hand injury due to 3 3 9 i. Use anti slip hand gloves. 2 2 4 RGF
movement and installation ii. First aid kit and first aider
of cone/rod tip. will be available at site
iii. Fire hazard due to use of 5 1 2 1 3 15 i. Proper grounding for vehicle 2 2 4 RGF
rotating motor and machine.

LEGEND: (P) - People ;(E) – Environment ;(A) – Asset ;(R) - Reputation;(S) – Severity of Consequence ;(L) – Likelihood of Occurrence
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ii. Portable Fire Extinguisher.

iii. Provide certified Fire
Watchman
iv. Damage to equipment, 3 2 3 9 i. Insure the competent person 2 2 4 RGF
injury to personnel operates the machine
ii. Vehicle should have third
party inspection
v. H2S Hazards 5 2 2 10 i. Conduct Gas test 3 1 3 RGF
continuously.
ii. Provide H2S monitor to
employees during work.
vi. Injury to the back during 3 2 6 i. Use proper lift technique. 1 1 1 RGF
rods lifting and installation. ii. Team Lifting
iii. Use appropriate PPE:
Gloves, steel toe shoes &
safety glasses
8 Perform seismic refraction i. Fire due to battery 5 1 2 1 3 15 i. Use standard cables and 2 2 1 RGF
& electrical resistivity tests. connection connections.
ii. Ensure the battery
connections are tight.
iii. Connecting ground wire
(earthing).
Provide certified Fire Watchman
9 Backfilling of drilled holes i. Personnel injury during 2 3 6 i. Work crew shall wear proper 2 2 4 RGF
handling of cement PPE, trained and experienced
to perform the task
ii. Fresh water shall be provided
and available for washing
purposes after handling
cement mixture
iii. First aid kit and first aider
will be available at site
10 Restoration of asphalt / i. Hand injury due to shovel 2 3 6 i. Use appropriate PPE: gloves, 1 1 1 RGF
concrete tool. steel toe shoes and safety
glasses.

LEGEND: (P) - People ;(E) – Environment ;(A) – Asset ;(R) - Reputation;(S) – Severity of Consequence ;(L) – Likelihood of Occurrence
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ii. Respiratory 2 3 6 i. Use safety mask. 1 1 1 RGF

problems due to
airborne cement
particle.
iii. Fire due to using of 5 1 3 15 i. Provide standby man. 2 3 6 RGF
compactor ii. Provide portable fire
extinguisher.
11 Personnel Protection Fire resistant Coverall 3 4 12 i. All personnel have to wear 1 1 1 RGF
Equipment (PPE) fire resistant coverall inside
the plant prior to proceed in
any activities
ii. All personnel to wear all PPE
like Helmet, Gloves, glasses,
ear plugs, heat stroke /
exhaustion
12 House Keeping i. Slips and trips 3 3 9 i. Stack and contain empty 1 1 1 RGF
bags.
ii. House keeping 3 1 3 9 i. Container for rubbish 1 1 1 RGF
/dustbin
ii. Move housekeeping to
above commute to
accommodation.
13 Lone Working i. Lack Of Supervision/ 3 3 9 i. Buddy system in place 1 1 1 RGF
Awareness resulting in ii. Compliance to HSE policy
injury

LEGEND: (P) - People ;(E) – Environment ;(A) – Asset ;(R) - Reputation;(S) – Severity of Consequence ;(L) – Likelihood of Occurrence
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 CONTRACTOR LOGO

JOB SAFETY ANALYSIS – COMMUNICATION SHEET

JSA Title
JSA Number
Job Supervisor
Job Start Date

Personnel involved in the job execution

S.No. Name Position Company Signature