RETAIL PERMIT TO WORK SYSTEM –JOB HAZARD ANALYSIS

Date:
Will the work involve any of the activities below? (Circle any that apply)
Prepared by: If ‘YES’ a Permit must be obtained

Company: PCA Hot work in Hazardous areas Confined space entry Excavation >/= 1.2 m
Work on Flammable Gas
Retail Station Address: Inerting or Gas Freeing Live Electrical Work
Systems
Other (specify):
Asbestos Work Explosive Blasting

JHA Reference No.: ____SHELL-PCA-JHA 15-WORK AT HEIGHT USING SCAFFOLDING______________ JHA Review No.: ________3.1_____________________
Making Predetermined JHA shall be verified and reviewed on site every day before performing the work

Description of work: __________________ Work at Height using Scaffolding ____________________

Step
Job Step Job Step Hazard Job Step Control
No
1 Identify and barricading  Vehicle will hit into the working area.  Wear reflective safety vest while barricading work area. Have personnel
operation area. control/direct traffic flow
2 Erection of scaffolding  Scaffold collapse. Personnel may fall from  Assemble the frame scaffolds with one other person so that one person
height due to shaky and topple of the is on the scaffold and one is passing materials from the ground. Inspect
incomplete scaffolds. May cause injury to frames, braces and other components for damage, bends and excessive
others too. rust or wear. Damage or bends of components will reduce the stability,
 Material edge or surface of scaffolds may workability and strength of scaffolds.
cause injury to personnel during
erecting/working session
3 Confirm site traffic flow  Scaffolds and workers knock by car  Flagman to control traffic flow
4 Hauling of materials and tools  Worker fall from height  Scaffold need to be at suitable height, fully boarded, installed with
to top of scaffolding  Falling objects guardrails and mid rail, inspected and tagged.
 Wear appropriate gloves when handling smooth & slippery surface
materials.
 Carry and handle materials with care (and patience).
5 Working on the scaffolds  Worker fall from height  Make sure workers are trained for the jobs.
 Falling objects  Scaffold need to be at suitable height, fully boarded, installed with
guardrails and mid rail, inspected and tagged.
 Make sure alert and caution while doing work.
 Good communication during task. Cordon off work area.
 Wear appropriate gloves when handling smooth & slippery surface
materials.

Shell Retail Permit to Work _ Version 5.0

6 Mobilizing scaffolding  Fall from height  Ensure no worker to stay on the scaffold when it is moving.
 Scaffold glide  Ensure sufficient manpower to control the movement of scaffold.
 Hit by public vehicle  Flagman to divert the traffic flow
7 Dismantling of scaffolding  Components might drop off and hit peoples  Handle with care. Pass to the personnel at the bottom platform.
at ground  Ensure no people at the bottom of the scaffolding.
8 Clear platform of all materials  Debris will drop off and hit someone at  Ensure toe board is installed
and debris. ground  Ensure platform are clear from any particles or objects

Personal Protective Equipment (PPE) appropriate to the task at hand shall be worn/used at all times.
Tick box any PPE that applies to this job

Any additional PPE appropriate to the task :

List required equipment / tools (e.g fire extinguisher, barricading / signs , hand tools, mechanical tools, plant etc.):

Shell Retail Permit to Work _ Version 5.0

The work crew acknowledges that they understand and will comply with the precautions listed above

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

NAME: SIGNATURE:

Shell Retail Permit to Work _ Version 5.0