Title of the Form Form No. Rev. No. Reference Document No.

Job Safety Analysis (JSA) Work Sheet PR/IS/SFD/F-001 04 PR/IS/SFD/P-003

Job to be Performed: Area grading JSA No. Date: New / Revised (Rev.0)
with fencing arrangement and
material loading/Unloading.
Job Safety Analysis
Worksheet Executing Organization Representative Proponent Section: Proponent Supervisor (name & title):
(Name & Title):
Mohamed Badrudeen, Sulthan A.
(DBN Project Engineer)
Executing Work Location: Proponent Department: Reviewed and approved by
Organization LUP 502 – Acid Flare South Area. Monomer-I (Proponent Section Head):
(Section/Dept.):
PMD/MEGA
Name of the Contractor (company) Performing the Job L&T (Larsen and Toubro). Work Order No. (If applicable): 4600004482
In addition to mandatory PPE additional PPE/Controls anticipated; check all that apply:
SCBA X Chemical PPE X Face Shield X MHB/SDS X

Respiratory Mask X Electrical PPE X Eye Protection PPE Others;

Fall Protection Ear Plugs/Muffs Eye Wash

Heat Resistance PPE X Floating Device X Coveralls

Residual
Risk Rating Risk Rating
Sequence of Job Steps to be Risk/Hazard (Refer (Low, Mitigation Hazard Control Measures (existing and additional) to (Low,
Action By
Performed Hazard Checklist) Moderate, reduce the risk to moderate or low. Moderate,
High, Critical) High,
Critical)
a. invalidity / Expired 1. Work permit Receiver/issuer shall be certified by PRC Job Supervisor,
Preparations Receiver and Moderate and have valid certificates. Low Permit Issuer &
a) Request for PTW Site Issuer’s 2. Consult the proponent and make sure all the identified Permit receiver,
survey and Certification work spots are correct and marked on the drawing. Site Safety
preparation work. b. Failure of work 3. Ensure that the approval is obtained from all the Officer
b) Daily safety Talk planning concerned and communication has been done with all
c. Lack of the affected parties.
Communications 4. Follow scope of work, methodology statement and the
and Control
contents of this JSA.
PR/IS/SFD/F-001
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 c) Work execution 5. A joint site inspection shall be conducted by the Issuer
d. Incorrect tool for or his designated representative and the Receiver
the job before the permit is approved / signed and after job
d) Tools & equipment completion prior closing the permit.
e. Lack of proper 6. During the toolbox talk the WP Receiver shall highlight
planning the key hazards and associated controls identified in the
JSA.
f. Lack of 7. Be aware of conflicting work scopes in areas prior to
competency commencing work task.
8. Provide good and appropriate PPE.
g. Defective tools & 9. The maximum voltage for portable electrical tools shall
equipment not exceed 220 volts.
10. Keep the worksite clean and tidy and free of electric trip
h. Electrocution hazards (housekeeping).
11. Take a rest at adequate intervals and drink water as
necessary.
12. Contractor safety officer and job supervisor to be always
available.
13. Temporary equipment must be inspected and tagged
with a valid PRC approved 3rd party Inspection Sticker
prior to use.
14. Temporary power supplies must be routed to prevent
tripping hazards.
15. Ensure a complete inspection of tools and equipment is
performed prior to start of work.
16. Use insulated tools for electrical work all tools and
equipment are to be operated according to
manufacturer’s instructions and to be examined before
use and defective equipment/tools replaced or repaired
immediately.
17. Use validly trained and certified employees to engage in
specified activity.
18. Ensure to Barricade and relevant warning signs are
provided at work activity Zone to avoid unauthorized
entry.
1.

1.

a. 1.

1.

1.

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 4. a. 1.

5. a. 1.

Legends: PTW -Permit to work, UL -Underwriters Laboratories, FM- Factory Manual, TBT – Toolbox talk, PPE-Personnel Protective Equipment

New Revised Revalidate

d Activity: Area grading with fencing arrangement and material loading/Unloading.

JSA Team Members:

Name Designation Department Sign

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 IMPORTANT:
 This JSA must be available at the place where the activity is being performed and all personnel involved must be informed of the hazards
associated with the activities and the control measures to eliminate or minimize the hazards.
 This JSA must be revised if the scope of work changes or if any other major contingency occurs. (Refer Section 4.3.12)
 In case the team assess the residual risks cannot be brought down to Moderate or below, the risk evaluation and control shall be done by
referring Corporate HSE Risk Management Manual.
 Proponent Organization and Executing Organization must sign JSA while revalidation. (Refer Section 4.3.13)
 In case the plant emergency alarm is sounded, all work must be stopped, all permits will be automatically cancelled and Emergency
Response Plan to be followed.
 Ensure the availability of Work Permit receiver during the activity, continuously.

Petro Rabigh Risk Matrix Hazard Effect / Consequence

1 2 3 4 5
Loss Type
Insignificant Minor Moderate Major Catastrophic
Single fatality to
Reversible injury to one worker and/or
Short term Reversible injury Multiple fatalities to worker
or more worker severe
Safety inconvenience i.e. requiring medical and/or impact on third party
resulting in loss time irreversible
First Aid treatment
injury/restricted duty damage to one or
more person
Reversible health Reversible of Severe, reversible Permanent Total Health impact on third party.
effects of little concern that would health effects of Disability to one Can include effects of
concern, requiring typically result in concern that would or more person. carcinogens, mutagens,
Health first aid treatment at medical treatment. typically result in a lost Can include teratogens and reproductive
most. Can include Can include time incident. progressive toxicants (known and
minor irritations of temperature Acute / short-term chronic conditions suspected), and life-
eyes, throat, nose and effects; travel effects associated with and/or acute / threatening respiratory
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 extreme temperature
or skin, or minor effects; or muscular-
effects; stress; and short-term high-
unaccustomed skeletal effects; sensitization)
sunburn. risk effects.
muscular discomfort. vibration effects;
nervous system effects.
Impact that is
Near-source
Near-source confined Near-source confined unconfined and Impact that is unconfined over
confined and
Natural Environment and promptly and medium-term requiring long- large public area and requiring
short-term
reversible impact. recovery impact. term recovery, long-term recovery, leaving
reversible impact.
leaving residual major residual damage.
damage.

Financial Impact
Note: This includes financial loss or increased cost or Ranging from Ranging from
Greater than US$150MM
saving opportunity loss due to production loss, business Less than US$2MM US$2MM to Ranging from US$10MM US$50MM to
interruption, and cost of repair/replacement of assets. US$10MM to US$50MM US$150MM

1 2 3 4 5
Insignificant Minor Moderate Major Catastrophic
Likelihood Qualitative Quantitative Risk Rating

A similar outcome
A has occurred more Greater than
(Almost than once per year 1X10-2 (1 in 100 Moderate High Critical Critical Critical
Certain) at specific plant / years)
site within Petro
Rabigh.

A similar outcome
has occurred more Between 1x10-3
B than once per year (1 in 1000 years)
Moderate High Critical Critical
(Likely) but at different and 1x10-2 (1 in Moderate
plants / sites of 100 years)
Petro Rabigh.

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 A similar outcome Between 1X10-4
C has occurred in (1 in 10,000
Petro Rabigh or Low Moderate Moderate High Critical
(Possible) years) and 1x10-3
more than once per (1 in 1000 years)
year in the industry.

Between 1x10-5
A similar outcome (1 in 100,000
D has occurred in the years) and 1x10-4 Low Low Moderate Moderate High
(Unlikely) industry, but not in (1 in 10,000
Petro Rabigh. years)
A similar outcome Less than 1x10-5
E
has never occurred (1 in 100,000 Low Low Low Moderate High
(Rare)
in the industry years)

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