JOB SAFETY ANALYSIS

HOW TO USE THIS FORM : Installation/Facility EDG

1) Crew performing task reviews ALL generic JSA considerations. Location Local Control Panel
2) Review previous JSA update(s) for useful information which will help this task. Associated Work Permit Type
3) Create new JSA update with generic form and ALL considerations for this task. Associated Work Permit Number
4) Carry out task as per plan. If any conditions change ---STOP & RE-ASSESS. Electrical Isolation Certificate Number
5) File JSA update for future reference. Physical Isolation Certificate Number

WORK ACTIVITY Pneumatic Test For FM200 Pipe (using N2 Nitrogen) JHA Cross-Reference Number

Job Description of Potential Potential

Step Job Step Hazards
Work and site 1.1 Protrusion to hand and
1 preparation finger
(housekeeping)
2.1 Manual lifting for nitrogen
gas cylinder by
manpower can cause
ergonomic hazards.
Install of nitrogen gas 2.2 Cylinder can fall while
2 for leak test of FM200 manual lifting.
pipe 2.3 Workers hit by the
cylinder.
2.4 Unsafe cylinder gas
position.
3.1 Cylinder fall from
standing.
Blow the pipe to clean
3.2 The pressure hose
iron dust inside pipe
disconnected.
happen during cutting,
3 3.3 N2 gas accumulate at
drilling and welding
using notrogen gas.
Local control panel room.
(5 bar pressure)
3.4 Dust/debris from inside
FM200 pipeline.
L S R Control/Recovery Measures L S R Result
Impact
 All personal to wear proper and suitable
hand protection glove.
 Minor injury 3 2 6  Eliminate or to make safe any 2 1 2 Acceptable
protruding hazard.
 First aid treatment.
 All worker must wear proper PPE when
do manual lifting.
 Provide glove to avoid pinch point.
 Do not lift the cylinder alone. Make sure
 Back ache do it with buddy system.
 Body injury  If possible use trolley or keep on
3 2 6 1 2 2 Acceptable
 Pinch point standing position and tightly bound to
strong structure.
 Do not locate cylinder gas in access &
egress pathway.
 Safe handling of cylinder gas, do not
move cylinder by rolling it.
 Make sure the cylinder is tighten to the
wall or something that not easily move.
 Material damage  Make sure all fittings is tighten properly
before blow the pressure for clean up
 Major
the pipe.
injury/Fatality 3 3 9 1 2 2 Acceptable
 Make sure all area that involve for this
 Asphyxia
activity is already barricade and
 Respiratory acute
provided with signage to avoid not
authorize person coming in or near at
the area.
 JOB SAFETY ANALYSIS
4.1 Worker fall from ladder or
scaffolding while
installing the testing
Installation of testing
device.
device (pressure
4.2 Testing device fall from
4 gauge, flexible hose,
height.
nitrogen gas, and pipe
4.3 Tools falling from height.
fitting)
4.4 Unstandard connection
hose.
5.1 Cylinder fall from
standing.
5.2 The pressure hose
disconnected.
5.3 Uncontrol filling pressure
Pressure test pipe from cylinder gas.
5 FM200 (27-31 bar 5.4 Communcation problem
pressure) between valve operator
and tester due to
separate room.
5.5 Leaking or cracking on
welding area or pipe
 OPEN ALL DOORS (ENTRY & EXIT)
in Local control panel for ventilation.
 Cover area (panel) below blowout end
pipe.
 Use Dust mask (PPE).
 Provide training for working at height
for worker that involve to the work
activity.
 Make sure the worker is a competent to
do the job.
 Install toe board at scaffolding to avoid
 Major falling material or tools from scaffolding.
injury/Fatality 3 3 9  Provide proper PPE for worker to avoid 1 2 2 Acceptable
 Material damage them from falling at height.
 Provided first aid kit box in place.
 Provide first aider and rescue plan
(refer to attached) in place.
 Use standard hose that appropriate
with maximum pressure for pneumatic
test (27,5 bar).
 Make sure all fittings is tighten properly
before blow the pressure for clean up
the pipe.
 Provide standby person at any
entrance for the test location.
 Make sure all area that involve for this
activity is already barricade and
provided with signage to avoid not
authorize person coming in or near at
the area (access control
 Material damage implementation).
 Major 3 3 9  Make sure the activity is conducted with 1 2 2 Acceptable
injury/Fatality competent person.
 Use regulator, pressure gauge and ball
valve to control pressure.
 Point blow out direction to safe
atmosfer and outlet area
protected/barricade/warning sign
(Danger of nitrogen gas).
 Use proper communication tools (HT).
 Cover existing equipment with
bluesheet and playwood.
 JOB SAFETY ANALYSIS

 All personnel to wear proper and

6.1 Protrusion to hand and
6 Housekeeping
finger
suitable hand protection glove.
 Minor injury (first
3 2 6  Eliminate or to make safe any 2 1 2 Acceptable
aid treatment)
protruding hazard.
 First aid treatment.

L - LIKELIHOOD S - SEVERITY R- RATING RESULTS

CATEGORY DEFINITION CATEGORY DEFINITION H 3 6 9 6–9 UNACCEPTABLE
LOW 1 REMOTE LOW 1 No Injury No Damage No Pollution M 2 4 6 3–4 TOLERABLE
Minor Pollu-
MEDIUM 2 POSSIBLE MEDIUM 2 First Aid Injury Minor Damage
tion L 1 2 3 1-2 ACCEPTABLE
Lost Time In- Major Pollu-
HIGH 3 PROBABLE HIGH 3 jury
Major Damage
tion L M H
IS THERE A SAFER WAY TO COMPLETE THE JOB ? ARE THERE ALTERNATIVES WITH
L- LIKELIHOOD
LESS RISK ?
 JOB SAFETY ANALYSIS

JSA Number: TASK SAFETY MANAGEMENT OUTLINE Date This JSA Created: 5-1-2015

Date JSA Last Revised : 7-1-2015

WORK ACTIVITY EQUIPMENT
Type of Equipment Manufacturer Tag. No. Precise Work Site

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Performed
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JSA SUBMITTED BY PERFORMING

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