Area区域: | Supervisor / Forman name 队长/工长 姓名: | Company公司: | Date&Time日期&时间: | ||||||||||
A. What is my team’s task today?我们今天的工作任务是什么? PTW Number:许可号: PTW Valid till许可有效期: JSA Reference /JSA参考: 工作安全分析表 : | |||||||||||||
B. Emergency Response procedure应急程序: Nearest Muster point 最近的集合点: Emergency number应急电话: Emergency Response Plan understood?知晓应急预案? | |||||||||||||
C. Night shift夜班 Any accesses need more lightings是否有入口/出口需要更多照明灯? Is the lighting suffisant at work place 工作区域照明是否足够? | |||||||||||||
D. Weather of the day天气情况: | |||||||||||||
E. Coactivity共同作业: | |||||||||||||
Nearby activities impacting me and actions taken 附近影响到我的活动和采取的行动 | Nearby activities I impact and actions taken 附近我影响到的活动和采取的行动 | ||||||||||||
F. Hazard Identification – To be filled in by Supervisor / Foreman 风险辨识-由主管/工长填写 | |||||||||||||
Task step 作业步骤 | What tools do we need? 我们需要什么工具? | What Hazards do we face? (CIRCLE THE HAZARDS) 我们会面对的风险(圈出来) | Precautions and PPE 预防措施及PPE | ||||||||||
Preparation准备 | 工作中涉及到的工机具。 | TOOLS 工具 | CONFINED. SPACE 受限空间 | Proper access provided:提供适当的入口/出口? Yes是 No否 Muster point reminded:提醒紧急集合点位置 Yes是 No否 Tools and equipment inspected:工具和设备已检查 Yes是 No否 Drinking water available:有饮用水 Yes是 No否 Team PPE inspected:PPE已检查 Yes是 No否 Working Situation Checked 工作环境检查 Yes是 No否 | |||||||||
LIFTING 吊装 | RADIOACT 辐射危险 | ||||||||||||
FIRE 火 | CHEMICAL 化学品 | ||||||||||||
Step 1: 第一步: | 根据操作规程和作业指导书步骤进行填写。 | DROPPED OBJECT 物体打击 | HANDLING 手动操作 | ||||||||||
Step2 第2步 | ELECTRICITY触电 | MOVING EQUIP 移动的设备 | |||||||||||
Step3 第3步 | SCAFFOLDING脚手架 | FALL跌落 | |||||||||||
Step4 第4步 | SLIP & TRIP滑道&绊倒 | BESIDE WATER溺水 | |||||||||||
Completion 完成 | HOT / COLD WEATHER高温/低温天气 | PRESSURE / ENERGY压力/能量 | Housekeeping done:卫生清理完成: Yes是 No否 PTW closed:许可作业关闭: Yes是 No否 | ||||||||||
PINCH / CUT 挤压/割伤 | HOT SURFACE 热表面 | Safe transportation安全运输: 与作业干涉的车辆伤害预防措施。 | |||||||||||
G. Signatures签名 | |||||||||||||
Supervisor / Foreman 主管/工长: Name and signature姓名和签名 | TPT Witness: TPT 见证: Name and signature姓名和签名 | ||||||||||||
Total number of team members:班组成员人数: Team members names and signatures班组成员名单及签名 | |||||||||||||
H. Additional comments其他说明: | |||||||||||||
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