JOB SAFETY ANALYSIS FORM Printed on : 26/02/2019

Ship: Scorpio Marine Management

JSA Number: 4613283 Human Resources

Office JSA Matrix

EEnFs integration - Roles and responsibilities.

DEPARTMENT
Technical

SAFETY ANALYSIS
HAZARDS INITIAL RANKING POST RANKING
Hazards Existing Safeguards SEVERITY LIKELIHOOD RISK Additional Safeguards SEVERITY LIKELIHOOD RISK

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JOB SAFETY ANALYSIS FORM Printed on : 26/02/2019
SAFE GUARDS
Additional Safeguards Existing Responsibility Action Item

REQUIRED PPE

REQUIRED WORK PERMITS

REQUIRED CERTIFICATION

REQUIRED TRAINING

REQUIRED ENDORSEMENTS

OTHER QUALIFICATIONS REQUIRED

PARTICIPANTS
Position Title Name Task Qualification Check?

STATUS
Action Acted On By
CREATED 11/02/2019 ANAITHANI

WO’s/SR’s
Doc. No. Status Date Cost Vendor Event

EQUIPMENT/SPACES
Type Equipment/Maintained Part/Space Warr. Exp. Date

REMARKS

MATRIX

Name: JSA Matrix Description:

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JOB SAFETY ANALYSIS FORM Printed on : 26/02/2019

JSA Matrix L1:Very L2:Unlikely L3:Occasional L4:Likely L5:Highly

Unlikely Likely

S1:No Impact / 1-Acceptable 2-Acceptable 3-Acceptable 4-Acceptable 5-Acceptable

No Injury

S2:Slight / 2-Acceptable 3-Acceptable 4-Acceptable 5-Acceptable 6-Tolerable

Slight Injury
(First Aid)

S3:Minor / 3-Acceptable 4-Acceptable 5-Acceptable 6-Tolerable 7-Tolerable

Minor Injury
requiring

S4:Serious / 4-Acceptable 5-Acceptable 6-Tolerable 7-Tolerable 8-Intolerable

Lost Time
Injury

S5:Severe / 5-Acceptable 6-Tolerable 7-Tolerable 8-Intolerable 9-Intolerable

Serious Injury
or Fatality

S6:Catastrophic 6-Tolerable 7-Tolerable 8-Intolerable 9-Intolerable 10-Intolerable

/ Multiple

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