TASK/ACTIVITY : GROUTING WORKS (FOR SHARED FENCE) DATE: Page 1 of 4

TITLE OF PERSON WHO DOES JOB: SUPERVISOR:

PREPARED BY: RECTO SUMALPONG
Masons Leandro Clemencia
INDUSTRIAL SECURITY LOCATION: AMJ Project Site
REVIEWED BY: SALIH ARASID
AND CONTRACTING
Tools / Equipment: Hand tools & Portable Power tools APPROVED BY: YOUSEF MADDAH

JOB SAFETY ANALYSIS (JSA)

SEQUENCE OF BASIC RISK RATING

POTENTIAL HAZARDS PREVENTIVE ACTIONS ACTION BY:
JOB STEPS LIKELIHOOD SEVERITY
RATING RATING
1 Grouting works  Obtain the concrete works Projects T&I
Authorization authorization & take the clearance Unit
all concerned divisions like
Operations.
2 Pre-Construction Safety  All employees assigned to this task Contractor /
Meeting. will attend a pre-construction safety Sub-
meeting, which will include the Contractor
pertinent JSAs, Standard Operating
Procedures, types of potential
hazards, and actual hazards present
and controls for those hazards.
3 Site Preparation  Lack of knowledge of work  All workers must have a thorough Contractor /
to be performed. knowledge of the work to be Sub-
performed. Contractor
 Obtain permit to work
 Read MSDS.
4 Grouting  Eye injury (cause by splash  Wear Safety Goggles Contractor /
& fumes)  Wear face shield (if necessary) Sub-
 Contact irritation, burn or  Safety gloves (appropriate type for Contractor
absorption (cause by splash chemical)
& skin contact)  Apron (if necessary)
 Long sleeves

ISC/HS/FRM/12 Rev 00
 TASK/ACTIVITY : GROUTING WORKS (FOR SHARED FENCE) DATE: Page 2 of 4

TITLE OF PERSON WHO DOES JOB: SUPERVISOR:

PREPARED BY: RECTO SUMALPONG
Masons Leandro Clemencia
INDUSTRIAL SECURITY LOCATION: AMJ Project Site
REVIEWED BY: SALIH ARASID
AND CONTRACTING
Tools / Equipment: Hand tools & Portable Power tools APPROVED BY: YOUSEF MADDAH

 Dust  Dust protection (respirator if

necessary)
 Face caused by splash  Wear Face shield (if necessary)

6 Housekeeping  See Housekeeping JSA Contractor /

Sub-
Contractor

Personal Protective Equipment: (Minimum requirement: safety shoes / hard hat / visi-vest / gloves on person and used as required)

Additional PPE: [x] Eye Protection ( safety goggles ) [x ] Others

Apron, Face shield, Dust Mask, Respirator if necessary.
[ ] Hearing Protection ________________________________________________

[ ] Fall Protection ________________________________________________

LIST OF PERSONS CARRYING OUT WORK

NAME (S) BADGE # DESIGNATION SIGNATURE(S)

1

ISC/HS/FRM/12 Rev 00
 TASK/ACTIVITY : GROUTING WORKS (FOR SHARED FENCE) DATE: Page 3 of 4

TITLE OF PERSON WHO DOES JOB: SUPERVISOR:

PREPARED BY: RECTO SUMALPONG
Masons Leandro Clemencia
INDUSTRIAL SECURITY LOCATION: AMJ Project Site
REVIEWED BY: SALIH ARASID
AND CONTRACTING
Tools / Equipment: Hand tools & Portable Power tools APPROVED BY: YOUSEF MADDAH

10

11

12

13

14

15

16

17

18

19

ISC/HS/FRM/12 Rev 00
 TASK/ACTIVITY : GROUTING WORKS (FOR SHARED FENCE) DATE: Page 4 of 4

TITLE OF PERSON WHO DOES JOB: SUPERVISOR:

PREPARED BY: RECTO SUMALPONG
Masons Leandro Clemencia
INDUSTRIAL SECURITY LOCATION: AMJ Project Site
REVIEWED BY: SALIH ARASID
AND CONTRACTING
Tools / Equipment: Hand tools & Portable Power tools APPROVED BY: YOUSEF MADDAH

ISC/HS/FRM/12 Rev 00