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JOB SAFETY ANALYSIS <br /> Location of Job(Unit/Location on Project): 1`1•x.. I.vp <br /> Required PPE Safety Access/ Location Supervisor of Wort <br /> SI4Fr�{ vesT <br /> -- Safe Haven JSA Prepared By <br /> Date 2--%-405- Wind Direction Are other crews in areas <br /> Pre-Job Evacuation Route: <br /> Preparation New <br /> Fill out JSA Assembly Point Revised <br /> Review JSA <br /> (EVERYONE) <br /> Sign JSA <br /> EVERYONE) <br /> Job Task Audit the Job <br /> ` <br /> Insert Dail Site Task(s) here Audit Time <br /> Monti 1170TAntqS <br /> Potential Hazards Supervisors Comments <br /> Insert Daily Site Specific Hazard Information here} <br /> L <br /> Recommended Action or Procedure Supervisor's Initials <br /> (Insert Daily Site Specific ways to Reduce Exposure to Hazard <br /> w here <br /> d�'l trS h1a iE r 7*ff_ W 177 LOCALS <br /> 19W C} OF bcs� taf�ovNDgv S <br /> Crew Name (Printed) Cr Signatures <br /> oM"PB ISA <br />