JOB SAFETY ANALYSIS WORKSHEET

COMPANY NAME:

DATE:

SITE NAME:

PERMIT TO WORK REQUIREMENT: YES

STAKEHOLDER REPRESENTATIVE NAME/TEL. NO:

CONTRACT NO.:

NO

ACTIVITY: To re-engineer the entire Fire Detection & Alarm System within Customers Complex (changing the installation

cable into Fire resistant cable, re-positioning of devices, extension to other areas that were not covered and integration of
the 4 Zone Conventional Fire Alarm Control Panel with interconnection to Fire Authority within the state

ATLASNET Contact Person - PM

Atlasnet Contact
HSE Officer

SITE
EMERGENCY NO.
EMERGENCY RESPONSE
NO. :

START DATE:

List plant, equipment

& tools to be used,
and Places to Work
Ladder
Electrical Tool Box
(Screw Drivers Set,
Plier, Cutter, Knife etc.)
Avometer

FINISH DATE:

List Hazardous
Substances
to be used or
handled
Fall from Heights,
Slippery
Electric Shock, Cut &
Injury

List PPE to be worn

Electric Shock

Hard Hat, Safety Boot,

Eye Glasses
Hand Gloves & Safety
Boot
Hand Gloves & Eye
Goggle
Safety Glasses, Highvisy clothing
(Reflective Vest),
Complete PPE, Torch
Light & Work with 2 or
more men
Dust Masks, Hearing
Protection, Hand
Gloves
Measuring Tape,
Cutter, Hand gloves,
Eye Glasses

Hammer

Hand /Leg Injury

PVC Pipes & Pegs

Hand/Eye Injury

Work at Ceiling

Insect Bite, Electric

Shock, fall from
height

Drilling Machine

Noise Pollution, Dust

& Vibration

Cables, Fishing Tape &

Devices

Fragile handle with

Care, Hand cuts,
pulling to damage

Hard Hat, Safety Boot

Safety Boots, Hand
Gloves, Eye Glass

(Tick)

List Hazards to
consider

(Tick)

Slips, trips and

falls from heights
Falling objects,
Electric Shock,
Cuts
Electric Shock,
Spark
Manual handling,
Injuries
Struck by moving
section
Inhalation of dust
or fumes, hidden
insect bite, dark
environment
Noise, Inhalation
of dust or fumes,
Vibration trips
Injuries, Pull, fall,
slips, cuts

paulsodipo@gmail.com
Page 1

JOB SAFETY ANALYSIS WORKSHEET

JOB HAZARD ANALYSIS PROPER:
ACTIVITY

HAZARDS
IDENTIFICATION

This are the tasks required to

perform the activity in the Sequence
they are carried out.

Against each task the

hazards lists that could
cause injury when the task
is performed.

CONTROLS &
RECOMMENDED &
ACTIONS
Control measures required to eliminate
or minimise the risk of injury arising
from the identified hazard

RESPONSIBILTY
PERSON
Name of the person responsible
(supervisor or above) to implement
the control measure identified

Decommissioning of the Existing Cable, PVC Pipe & Cable Laying, Connection, Integration, Configuration & Commissioning.

Entry to Site/Venue

Entry to unsafe area

Movement of site
personnel, vehicles, plant
& equipment

Report to site office for site

induction, Work Area, Mustard
Point
Risk assessment of site condition

PVC Piping, Cable Laying &

Fixing of devices

Fall from heights, Slips, Cuts

& dust

Training employees in manual

handling and team lifting

Manual handling injuries, cuts,

splinters & abrasions

Wear gloves (PPE)

Being struck by hammer,

Noise, Load lifting

Training employees in manual handling

The use of P.P.E equipment such

as gloves. Team lifting

Slips, trips & falls

Unload equipment on a level

clear area

Device & Equipment

Connection, System
Integration, Configuration,
Programming &
Commissioning

Trips & falls

Handle & Proper handling, Ensure

site is clear of any debris,
obstructions
Wearing Safety boot

Handling Over & Work Area

Clearing and Documentation

Pearce with debris, pins &

spares

Stakeholders Reps, HSE &

PM

PM
/IMPLEMENTATION
LEADER/ CIVIL
ENGINEER HEAD &
HSE MGR.

Define & barricade work area &

fall areas
Clearing area

Stakeholder & PM

paulsodipo@gmail.com
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JOB SAFETY ANALYSIS WORKSHEET

LADDERS
When using a ladder, abide by the following guidelines:
Your ladder will indicate which rungs you may stand on. Do not stand on any rungs not recommended by the
ladders manufacturer.
To minimise slippage, clean boots of mud and debris before use.
Ensure the ladder is on a stable even surface.
Keep both hands free to use when climbing or ascending, maintain three point of contact with the ladder.
Carry tools in pockets or hoist them up with a rope in a canvas bag.
Have an assistant hold the bottom of the ladder to prevent movement.
Barricade the work area when the public or vehicles are in the vicinity.
Keep the body within the ladder side rails.
Do not straddle the ladder or support planks with the ladder.
Do not perform hot work while working on a ladder.
Do not work backwards on the ladder.
Do not use any equipment requiring two-handed operation.
Do not use any PPE, which impairs vision.
Do not use the ladder for anything but its intended purpose.
Do not work over other people and do not allow anybody else to be on the ladder at the same time.
Do not use the ladder in wet or windy conditions.
Ladders should not be used in access areas or within the arc of swinging doors.
INCIDENTS
Report all incidents or near misses to the Stakeholders representative
PERSONAL PROTECTIVE EQUIPMENT (PPE)
All persons working on the CAP site must identify and use appropriate PPE for the works they are undertaking,
including eye, hearing and sun protection.
SAFETY VESTS
Safety Vests are compulsory whilst in the CAP venues during the move in and move out of events.

paulsodipo@gmail.com
Page 3