INTERCONNECTION SYSTEM :JOB SAFETY ANALYSIS FORM
SEQUENCE OF BASIC ACTIVITY STEPS/
SCAFFOLD ERECTION
1. Hold daily total safety task instruction meeting Lack of PPE
2. Dewatering of concrete chamber
3. Established pipe hole on concrete wall
4. Hole drilling on concrete wall
5. Pipe fitting on cocnrete wall opening
6. Install form works, concrete grouting and
remove form works
POTENTIAL HAZARD HAZARDS CONTROL RESPONSIBLE PARTY
Inspect issue and control use of PPE/ Explain daily
work activity Site Supervisor
Anchor point for safety harness and wearing safety
harness, Belt and Tool Holders/ Cordon off the area
Worker falling, Trip,Tools falling by hard barricade Site Supervisor
Safety harness anchored, Belt and Tool Holders/
Provide lookout and emergency safety ladder/
Trip, Falls. Unsafe handling, Check oxygen inside chamber/Cordon off the area
Tools falling by hard barricade Site Supervisor
Safety harness anchored, Belt and Tool Holders/
Provide lookout and emergency safety ladder/
Trip, Falls. Unsafe handling, Check oxygen inside chamber/Cordon off the area
Tools falling by hard barricade Site Supervisor
Safety harness anchored, Belt and Tool Holders/
Provide lookout and emergency safety ladder/
Trip, Falls. Unsafe handling, Check oxygen inside chamber/Cordon off the area
Tools falling by hard barricade Site Supervisor
Safety harness anchored, Belt and Tool Holders/
Provide lookout and emergency safety ladder/
Trip, Falls. Unsafe handling, Check oxygen inside chamber/Cordon off the area
Tools falling by hard barricade Site Supervisor
REVISION: 1
Concrete Batching Plant Requirements
Description unit Qty
1) Design Mix 20N/mm2 or 3000 psi ( 28 days ) ea 1
2) Design Mix 28N/mm2 or 3500 psi ( 28 days ) ea 1
3) Test Certificate
a. Cement ea 1
b. Sand ea 1
c. Gravel stone ea 1
d. Water ea 1
e. Admixture ea 1
4) Batching plant calibration certificate ea 1
5) Testing equipment calibration certificate ea 1
6) Concrete cylinder sample
a. 3000 psi ( 28 days ) ea 3
b. 3500 psi ( 28 days ) ea 3

Note: All of the above, need to be submitted today to CTJV

MANHOLES TABULATED DATA Width x 2 Width x 2
SURVEY ORDINATES Top wall Bottom slab Wall & slab Height ( outside-mtrs ( inside
Description Northing Easting finished elev finished elev. Thickness ( meters ) ) -mtrs )
Manholes # 1
Manholes # 2
Manholes # 3
Manholes # 4
Manholes # 5
Manholes # 6
Manholes # 7
Manholes # 8
Manholes # 9
Manholes # 10
Manholes # 11