Potential Safety Or Environmental Hazards for Each Step

JOB SAFETY ANALYSIS Page 1 of 4

Date: / Location:
DescribeSpecific Job Being Analyzed:
Daniel SeniorOrifice Meter / The supervisor of the job/task/activity/work onsite must conduct the JSA, sign the JSA, and ensure that all personnel participating in the job understand and sign the JSA.
JSA Conducted By:
Designated UWA:
NOTE: Fieldwood Safe Work Practices For All Activities Selected Must be Reviewed and Considered In Development of the Job Safety Analysis
All Hazards, PPE and Permits Identified Below Must Be Addressed in JSA
Hazard Checklist: / Additional PPE Checklist: / Permits /Procedures Required:
Fire/Hotwork
Open Holes
Falling Objects
SimOps
Pinch Points
Cranes/Rigging
Stored Energy
Electricity / Chemicals
Spills/Leaks
Heights
Noise
Pressure
Fumes
Vibration
Other: / Weather
Lighting
Confined Space
Moving Machinery
Insect/Animal Bites
Tools/Equipment
Rotating Equipment / Face Shield
Goggles
Special Gloves
Hearing Protection
Personal Flotation
Fall Protection
Respirator
Other: / Hot Work Permit
Confined Space Entry Permit
Energy Isolation/LOTO Permit
Open Process Piping Permit
Crane Operation and Rigging
Fall Protection Procedures
Open Hole Barricade
Others:

List All Personnel Involved With Job Including Supervisor (Please Print Name & Initial):

Print Name

Initials

Company

Print Name

Initials

Company

SEQUENCE OF JOB STEPS

POTENTIAL SAFETY OR ENVIRONMENTAL HAZARDS FOR EACH STEP

SAFETY OR ENVIRONMENTAL HAZARD CONTROLS

FOR EACH STEP

RESPONSIBLE PERSON(S)

(IF APPLICABLE)
Qualified Person:

Assign trained person to perform job/task.
Review Daniels Senior Orifice Meter “Quick Change” procedure prior to performing work/task.

/ Untrained personnel. Incorrect procedure used. Pressure. / Ensure person(s) assigned to perform task/job are trained and they have reviewed the Daniels Junior Orifice Meter Operating Instructions located on the SEMS Portal Section I Operational Guidelines, Chapter4
Survey Work Area:
Perform walk through and inspection of the job or work area. / Slips, trip or falls. Obstructions to access Daniels meter. Piping or other objects restrictions. / Use caution maneuvering in an around piping, valves, and/or equipment or obstructions.
Tools and Equipment:
Gather correct meter wrench, replacement orifice plate, rags, etc. to perform work. / Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. / Proper hand placement. Impact resistant gloves. Use correct tool for the job.
Equalizer Valve & Gate:
Open equalizer valve slowly and then roll the gate to open position. Close equalizer valve. / Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. / Proper hand placement. Impact resistant gloves. Use correct tool for the job. Secure footing when pulling or pushing.
Plate and Gate:
Roll plate to the top chamber of the Daniels meter and then close the gate valve. / Pressure. Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. Struck by objects. / Proper hand placement. Impact resistant gloves. Use correct tool for the job. Secure footing when pulling or pushing. Proper body position clear of the line of fire.
Bleeder, Pressure, Seal Bar:
Open bleeder valve and bleed pressure. / Pressure releases. Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. Struck by objects. / Proper hand placement. Impact resistant gloves.Secure footing when pulling or pushing. Proper body position clear of the line of fire.
Sealing Bar:

Remove top chamber sealing bar, gasket and clamp bar. (Use caution, potential residual pressure)

/ Pressure releases. Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. Struck by objects. / Proper hand placement. Impact resistant gloves. Use correct tool for the job. Secure footing when pulling or pushing. Proper body position clear of the line of fire. PPE
Remove Plate:
Roll out plate and perform inspection of existing or replacement plate. / Sharp edges. Hand or finger injury. Pinch points / Proper hand placement. Impact resistant gloves.
Install Plate and Seal Bar:

Reinsert plate into carrier and roll carrier into upper chamber.
Reinstall gasket and seal bar.
Reinstall clamp bar and tighten.

/ Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. Struck by objects. / Proper hand placement. Impact resistant gloves. Use correct tool for the job. Secure footing when pulling or pushing. Proper body position clear of the line of fire.
Bleeder, Equalizer and Gate Valve:

First, close bleeder valve.
Next, open equalizer valve
Then open the gatevalve.

Roll plate into bottom chamber
Close gate valve
Close equalizer.

/ Pressure. Pinch points. Wrench slipping from stem. Hand or finger injury. Loss of balance. Struck by objects / Proper hand placement. Impact resistant gloves. Use correct tool for the job. Secure footing when pulling or pushing.
Housekeeping:
Gather tools, equipment, store properly and clean area. / Hand or finger injury. Incorrect tools. Poor positioning or posture. / Proper hand placement. Impact resistant gloves. Proper lifting bending.
***EVERYONE HAS STOP WORK AUTHORITY***
If Stop Work is initiated,the person with UWA must be notified and must authorize return to work.

(Note: Use another form and number accordingly if additional space is needed for names or job sequence steps)

Signatures:(indicate individuals are aware of the hazards andwill adhere to the recommended preventions and mitigations while performing and/or supervising the job)

Immediate Supervisor of Job/Task:Name (print): Company:

Signature:Date:

Person in Charge or Consultant: Name (print): Company:

Signature: Date:

Authorization to Resume Work

When Stop Work Authority (SWA) is initiated, the individual with Ultimate Work
Authority is responsible for documenting, as soon as practical, that the risk,
hazard or danger no longer exists, and it is safe to resume work.
Description of Stop Work and Corrective Actions:
Ultimate Work Authority (UWA) Approval to Resume Work Signature: / Time: / Date: