Elkhorn Construction Inc.

A BJSA is a tool in which we plan our work, identify hazards, mitigate the hazards, and assign the responsible people.It is basically the plan we will use to complete our work.

Client/Job # Location/Area: Date:

Task Description:

What is the worst thing that could happen?

Permit required: Hot Work Ground Disturbance Confined Space LOTO Lift Plan

Inspection/Review Scaffold Equipment Excavation Operator certification MSDS

Operator's:

Spotter's:

Hazard identification Tool

Gravity Motion Mechanical Electrical Pressure Temperature

Falling objects Vehicle Rotating equip. Pow er lines Pipes Open f lame

Collapsing Equipment Conveyor Transformers Cylinder Ignition source

Trips Loads Belts Static Vessels Hot/cold/surface

Falls Wind Motors Lighting Tanks Liquid/gas/steam

Body position Wiring Pneumatic Friction

GFCI Hydraulic Weather conditions

Work Area Sketch

Biological Radiation Sound People Location Chemical

Animal Lighting Equipment noise Short service Traff ic Vapors

Bacterial Welding arc Impact noise Fatigue Congested Reactive

Virual Solar rays Vibration Stress Multiple operations Toxic compounds

Blood pathogens Microw aves High pressure release Communication Limited access Corrosive

Food/w ater Laser Communication Impairments Obstructions Combustibles

X-ray Housekeeping Fumes

Oxygen deficiency

Personal Protective Equipment Required

Hard Hat Leather gloves dust mask Material Spoggles Sleeves

Hood Chemical gloves half face mask Harness Safety Glasses Steeltoe Boots

Face Shield Cutting gloves full face mask FRC ear plugs Metatarsal Foot Guards

Goggles Chemical suit gas monitor Rubber boots ear muffs

Has personal working on task been trained and certify to utilize this PPE?

What is the emergency response plan review?

Where is the muster/assembling point?

Comments:

Completed by: Review by: Audited By:

Team Leader

I understand the specific safety requirements of the job & my STOP Work Authority responsibility Crew Signatures (Print your name legibly) SSE? SSE? SSE?

Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N

Steps for task Tool & Equip Potential hazards per step Steps to control/mitigate Responsible party

The purpose of the BJSA is to document how we will complete our work in a manner that identifies and protects us from any hazards we may face.

The BJSA should be completed by a person that is familiar with the task to be done and hazards we may face.

It is usually done by a foreman or team lead.

The entire crew should discuss the BJSA and complete it as team.

A foreman may not notice something that a laborer sees as potentially hazardous.

A BJSA should be completed before we start any task.

If the task poses any hazards a BJSA is required. Normal office work would be an example of low risk task that would not need a BJSA

If we finish with a task and start a new task not covered on the original BJSA then we need a new one.

If conditions or hazards change then we need to updated and review the BJSA

Job Number, Elkhorn Office(Western Slope),DateTask Description-What are we going to do?What is the worst thing that may happen?

Other permits associated with this BJSAInspections required?

Who are the TRAINED operators and spotters?

Client/Job # Location/Area: Date:

Task Description:

What is the worst thing that could happen?

Permit required: Hot Work Ground Disturbance Confined Space LOTO Lift Plan

Inspection/Review Scaffold Equipment Excavation Operator certification MSDS

Operator's:

Spotter's:

oThe Hazard ID tool helps us to recognize hazards present during our workoCircle the PPE required for this job task-Does everyone know how to use the PPE

oCircle all hazards present. We will mitigate or reduce them later in the BJSAoSketch our work area in the box

o Identify the location where we will muster and show it on the sketch

Hazard identification Tool

Gravity Motion Mechanical Electrical Pressure Temperature

Falling objects Vehicle Rotating equip. Pow er lines Pipes Open f lame

Collapsing Equipment Conveyor Transformers Cylinder Ignition source

Trips Loads Belts Static Vessels Hot/cold/surface

Falls Wind Motors Lighting Tanks Liquid/gas/steam

Body position Wiring Pneumatic Friction

GFCI Hydraulic Weather conditions

Work Area Sketch

Biological Radiation Sound People Location Chemical

Animal Lighting Equipment noise Short service Traff ic Vapors

Bacterial Welding arc Impact noise Fatigue Congested Reactive

Virual Solar rays Vibration Stress Multiple operations Toxic compounds

Blood pathogens Microw aves High pressure release Communication Limited access Corrosive

Food/w ater Laser Communication Impairments Obstructions Combustibles

X-ray Housekeeping Fumes

Oxygen deficiency

Personal Protective Equipment Required

Hard Hat Leather gloves dust mask Material Spoggles Sleeves

Hood Chemical gloves half face mask Harness Safety Glasses Steeltoe Boots

Face Shield Cutting gloves full face mask FRC ear plugs Metatarsal Foot Guards

Goggles Chemical suit gas monitor Rubber boots ear muffs

Has personal working on task been trained and certify to utilize this PPE?

What is the emergency response plan review?

Where is the muster/assembling point?

oObservable steps for the taskoTools and Equipment used to complete the task

oHazards we face while completing the taskoSteps to control or mitigate the hazards

oWho is responsible for the hazard control?

Comments:

Steps for task Tool & Equip Potential hazards per step Steps to control/mitigate Responsible party

o The job steps must be observable steps that we will do to complete the task. For example, Task: “Bolt 12 inch valve to metering skid”. Don’t make the steps too general, add enough detail so the steps are clear enough that those working on the task and others observing can understand what is to be done but they should not be a Standard Operating Procedure but a reminder of each general step of the task.

o A task should have 4-12 job steps. Too few steps will be too vague and more than 12 steps probably indicates a separate task that requires a separate BJSA. If additional room is needed, use a blank BJSA.

o Each step should note what is to be done, not how it is done.

o Keep the job steps in the correct order.

o Any tools or equipment needed for the job step should be listed. Having them available make our job safer and more efficient.

o Having them listed reminds us of hazards they may create.

o We need to identify any potential hazards we face at each job step. These can be large hazards like a crane dropping a load or a small hazard of bees being around.

o We should list any hazards identified on the Hazard ID tool (front page)

o The entire crew should list hazards. A group is more likely to think of all the hazards than a single person.

o An example may be “sparks from grinding that can enter eyes or cause a fire”

o Once we have identified the hazards, we need to write how we will eliminate or control the hazard.

o It is better to completely get rid of the hazard if possible. For example weld pipe on the ground instead of a heights to eliminate a fall hazard.

o If we cant do that, we should try to control the hazard. If we can’t weld the pipe on the ground we may build a scaffold platform to reduce the fall hazard.

o The last form of protection should PPE. If we can’t weld the pipe from scaffold then we would need to utilize a harness & lanyard attached to an anchor point

o Be specific in how we will control the hazard. Avoid phrases like “use PPE”. It should be something like “wear ear plugs and ear muffs while working in the compressor building”.

o Keep the BJSA organized in a way that it is easy to see what we should be doing to protect ourselves. That can be listing the hazard on one line and listing the mitigation on the same line to the right. You may also number a hazard as #1 and label the mitigation with the same #1.

o Once we have identified the hazard, talked about how we will deal with the hazard, then we will assign someone to be responsible for the hazard control.

o This may be one person that will wear hearing protection while grinding or the entire crew working next to a compressor.

o If a person is assigned, they need to make sure that they have taken care of the hazard before work starts.

oPrint who completed the BJSA, the foreman that reviewed it prior to the start of work, and who audits the form.

oThe crew should sign it once they review the BJSA. By signing it they agree that they understand it, agree to follow what it says, and they understand they must stop the work if we are not following our plan.

oThey should also circle Y/N if they are a short service employee to let others know that they may need additional guidance.

Completed by: Review by: Audited By:

Team Leader

I understand the specific safety requirements of the job & my STOP Work Authority responsibility Crew Signatures (Print your name legibly) SSE? SSE? SSE?

Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N Y / N

o The BJSA is a tool that will only protect us if we follow what it says. It takes everyone following the plan for it be effective.

o The BJSA must be in place BEFORE we start the work. You are not permitted to go to work until it is completed correctly.

o If conditions or our job steps change, we need to address those changes on the BJSA.

o Remember if we finish one task before days end, we need to develop another BJSA to start a new task.

o If others are entering our work area, we need to greet them, ask them to review & sign our BJSA.

o This could be other Elkhorn work groups, client personnel, or other contractors.

o If you enter another groups work area ask to review their BJSA. You will be exposed to the same hazards they face, so you need to know how to protect yourself.

o As a group, complete a BJSA for changing a flat tire on a pickup truck.

o Review the previous slides if needed to assist in the process.

Created by Justin Booth, OHST, CHST