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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
ACTIVITY OR TASK:HYDRO TESTING SPOOL PIECES AND PIPE WORK
JSA Preparation & task work team:
Competence = Relevant Training/Qualifications + Experience

Location / Project: Job Number: JSA Number: M36 Codes of Practice & Legislation that are applicable: JSA Revision:

Competence/ Qualificn reqd to complete work safely JSA approved by person responsible i.e.
Team Leader / Tradesman

Name:

Position / Competence/ License:

Date:

2. HAZARD IDENTIFICATION
compulsory

Identify hazards that may be present by ticking items on the list below.

3. PRECAUTIONS: hard hat, safety glasses, safety boots

ADDITIONAL PRECAUTIONS
Gloves: type . Goggles Full Face Shield High Visibility Vest Harness Fire Extinguishers Barricades Ventilation Lighting Erect Scaffolding to access Respirator or Dust mask Erect Warning signs Personal Locks or Tag system Group isolation Welding screen Fall Arrest systems Welding Face Shield

WORK LOCATION
Difficult Entry/Exit Oxygen Deficiency Oxygen Excess Engulfment (trench collapse) Poisonous Gas Present Temperature Extremes Defined Confined Space Explosive Gas Present

HAZARDOUS AREA
Hazardous Substances - attach MSDS to JSA Working at Heights Remote Area Motor Room Hazards Toxic Substances Potential for Difficult Rescue

HIGH RISK
Falling Objects Poor Lighting Slippery Surfaces Multiple Electrical Feeds Trip Hazards Electrical Hazards - LV Electrical Hazards - HV Manual Handling Sharp Materials Ladders used in the task Working at Heights Working near Crane & Crane Runways Rail Movement Pressurised Fluids Flamm. Materials Present

HIGH RISK
Suspended loads Poor Visibility Inhalable Dusts/Fibres High Noise Levels Use of Chemicals Elevated Work Platform Difficulty to Communicate amongst workers Moving Machinery Tools & Equipment Heat/ Sunlight/ Radiation Traffic Movement Working near Operation Processing Lines Live Rails Pneumatics

PERMITS
Hot Work Excavation Confined Space Hazardous Work Clearance Access to Area High Voltage Access Scaffolding Other?

HAZARDOUS SUBSTANCES in work area / to be used

-attach MSDS

PERMIT NUMBER:

4. ENVIRONMENTAL HAZARDS (IMPACTS) tick those identified

Air Pollution (dust, fumes) Noise (plant & equipment) Spills to drains/waterways Spills to ground Soil Erosion Hazard to Flora /Fauna

Other:

RISK RATING TABLE

This table is used to calculate whether the hazard you have identified is Extreme: 9-10 High: 7-8, Medium: 5-6 or Low: 3-4
The objective of rating the risk is to lower the risk by initiating risk control measures. The score is

Likelihood: How likely is it to be that bad? Almost Certain Expected to Occur

Consequences: how severe an injury? Death

Serious Injuries Medical Treatment Reqd 1st Aid reqd

10 9 8 7 6

9 8 7 6

8 7 6 5

7 6 5 4 3

5. EQUIPMENT REQUIRED: Static Plant & Equipment

Mobile Plant & Equipment

Likely could
happen sometime

Moderate could
happen but not likely

Unlikely could
happen but very rare

Revision Date: March 2005

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Rare - could happen

but probably never will

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT
Safety / Emergency Equipt
noted in the JSA risk score column on the next page both before & after risk control measures have been nominated.

NAME OF TASK: HYDRO TESTING SPOOL PIECES AND PIPE WORK

JSA Number: Risk Rating

M36

Rev: Risk Rating

Of the risk following corrective action

Step No.
Logical sequence

Sequence of Basic Job Steps

Break down Job into steps. Each step should accomplish a major task and be logical. Environmental Aspects

Potential Safety & Environmental Hazards/Impacts

Recommended Corrective Action or Procedure

Determine what actions are necessary to eliminate or minimise all hazards that could lead to an accident, injury, illness or environmental incident. The risk must be reduced or controlled to a level that is acceptable before work commences. Indicate who is to perform the action where applicable against each action

Identify the hazards (health and safety or Use table on environmental) associated with each step, the previous examine each to find all possible risk factors page to score
risk

2 3 4

6 7 8

Discuss scope of work and work method Personal Injury resulting from with workforce working with hand tools and lines under pressure Obtain PTW Injury / damage as a result of incorrect information Identify work area Risk of injury due to low awareness of work environment Fit blanks and fittings into spool pieces Personal Injury resulting from incorrect work methods and incorrect tools Hydro Testing Personal Injury resulting from incorrect work methods, incomplete fittings Personal Injury resulting from High Pressure Hose Bursting, Faulty Equipment, Incorrect work methods. Equipment Damage, Personal Injury resulting from Blow out of equipment under test. Removing Blanks and Fittings Personal Injury resulting from trapped pressure escaping Clean up work area Personal Injury resulting from uneven, slippery work area Remove bunting and signage Personal Injury resulting from uneven, slippery work area

Toolbox Meeting, Barriers, Signage, Appropriate tools, PPE, Correct Work Methods Obtain correct PTW. Training in PTW system. Take 5, be aware of hazards Correct Lifting Techniques, Correct tools, PPE, Supervision

Inspect fittings for compatability & condition, correct torque-ing techniques, PPE, Supervision Inspect hoses and fittings prior to use, inspect pressure unit and safety device prior to use, PPE Barriers, Signs, Sentry to control entry to work area, Inspect PSV for condition and correct setting Ensure equipment drained and depressurized prior to removing fittings, PPE, Supervision. Correct lifting techniques, PPE, supervision. Correct lifting techniques, PPE, supervision.

Revision Date: March 2005

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) / SAFE WORK METHOD STATEMENT

Revision Date: March 2005

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JOB SAFETY & ENVIRONMENT ANALYSIS (JSA) CONSULTATION & SIGN-OFF RECORD
I confirm by my signature below, that I have attended a briefing on the requirements of the attached Job Safety & Environment Analysis and agree to perform the work in the manner detailed on it. I confirm that copies of the relevant Permits, MSDS's, Isolation Plans etc. have been reviewed.
JSA NAME JSA No:

Rev: DATE

NAME

(Please print)

SIGNATURE

THIS SAFE WORK BRIEFING / TRAINING WAS CARRIED OUT BY (responsible person at that location) : Name: Signature: Date: Client sign off (where applicable) Site / Project Manager sign off (document reviewed)

Revision Date: March 2005

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