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TEAM Chevron - Job Safety Analysis P4ARCAD1SH'b'-,e,isL-t"-,nt,uralandltancy <br /> sets <br /> JSA Acknowledgement <br /> "I have read this JSA, and I understand the hazards and safe work practices associated with the task. <br /> If conditions change or an additional hazard is recognized, I will Stop Work and notify the Site H&S Officer immediately:" <br /> This JSA must be acknowledged by affected workers every shift. <br /> Name Signature Initials Used on Form Date Date Date <br /> PMCo w. <br /> Verification of Critical Actions—Undersigned verifies that critical actions are in place, or have been evaluated based on availability, effectiveness <br /> and understood by the crew prior to work starting. <br /> Name of Verifier Signature Date Date Date <br /> End of Day Lookback—Use this section to log changes made to the JSA throughout the day and note any recommendations for Task JSA. <br /> Brief description Lookback Lookback Leader Name Date <br /> arcadis.com Page: <br /> Waste Containerization and Sampling JSA_pv 4/4 <br />