TYPICAL JHA FORM

COMPANY NAME CLIENT NAME

DOCUMENT REFRENCE NUMBER

JHA NO.: XXXXXXXXX REVISION NO.:0 AREA: XXXXXXX JOB LOCATION: XXXXXXX DATE:XXXXXX
Hazardous Area Classification: Zone 0 , Zone 1 , Zone 2 , Non Hazardous
Job Ref (Project No./Work Order No.:

Job Description: De-Spading Activities for N2 purging into station piping Permit Type & No. :________________ _____________

RISK ASSESSMENT MATREX

Risk Rating Residual
Activities (Job Action Party /
S/N Potential Hazard Before Controls/Mitigation Measures Risk /
Steps) Remark
Mitigation Rating
Work Permit Unauthorized commencement of works Medium= C2 Authorized work permit holders shall ensure obtaining Low=C1 Site Supervisor
and maintaining valid work permits. and
May result in exposing people and/or potential to
harm or danger. The supervisor responsible for this activity has to check Safety Officer
the PPE of his staff to ensure that all required items are
available and properly used.
1
Inform all people regarding permit conditions before
work starts.
Supervisors must conduct daily toolbox talk about
nature of work and associated potential hazards and
their essential precautionary measures.
Gas test May found toxic gas or H2S gas leak or extreme Medium= C2 Carryout gas test by Authorized gas tester time to time if Low =C1 Site
oxygen limit in air required. Supervisor/PTW
2 All groups working in different area inside station shall
have H2S personal gas monitor/Toxic clips

3 Using of hand tools
Body pain Medium= C2 All operatives shall be trained for proper handling of Low= C1 Site Supervisor
tools. and
Risk of injury due to use of hand tools
Appropriate tools only have to be used and its Safety Officer
Risk of striking hand
requirements
Risk of striking others
All operatives shall wear their PPEs without fail.
Risk of eye injury from metal chips
Keep only required amount of tools at site.
Cuts From Sharp Objects
All tools shall be kept clean for easy use.
Fall, hit and strip
Ensure other personnel are well clear.

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 Beware of sharp edges on tools
The right tool for the job should always be used to
decrease the chances of injury, incidents, or damage to
a tool through improper use

HSE check list Lack of safety awareness Medium= C2 Obtain work permits/ All personnel shall be H2S trained Low= C1 Site supervisor &
&Prior to safety officer
Comply with all general job requirements mentioned on
commencing PTW
mobilization to Toolbox Talk about work activities.
4 site
All safety requirements stated on the work permit must
be fulfilled

Medium= C2 Working area shall be barricaded and access shall Low= C1 Site supervisor &
Barricading and Accidents and incidents may take place as a result of lack be restricted. safety officer/ALL
setting warning sign of attention.
Use safety cones bounded by safety caution tape to
5 cordon the working area.
Warning signs will be settled in place of work for
attention

General Faulty Equipment Medium= C2 Survey the work area and check utilities that need to Low =C1 All
safety/Emergency turn off
Health Hazards / Heat Stress
condition Ensure equipment is maintained in good working order
Back-strain
and properly used .check equipment before use.
Emergency condition
Ensure that proper barricade and sign have been placed
Work in confined space around the working areas
Provide drinking water at the job site according weather
condition.
CLIENT work and rest procedure shall be followed.
Toolbox Talk on possible emergency and response
procedure and work activities
6
Each employee should be instructed in safe working
procedure/technique and emergency procedure and
what they should to do in case of emergency inform
every one about the emergency exit and assembly
points and emergency contact numbers.
Provide proper access and ladders
If work at height provide proper scaffolding.
Follow security rules and regulation dont try to cross
fence illegally use always provided approve gates or exit.
Keep gate pass all time with you and no body allowed
without gate pass or expired gate pass

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 Site preparation and Personal injury Medium= C2 Inspect all tool and equipment Low= C1 Site supervisor &
movement of safety officer
Manually handling injury Observe proper manual handling techniques
personnel, tools
equipment Uninspected tools equipment Provide adequate amount of cold drinking water
7 Over exhaustion/extreme weather condition Maintain work rest period
Slips ,trips and falls Suitable access and egress to be provided
Sharp object Wearing of PPE

De-spading Valve .flanges Passing Medium= C2 Prior to start work identify and marked all de-spading Low =C1 Construction
location as per drawing to avoid wrong working. supervisor
Leak / Spill
Exposure to Toxic Vapour Proper coordination is required when performing a
group task.
Presence of toxic gas/hydrocarbons
Proper PPE
De-spading on Wrong location
Make sure for isolation/depressurize remains their pipe/
Fall. equipment/system.
8 Hit. Double check spade list prior to start/lineup the
Slip. line/system
Make sure that all Lines related to tie-ins isolated,
depressurized
De-spading must be done as per PRC and spade list
Slowly Gradually Lose The Bolt And Remove /or turn
over the spa
Check the wind direction also
If Work at height Falling hazards Medium= C2 Provide secure and approved scaffolding by Low= C1 Site supervisor &
Falls from Heights certified scaffolding crew safety officer
Slips, Trips, or Fall Personnel shall have fall protection whenever
Fall of load, tools and materials on ground crew working at the edge of scaffolding platform
Safe access (ladder) shall be provided.
9
Ladders shall extend at as per QP procedure.
Use full body harness
Provide good working platform
Dont dont try to overload scaffolding platform
allow other peoples under the overhead activities.
Lightning Medium= C2 All work shall terminate and each employee shall Low =C1 Site supervisor &
move to a place of safety when environmental safety officer
Environmental Rain
conditions create a hazard for the employee.
10 Conditions Strong winds
Follow the summer working/timing procedure and
Darkness/ fog
requirement
Heat stroke
Housekeeping. Debris causing Slips, trips and falls. Medium= C2 Regular housekeeping at site shall be performed. Low= C1 Site Supervisor,
Fire risk due to presence of combustible materials / Adequate and correct stacking of materials. Workers
11 and
debris. Regular inspection and immediate corrective action. Keep
Safety Officer
always clear of obstruction.
Regular clearing of work site shall be implemented.

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TEAM MEMBERS & ENDORSEMENT

POSITION /REF POSITION /REF

NAME SIGN S/N NAME SIGN
INDICATOR INDICATOR

JHA Team Leader Authorization: Ref Indicator: Sign:

JHA Approval (Permit Authority / Asset Holder): Ref Indicator: Sign:

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