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 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
Electrical
1 Waseem Ahmad SCEEI 4
Engineer
2 Ahmed Rehman Civil Engineer SCEEI 5
3 6 `

Inherent risk
Hazards Additional
Potential consequences level Residual risk
Step Description of job/task step and Hazard/risk controls hazard / risk
on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) threats / already in place controls
Environment and Asset not / not Acceptable)
causes recommended
Acceptable)
Isolate & test power,
ground lead, Lock-Tag
Electric shock,
1 Check and repair the equipment Electrical & sign, Man watching, Operator Acceptable
equipment breakdown
use high voltage
insulation PPE

HSE Document No. 3.8.5, Revision 2.0 (Trial Version) Form - 01 Page 1
Inherent risk
Hazards Additional
Potential consequences level Residual risk
Step Description of job/task step and Hazard/risk controls hazard / risk
on Health, Safety, (Acceptable / Action by level (Acceptable
No. (what and where) threats / already in place controls
Environment and Asset not / not Acceptable)
causes recommended
Acceptable)
Isolate & test power, Acceptable
Open control panel, check and Electric shock, fire, Man watching, Fire
2 Electrical Acceptable Electrical
clean equipment breakdown extinguisher, use high
voltage insulation PPE
Fire extinguisher, Acceptable
Electrical
Check bus bar nut & bolt, control Electric shock, fire, Insulation rubber mat,
3 Electric Acceptable
terminal tightness equipment breakdown use high voltage
insulation PPE
Insulation rubber mat,
Electric shock, Electrical Acceptable
4 Check and repair the equipment Electric ground lead, use high Acceptable
equipment breakdown
voltage insulation PPE
Manual Drop tools in the Electrical Acceptable
5 Collect tools Tool list, check twice Acceptable
Handling equipment, breakdown
Electric shock, fire, Fire extinguisher, Operator Acceptable
6 Resume the equipment Electric Acceptable
equipment breakdown Insulation rubber mat & CCR

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 2
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)________________
☐ 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 3
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