Job Safety Analysis

Complete Daily (Before Beginning Work or for Pre-Job Analysis)

Job Information

MM slash DD slash YYYY

Project Personnel

Personnel 1 (CPR/First Aid)
Personnel 2 (CPR/First Aid)
Personnel 3 (CPR/First Aid)
Personnel 4 (CPR/First Aid)
Personnel 5 (CPR/First Aid)
Personnel 6 (CPR/First Aid)

Emergency Procedures

Are 911 system functional with cell phone use?

Job/Task for Today or Pre-Job Analysis

Check which is being performed:

Job Safety Analysis (Job Exposures)

Hazards Identification: (Items checked below relate to existing conditions, or may be a result of site operations)
Physical Hazards
Health Hazards

Hazard Control Measures

Personal Protective Equipment/Monitoring Equipment
Inspections
Inspections Safety Program/Training

Complete for Civil Work

Cave-in control measures to be used if excavation will be greater than 5 feet and personnel are entering the trench:

Complete for Tower/Rooftop Work (Fall Protection & Using Suspended Personnel Platform)

Fall protection to be used:

NOTE: Controlled Descents and Suspended Positioning

Anchorages used to support suspended positioning rigs shall be independent of any anchorage being used for attachment of a PF AS and shall be capable of supporting at least 5,000 pounds per employee attached. Ropes and straps (webbing) used in suspension and descent rigs shall be made from synthetic fibers. Suspension and descent lines or systems and all necessary slings, connectors and friction devices shall have a minimum breaking strength of 5,000 pounds. All lines shall be protected against being cut or abraded. Each employee on a suspended positioning rig shall be protected by a PFAS.

Has each employee inspected his or her fall protection equipment?
Hoisting Equipment to be used:
EWS

Emergent Wireless Solutions

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