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    Att Job Safety Assessment (Jsa) Rev F Dated 9-22-15

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    Brandon Moore
    1) All injuries and incidents must be reported within critical timelines as outlined in Ericsson's Injury Incident Reporting Instructions. 2) A Job Safety Analysis (JSA) form is provided to be completed daily before beginning any work and must be updated if work or exposures change. 3) The JSA identifies potential hazards such as falls, electricity, vehicle traffic, and noise and outlines control measures including use of personal protective equipment, inspections, safety programs and training.

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    Att Job Safety Assessment (Jsa) Rev F Dated 9-22-15

    Uploaded by

    Brandon Moore
    416 views2 pages
    1) All injuries and incidents must be reported within critical timelines as outlined in Ericsson's Injury Incident Reporting Instructions. 2) A Job Safety Analysis (JSA) form is provided to be completed daily before beginning any work and must be updated if work or exposures change. 3) The JSA identifies potential hazards such as falls, electricity, vehicle traffic, and noise and outlines control measures including use of personal protective equipment, inspections, safety programs and training.

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    Att Job Safety Assessment (Jsa) Rev f Dated 9-22-15

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    Att Job Safety Assessment (Jsa) Rev f Dated 9-22-15

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    1) All injuries and incidents must be reported within critical timelines as outlined in Ericsson's Injury Incident Reporting Instructions. 2) A Job Safety Analysis (JSA) form is provided to be completed daily before beginning any work and must be updated if work or exposures change. 3) The JSA identifies potential hazards such as falls, electricity, vehicle traffic, and noise and outlines control measures including use of personal protective equipment, inspections, safety programs and training.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    416 views2 pages

    Att Job Safety Assessment (Jsa) Rev F Dated 9-22-15

    Uploaded by

    Brandon Moore
    1) All injuries and incidents must be reported within critical timelines as outlined in Ericsson's Injury Incident Reporting Instructions. 2) A Job Safety Analysis (JSA) form is provided to be completed daily before beginning any work and must be updated if work or exposures change. 3) The JSA identifies potential hazards such as falls, electricity, vehicle traffic, and noise and outlines control measures including use of personal protective equipment, inspections, safety programs and training.

    Copyright:

    © All Rights Reserved
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    of 2

    Important: All injuries and incidents must be reported within critical timelines.

    See Ericsson Injury Incident Reporting Instructions

    (JSA) Job Safety Analysis


    Complete Daily (Before Beginning Work or for Pre-Job Planning/Analysis) Page 1 of 2
    (Must be updated if the work or exposures change)
    Job Information
    Date: Site Name: Site ID or FA Loc. #
    Site Address: Person Completing JSA:

    Project Personnel
    Name: Company: CPR/First Name: Company: CPR/First
    Aid Aid
    Yes Yes
    No No
    Yes Yes
    No No
    Yes Yes
    No No

    Emergency Procedures
    List telephone numbers and attach directions to the site:
    Are 911 systems functional with cell phone use? Yes No
    Tower Rescue Procedures to be used (per your company policy):

    Fire Department: In House Crew Other


    Ambulance: Telephone Co:
    Local Hospital: Police:
    Evacuation Point: Utility Co:

    Job/Task for Today or Pre-Job Analysis


    Check which is being performed:

    Line and Antennas Tower Work/Erection Civil/Concrete Electrical Hot Work/Hot Work
    Permit
    Crane Operations Critical Lift If yes, you must complete a Critical Lift Permit. Rooftop Work
    Controlled Descent If yes you must submit a Controlled Descent Plan to the Ericsson PM/CM and receive approval prior to performing the
    descent
    Hot Work Procedures- electrical panels etc.
    Welding and grinding safety precautions on Towers, Roofs, and ground.(These are minimal requirements, additional precautions may be necessary):
    o Fire blankets on site
    o Spotter(s) should be where the welder is working and in a position to see where sparks and slag is falling or blowing
    o Spotter(s) should be on the ground to perform spot checks and to put fires out as they start
    o Welding is not permitted with wind in excess of 20 mph unless additional precautions are taken and approved by the Ericsson
    market PM/CM
    o Review site access - water truck needs access to anywhere sparks could be present
    o Minimum of two easily accessible fire extinguishers. More may be required depending on site conditions and area
    o Contact the local fire department before the job starts to verify current conditions. (Restrictions, Permits).

    Other - Describe Job/Issues: Please use the back of the form for additional notes, comments or drawings if needed

    Rev F 09.15.2015
    Important: All injuries and incidents must be reported within critical timelines.
    See Ericsson Injury Incident Reporting Instructions
    (JSA) Job Safety Analysis
    Page 2 of 2
    (Job Exposures)
    Hazards Identification: (Items checked below relate to existing conditions, or may be a result of site operations)

    Physical Hazards Health Hazards


    Falls from elevations Electrical Heat Stress Cold Stress
    Slips, Trip, or falls Underground utilities High Noise (>85 dBA) Chemical Exposure
    Vehicle Traffic Elevation/Site Terrain Silica Exposure (Concrete Cutting)
    Hot Work( including welding and/or grinding) EME/RF Lifting Hazards
    (see precautions under Job task) Other: _______________
    Other :_____________________________
    (3) Hazard Control Measures
    Personal Protective Inspections Inspections Safety Program/Training
    Equipment/Monitoring
    Equipment
    Hard Hat Safety Glasses Tools/Equipment Rigging Tailgate Meeting 4 in-1 Signs
    Hearing Fall Protection Housekeeping Tag Lines Lockout/Tagout Excavation Log
    Gloves RF Suits Ground Fault Protection Permit System (Hoisting Personnel, Confined Space,
    RF Monitors Gin Poles Hoists Excavation, Critical Lifts, Controlled Descents etc.)
    RF Training
    Complete for Civil Work
    1. Describe type and depth of excavations:
    2.Cave-in control measures to be used if excavation will be greater than 5 feet and personnel are entering the trench:

    Sloping Benching Shoring Trench Shield/Box Ladder in Trench at @ 4+ Feet Required


    3. Describe elevation/site terrain/environmental concerns or hazards:

    4. Describe hazards with site/vehicle access (i.e. boom and cranes/electrical lines) and storage of materials:

    5. Describe the type of electrical concerns or hazards:

    Complete for Tower/Rooftop Work (Fall Protection & Using Suspended Personnel Platform)
    Type of Tower/Rooftop: Type of Antenna Boom:
    Fall protection to be used:
    Full Body Harness Double Leg or Two Lanyards Rope Grab Cable Grab
    Retractable Lifeline Anchorage Straps Ropes Descenders
    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 PFAS 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.
    1. Has each employee inspected his or her fall protection equipment? Yes No
    2. Describe the fall protection system to be used for the job including Controlled Descent Applications: Use back of the form
    3. Describe the fall protection system to be used when accessing antenna booms or performing tower erection: Use back of the form
    4. Hoisting Equipment to be used:
    Suspended Personnel Platform (Man-basket) Crane/Boom Truck Gin Pole
    5. Has a Suspended Personnel Platform Permit been completed and submitted to the Ericsson PM/CM?
    JSA Review - Managers/Supervisors/Leads Contractor All Crew Members
    Name Signature Name Signature

    Additional Comments: Use back of form

    Rev F 09.15.2015

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