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Job Safety Analysis <br /> -M <br /> Pre-Job Preparation Safety Access/Location Employee Authorization to STOP Work <br /> Vacuum Box Breakdown I have been given authorization,without fear of reprimand or retaliation,to immediately <br /> 1. Get Permit for Job STOP any work activity that presents a danger to me,my co-worker or the public;get <br /> 2. Fill out JSA Wind Direction: involved,question and rectify any situation that is identified as not being in compliance <br /> 3. Review JSA(EVERYONE) Iwith our safety and health policies;to report any unsafe conditions or acts to supervision <br /> 4. Sign JSA(EVERYONE) Evacuation Route: <br /> and question any activity that involves violation of established Safety and Health policies. <br /> Assembly Point: <br /> Job Tasks: (What are you doing?) Potential Hazards: Recommended Action or Procedure to <br /> eliminate/miti ate Hazards <br /> Vacuum Box Breakdown Hydraulic Failure,Vacuum Failure, Loose Parts, All hydraulic parts are sold at NAPA and tractor <br /> Rubber Skirt gets Worn,Torn supply. The vacuum will be supplied by the header <br /> and lateral. All parts are common nuts and bolts sold <br /> at NAPA and tractor supplies. There will be plenty of <br /> spare skirting on site. We have SCBA and EGRESS <br /> breathing air units on site to make all repairs. If <br /> possible all repairs will be made after drilling is <br /> completed. If repairs must be made while on a well; <br /> we will use level B Protection. <br /> Crew Name Signatures <br /> Job Close Out <br /> Any incidents/Injuries/Near miss/STOP work reported? Job Audited Recommendations: <br /> List: Time: <br /> Supervisor/Auditor Signature: <br /> Before starting work: Is this the SAFEST way to do this JOB? <br /> `I will not put myself or let my co-workers perform any task that 1 would not allow my son or daughter in, on or around." <br /> Consider the following and check the items which apply to the job, then review with the work crew. <br />