Singapore Project

Part 1

JOB SAFETY AND ENVIRONMENTAL ANALYSIS WORKSHEET

Workface or Plant location : ABC Shelter

JSEA No:

Job or task description: Sand/cement screeding to Ext'g slab

Revision:

JSEA Team (Attach separate sheet if

AA (SS)

CC (PM)

REVIEWED BY:

DATE:

BB (LS)

DD (SM)

REVIEWED BY:

DATE:

required)

Type of Permit Required:

{FPP or EM}
(please indicate by F or EM)

Type of Lockout or Isolation Required:

(please indicate by ticking)

Additional PPE Required

{Over and above project standard}
(please indicate by ticking)

Equipment Required:
(please indicate by ticking)

Hot Work

Electrical

Chemicals

Face Shield

Safety Harness

Barricading/Signs

Confined Space

Mechanical

High Voltage

Chemical Goggles

Dust Masks

Electrical Earth Leakage Unit

Excavation / Penetration

Manual Valves

Hydraulic

Disposable overalls

Respirator

Fire Extinguisher

Electrical

Pneumatics

Liquids

Rubber Boots

PPE

Lifting Equipment

Radiography

Marine

Welding Gloves

Hand Gloves

Static line/Life line

Working over Water

Kevlar Gloves

Digital Earth Tester

Other:

Chemical Gloves

Cables & Rods

Potential Environmental Hazards

Hazardous Materials / Substances

Manual Handling

(Please Tick Box)

Any box ticked must be mitigated in line with FWP
Environmental plans and noted in part 2 under hazard
controls in this form

(List any hazardous materials to be used or present in the

work Area. Attach an MSDS for each)
Chemical controls must be noted in part 2 under hazard
controls in this form

Will Hazardous manual Handling be possible during the job? E.G. Lifting,
pushing, pulling, Twisting or bending? If so tick the box that most likely
describes the manual handling risk and include the code on each JSEA
Job step, and the control in part 2 under hazard controls in this form

Air Pollution (dust, fumes)

NONE

Hazard to Flora or Fauna

MH1

Noise (plant & equipment)

MH2

Spills to drains / waterways

MH3

Spills to ground

MH4

Soil Erosion

MH5

FPP SHE-F-027

Revision A1

There will be no Hazardous Manual handling in

this job.
The task may involve high forces.
The task will require repetitive forceful
movements?
The task is likely to cause fatigue or soreness due
to its long duration
Environmental factors are likely to increase the
chance of injury.
Awkward posture or movements likely

Page 1

Probability

Consequences

A common or repeating occurance

B known to occur or It has happened
C could occur, Ive heard of it happening
D not likely to occur
E practically impossible
Risk Calculator legend
L = Low Risk M = Medium Risk

STE
P
NO.

Part 2

People
1 fatality or permanent disability
2 lost time injury or illness
3 medical treatment
4 first aid treatment
5 incident report only

S = Significant Risk

Environment
A common o
1 toxic release off site with detrimental effect
2 off site release with no detrimental effect
3 off site release contained with outside assistance
4 on site release immediately contained
5 no environmental impact

H = High Risk

JOB STEP

POTENTIAL HAZARD

List the steps required to perform

the task in the sequence they are
carried out.

Against each step list the potential /

risk hazards that could cause injury /
damage when the task step is
performed.

Consequence

B
H

Probability

Risk
Rank
L,M,S
or H

REQUIRED HAZARD CONTROL

RESPONSIBILITY

For each hazard identified list the

control measures required to eliminate
or minimize the risk of injury.
(use hierarchy of controls)

Nominate the person

who will be required
to action the control
measures.

1
2
3
4
5
6

FWP SHE-F-027

Revision A1

Page 2

Part 3

SUPPORTING JSEA REQUIREMENTS

Specific personnel qualifications required

Task Supervisor
Safety Supervisor

Critical personnel duties and responsibilities:

Ensure all work activities in accordance to
EM/FPP code of conducts, JSEA and method of
statement
Ensure that the work carried in safe manner and
JSEA complied

Training required to conduct work

SOC(OP)/SIC

SOC(OP)/SIC

LEW

Engineering Details/ As built drawings /Permits /MOM Approvals

reqd:
PTW

Specific Regulations, Codes of Practice, Legislation :

Plant and Equipment to be used.

Plant and equipment inspections required

Electrical breaker and cutter

LEW certified with valid sticker

Hand tools

Not modified

FWP SHE-F-027

MSDS

Revision A1

Page 3

Part 4

JOB SAFETY AND ENVIRONMENTAL ANALYSIS SIGN ON SHEET

Employee Acknowledgement

NOTE: EVERY MEMBER OF THE WORK CREW/TEAM MUST SIGN OFF ON THIS SECTION OF THE JSEA FORM TO ACKNOWLEDGE AWARENESS & PARTICIPATION
Team Member to print name
Team Member to Sign
Date
Team Member to print name
Team Member to Sign
Date

FWP SHE-F-027

Revision A1

Page 4