Appendix A: Format for JHA Worksheet

JHA No: CPF2/PCH/PP/ELEC/003

JOB HAZARD ANALYSIS Date: 12/05/2018
Next Review Date /
PetroChina (Halfaya) Non-Routine Job/Task Routine Job/Task 11/05/2019
Valid till:
Reference: Synchronization
Location: CPF-2, Backup Power Plant Area (WO /Project #) Project
Performing Agency: SCEEI/ Raban Al Safina
Job/Task Description:
Excavation, conduit pipe cutting & laying, preparing concrete manhole, back filling and compaction work Synchronization Project at CPF-2, Backup Power Plant Area

Section / Section /
No. Name Position Signature No Name Position Signature
Contractor Contractor
Project
1 Waseem Ahmad SCEEI 4
Manager
2 Ahmed Rehman Civil Engineer SCEEI 5
3 6 `

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 1
 Inherent risk
Additional
Hazards and Potential consequences level Residual risk
Step Description of job/task step Hazard/risk controls hazard / risk
threats / on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) already in place controls
causes Environment and Asset not / not Acceptable)
recommended
Acceptable)
•Locate underground /
aboveground services
referring to the site
map / drawing.
Location of
•Endorsements in
Underground /
Excavation Notification
Aboveground Services
from the concerned
(such pipeline, cables
Pre - work Teams for the services
1 Civil etc)
in the area to be
excavated.
•Hold pre-job safety
meeting
Non-compliance of
PCH Procedures or  Get authorization for
Engineering Hot Work Permit
Standards Conduct Toolbox Talk
2 Civil Damage to
Excavation Isolate & test
underground /
power, Man
aboveground
watching, Fire
Services (such
extinguisher, use
pipeline, cables
PPE
etc)
Cave-in's of Utilize sloping,
excavation benching & shoring as
needed

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 2
 Inherent risk
Additional
Hazards and Potential consequences level Residual risk
Step Description of job/task step Hazard/risk controls hazard / risk
threats / on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) already in place controls
causes Environment and Asset not / not Acceptable)
recommended
Acceptable)
 Keep excavated
material at least 2
feet away from the
Collapse of Excavated edge of the trench.
Materials Inspection for soil
condition before
starting excavation
work.
•Keep the equipment /
mobile plant at least 3
Accidental fall of
meters away from the
equipment / mobile
edge of the trench.
plant
•Wear appropriate
PPE
Carry out gas test
Possibility of toxic /
before excavating in
flammable gas
hazardous area.
Ensure the approach
to Emergency
Blocking Emergency
Equipment is not
Equipment
blocked due to open
trenches.
•Barricade the
3 Post Excavation Civil Unattended trenches trenches
•Use of Warning signs
proper tools and PPE,
Electroshock, Touch hot Multi- gas detector
Mechanical parts, Fumes, Dust,
4 Cutting & Drilling
Noise, Heat, Spark, hot
Gloves, Fire
/ Civil
particles extinguisher, Hearing
protection, gloves

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 3
 Inherent risk
Additional
Hazards and Potential consequences level Residual risk
Step Description of job/task step Hazard/risk controls hazard / risk
threats / on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) already in place controls
causes Environment and Asset not / not Acceptable)
recommended
Acceptable)
Work areas of
equipment, tools,
construction debris
Civil/ Slips, Trips, Falls, and other materials,
5 Pipe laying
Mechanical heavy weight, heat Mark, identify, or
barricade other
obstructions, PPE,
drinking water
Work areas of
equipment, tools,
construction debris
Slips, Trips, Falls, and other materials,
6 Preparing concrete Manhole Civil
heavy weight, heat Mark, identify, or
barricade other
obstructions, PPE,
drinking water
7 Civil Slips, Trips, Falls Clear walkways, work
Backfilling & Compacting Soils
areas of equipment,
tools, construction
debris and other
materials,
Mark, identify, or
barricade other
obstructions, PPE

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 4
 Inherent risk
Additional
Hazards and Potential consequences level Residual risk
Step Description of job/task step Hazard/risk controls hazard / risk
threats / on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) already in place controls
causes Environment and Asset not / not Acceptable)
recommended
Acceptable)
•Observe proper lifting
techniques
•Obey sensible lifting
limits (60 lb. maximum
Handling Heavy per person manual
Objects lifting)
•Use mechanical lifting
equipment (hand
carts, trucks) to move
large, awkward loads
Struck by/ Against •Wear reflective hi-vis
Heavy Equipment, vests when exposed
Flying Debris, to vehicular traffic
Protruding Objects •Isolate equipment
swings areas
•Make eye contact
with operators before
approaching
equipment
•Barricade or enclose
the work area
•Restrict work area
entry to authorized
personnel only during
construction activities
•Wear hard hats,
safety glasses with
side shields, and
steel-toe safety boots
•Understand and
review hand signals

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 5
 Inherent risk
Additional
Hazards and Potential consequences level Residual risk
Step Description of job/task step Hazard/risk controls hazard / risk
threats / on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) already in place controls
causes Environment and Asset not / not Acceptable)
recommended
Acceptable)
Rotate compaction
tasks to minimize
worker exposure to
Vibration equipment vibration
Use compactors with
vibration dampening
devices
High Noise Levels •Use hearing
protection when
exposed to excessive
noise levels (greater
than 85 dBA over an
8-hour work period

• Assess noise
level with sound level
meter if possibility
exists that level may
exceed 85dBA TWA

Review – Performing Agency Approval – PetroChina Authorities

Area Authority Section Head / Deputy Manager

Discipline Engineer Contract Focal Department / PMC (If any)
☐ Approved - all non-routine jobs/tasks ☐ Approved – all routine jobs/tasks
☐ Confirmed - all routine jobs / tasks
Name Name Name Name

Sign Sign Sign Sign

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 6
HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 7
 Hazard Prompt – “Check  ”
Identify the job/task hazards and assess the risks of personnel may be exposed to before safeguards are implemented
☐ Electrical ☐ Chemical ☐ Tools ☐ Gases
☐ Vehicles ☐ Height ☐ Depth ☐ Weight
☐ Pressure ☐ Access ☐ Vibration ☐ Noise
☐ Weather /Working environment ☐ Bacteria ☐ Dust ☐ Slip / Trip
☐ Radiation ☐ Rotating Equipment ☐ Moving Equipment ☐ Lifting Equipment
☐ Heat ☐ Dehydration/ Hot Work / Sun ☐ Hot / Cold Objects ☐ Overhead Hazards
☐ Biological ☐ Entrapment ☐ Lighting ☐ Manual Handling
☐ Conflicting Activities Others: _____________________
Personal Protective Equipment for Job/Task
Minimum PPE Requirements: 1) __ Goggles ______________, 2_____Ear plug___________, 3) ___Gas Detector____, 4)_Hard Hat____,5) Safety shoes________
☐ Safety Harness ☐ Face Shield ☐ Airline ☐ Gloves – Hyflex (Nitrile)
☐ Face Mask ☐ Sun Screen ☐ Dusk Mask ☐ Gloves – Leather Riggers
☐ Clear Safety Glasses ☐ Hearing Protection ☐ Confined Space Harness Others: __________________
☐ Monogoggles ☐ Breathing Apparatus ☐ Gloves - PVC
Plant, Equipment & Tools for Job/Task
☐ Ladder ☐ Drill ☐ Excavator ☐ MEWP (Mobile Elevating Work Platform)
☐ Hand Tools ☐ Grinder ☐ Winch ☐ Fans
☐ Shovel ☐ Scaffold ☐ Extension Leads ☐ Vacuum Cleaner
☐ Welding Machine ☐ Fire Extinguisher ☐ Power Source ☐ Spill kits / Housekeeping
☐ Compactor ☐ Fire Blanket ☐ Crane Others: __________________
Tagging & Signs
☐ Men Working Above ☐ Flagging ☐ Personal Danger Tags ☐ Information Tags
☐ Barrier Mesh ☐ Personal Locks ☐ Out of Service Tags Others: __________________
Instructions, Permits, Certificates
☐ Method Statement ☐ P & IDs ☐ Cold Work Permit ☐ Isolation Certificate (Electrical) ☐ Radiography Certificate
☐ Procedures ☐ MSDSs ☐ Hot Work Permit ☐ Confined Space Certificate ☐ Demolition of Security Defense
☐ Work Instructions ☐ SIMOPS ☐ Gas test Certificate ☐ Road Closure Certificate
☐ Emergency procedure ☐ Toolbox talk ☐ Isolation Certificate (Physical) ☐ Excavation Certificate

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 8
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