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JOB SAFETY ANALYSIS FRONT SHEET

INSTALLATION/SITE DATE
JSA REF NO JSA TEAM ( NAME LIST )
DEPARTMENT MECHANICAL
PERMIT TO WORK NO
TASK DESCRIPTION

REFERENCES & ANY OTHER RELEVENT INFORMATION CONFIRMED ALARP


JSA APPROVED BY
Ids ,drawings, procedures, work instructions, certificates,special tools or equipments) (installation/facility/site manager)
Name
Signature
Position
Date

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