Moderate Risk Job Safety Analysis

This Job Safety Analysis (JSA) must be completed by the contractor and approved by the Argonne project specialist/technical
representative before work can begin. It is designed to be completed electronically and must be printed and displayed at the work site.
A Job Safety Analysis (JSA) is an important accident prevention tool that identifies hazards so they can be eliminated or minimized
before a job is performed and before a hazard can have an impact on workers. The scope of work and all SDSs must be attached
before this JSA can be reviewed and signed.

Project/Job Title

Contract Number Building/Area

Argonne
Contractor (to be completed by Argonne project manager)

Contractor Project Specialist/

Technical Rep
Project Manager Phone No.
Phone No. Alternative No.
Alternative No. Div. ES&H Coordinator
Foreman Phone No.
Phone No. Alternative No.
Alternative No. Other
ESH Rep.
Phone No.
Alternative No.

Argonne Reviewers
Contractor-Designated Competent Person (to be completed by Argonne project manager)

Discipline
Project Specialist/Technical Representative Date
Employee Name
Division ES&H Coordinator Date

Optional SME Reviewers

SME (as needed) Date

SME (as needed) Date

SME (as needed) Date

SME (as needed) Date

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Hazards Analysis. List all basic job tasks, the hazards associated with them, and a list of controls. The form is pre-filled with some basic tasks, hazards, and
controls. Use them if they apply. Remove those that are not relevant to the project. Additional tasks, hazards, and controls may need to be added.
Note: Be sure to list the Hazards rather than the Injuries, Accidents, or other results of a hazard. For example:
Hazard: A potential danger. Oil on the floor is a hazard.
Accident: An unintended event that may result in injury, loss, or damage. Slipping on the oil is an accident.
Injury: Result of an accident, such as a sprained wrist suffered from slipping on the oil and falling.

Phase of Work Safety Hazard Controls for Hazards

Use of hand tools Broken or Unauthorized Tools All tools and equipment must be inspected by Argonne PS/Tech Rep prior to use. Any tool or
piece of equipment deemed unsatisfactory will be tagged and removed from the worksite.
Any tool or piece of equipment that leaves the Argonne site will have to be re-inspected upon
its return. GFCIs must be used on all portable electrical equipment, 125v or less. Extension
cords must be at least 14ga.
Using Portable Ladders (e.g., A-frame, Falls Before use, check the load rating of the ladder, to make sure the ladder can support the
straight, or extension) combined weight of the user, the weight of tools, and the weight of any material that will be
placed on the ladder. This includes the weight of anything that may be supported by the user.
All portable ladders must be non-conductive (dry wood, fiberglass, resin). Ladders must be
inspected prior to each use. Workers using ladders shall not work above the rated working
height. All extension ladders will be tied off at the top. Another worker will secure the ladder
while it’s being tied off.
Use of Fixed Ladders Falls Before use, check the status of the fixed ladder by looking at the yellow ladder, and the white
ladder inspection tags.

If either of the yellow or white tag is missing or illegible do not use the ladder and contact the
Argonne representative.

If it has been more 12 months since the ladder was last inspected (white tag), do not use the
ladder and contact the Argonne representative immediately to arrange for an inspection of the
ladder.

If both tags are present and it has been less than 12 months since the ladder has been
inspected (white tag) proceed to conduct a pre-use inspection following instructions on the
back of the white tag. If the ladder is compliant, proceed to use the ladder. If there is a
deficiency with the ladder, do not use the ladder and contact the Argonne representative
immediately to arrange for an inspection of the ladder

Maintain three points of contact at all times when climbing a fixed ladder.
Keep hands free of additional material when climbing. Use a rope to lift material and tools.

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 Phase of Work Safety Hazard Controls for Hazards
Delivery of materials or equipment Gap between delivery vehicle and the When utilizing a dock, trucks must be backed to the dock to minimize hazardous gaps.
dock
Dock plate or dock levelers must be used to bridge when the gap between the vehicle and the
dock creates a hazard for the equipment or materials being transferred.

Make shift dock plates/bridges are not allowed.

Stepping off the edge of a tail or lift Do not overcrowd the area of the lift gate. Always leave enough room for the employee to
gate safely maneuver themselves and material/equipment being transferred.

Working or standing on the tailgate while loading or unloading equipment or material is

prohibited.
Handling of Chemical/Products Chemical exposure. Submit for review by Argonne personnel, all SDSs for materials that will be used on site by
the contractor. These SDS(s) must be submitted with this JSA for review prior to approval.
Review and adhere to SDS(s) before handling chemicals/ products. SDSs must be at the job
site attached to the JSA. If additional PPE is prescribed within the SDS, the contractor must
acquire and utilize the additional PPE.
Use of Drones (unmanned aircraft Damage/contact with aircraft Maintain situational awareness at all times
systems/UAS) Damage/contact with individuals Stay below 400 feet
Damage/contact with structures Maintain visual contact with the drone at all times
Damage/contact with vehicles All drones must be registered with the FAA
Damage/contact with equipment Do not fly over unprotected persons or moving vehicles and remain at least 25 feet away from
individual and vulnerable property.
If operating within 5 miles of an airport, contact the airport or control tower.
Fly no closer than 2 nautical miles from a heliport.
Remain well clear of and do not interfere with manned aircraft operations, and
you must see and avoid other aircraft and obstacles at all times.
Do not conduct surveillance or photograph persons where there is an expectation of privacy
(private dwellings)
Maintain proof of registration at all times the drone is in flight.
The drone registration number must be clearly marked on the drone.
Do not fly near or over sensitive infrastructures such as power stations, water
treatment facilities, correctional facilities, heavily traveled roadways, government
facilities, etc.
Notify Argonne Security and Fire Department before conducting daily operations

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 Safety Data Sheets (SDS)

Attach a copy of the SDS for each hazardous material that will be used, for review by Argonne personnel. Attach
copies of all required training certification for hazardous materials.

Listing each hazardous material is optional at the discretion of the project manager/technical representative.

Hazardous materials to be used on this site are:

1. 3. 5.
2. 4. 6.

Argonne Contractors Requirements for Moderate Risk Projects

1. All contractor personnel assigned to work under moderate risk contracts on the Argonne site will attend the
Argonne Contractor Safety Orientation (CSO) for service contracts. The contractor must maintain proof of this
training on his/her person by carrying the CSO Argonne card, provided by the instructor. The contractor must
provide proof of this training to the Argonne or DOE representative when requested.

2. DOE Job Safety & Health poster (attached) must be maintained on the job site.

3. All changes to the original scope of work must be communicated to workers by the contractors’ line
management, only after obtaining review and approval by the Project Manager, Project Specialist, or the
Technical representative.

4. The contractor must have an ESH Representative on site at all times when work is being performed.

5. All contractor personnel must attend building/area orientation in relation to their scope of work to ensure they
are aware of shelters during severe weather or emergency evacuation meeting points as well as any other special
conditions in relation to the specific building/area.

6. The contractor must report in daily, by 8 am, the number of employees he has on site by calling 630-252-7200.
Additional information required includes the building number or area where the work is being done as well as
the contract number. In addition, notification to the PS/Tech Rep of arrival and departure is required.

7. Imminent danger violations will result in an immediate 6-month suspension. Other lesser violations will receive
“tickets” and/or other penalties per the contract.

8. In case of any injury or illness, no matter how minor, notify the Argonne Tech Rep., Project Specialist, or
Project Manager of the situation.

9. In the event of an emergency or if immediate medical assistance is needed, contact the Argonne National
Laboratory Fire Department by calling (inside line) 911 (by cell phone) 630-252-1911. After calling the fire
department, notify the Argonne Tech Rep. or Project Specialist of the situation.

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 Emergency Information
(provided by Argonne project manager or technical representative)
Note: the emergency number to call from a cell phone is 630-252-1911.

Emergency Phone Number* Argonne Phone – 911…….Cell Phone 630-252-1911

Location of assembly point:

Location of Tornado Shelter

*This information to be provided by the Argonne PS/Tech Rep.

Basic Safety Rule Reminders:

1. Hard hats must be worn where there is a potential of falling objects, or bump hazards. All hard hats must
comply with ANSI Z89.1, American National Standard for Industrial Head Protection.
2. Safety glasses with side shields are required to be worn at all times. All safety eyewear must comply with
ANSI Z87.1, American National Standard Occupational and Educational Personal Eye and Face Protection
Devices.
3. Sturdy leather work shoes or boots must be worn at all times in the work zones, unless otherwise agreed upon
between the PS/Tech Rep and the contractor.
4. All tools and equipment must be inspected by Argonne before use. Do not use defective tools.
5. Where work creates hazards, these work areas must be clearly marked (e.g., barrier tape, snow fencing, traffic
cone, etc.) and appropriate signage posted to alert passers-by to hazards. All signage must be in compliance
with 29 CFR 1910.145 Specification for accident prevention signs and tags.
6. All 125-volt, 15-20 and 30-ampere receptacles shall be protected by the use of a Ground Fault Circuit
Interrupter which must be tested daily prior to use. All other receptacles must use an Assured Equipment
Ground Conductor Program.
7. Do not allow materials or equipment to obstruct stairways, passageways, and access ways.
8. Maintain an orderly work area.
9. All injuries/illnesses and near misses must be reported to the Project Specialist/Technical Representative as
soon as possible.
10. All portable ladders must be made of non-conductive material (e.g., wood or fiberglass).
11. Any laser use (class 3a, 3b, or 4) requires Argonne ES&H review.
12. All Argonne employees, visitors, facility users, and contractors and their employees are authorized to temporarily cease, or
suspend, their own work to immediately correct a deficiency or unsafe condition that does not pose an immediate danger to
themselves, other employees, the public, or the environment. Examples of circumstances under which an employee may
suspend work include, but are not limited to: damage to personal protective equipment during the course of work,
housekeeping issues, minor facility deficiencies, or minor chemical spills. Employees may also suspend work if something
unusual or unanticipated occurs and they need to take time to evaluate the situation and decide what to do (this scenario may
result in a decision that no change or correction is required). Employees may restart suspended work without their
supervisor’s authorization.
13. All Argonne employees, visitors, facility users, and contractors and their employees are empowered and obligated to stop any
activity that they deem to pose an immediate danger to themselves; other employees, visitors, users, or contractors and
their employees; the public; or the environment. This authority is referred to as “stop-work authority”.
Individuals who exercise stop work authority are also obligated to immediately report their action to the
division director or department head or other line supervisor or the relevant organization.

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 Workers performing the job must sign below.

My employer has reviewed this JSA and answered my questions about hazards related to this job and
what I need to do to work safely. I have also been given an orientation of the work area, including the
location of telephones and emergency equipment, and covering how to respond to fire and severe
weather.

Name (please print) Badge No. Signature Date

Note: Provide the Argonne Project Specialist/Technical Representative with a copy of this sheet at the
start of the job and again each time new workers are added to your crew.

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