1. Start JSA Team JSA Note Inspect Site Hazards Resolve JSA Sign Permit
No Refinery worker or contractor is allowed to perform work at the Memphis Terminal without a completing a Field JSA and having a valid Work Permit to insure that conditions, practices and plans are in place to complete the work safely and effectively.
Field JSA is a Job Safety Analysis performed by all members of the work crews at the work site along with the terminal representative.
Each individual is responsible for their actions and for helping ensure a safe workplace.
Start JSA
Team
JSA
Note
Inspect
Site
Hazards
Resolve
JSA
Sign
Permit
Work
Job Do
End Job
& WO
10/30/2019

2. Following completion of a Job Site JSA – A “Work Permit” must be completed to define the type of work that will be performed and insure that all precautions have been taken.
The “Work Permit” forms are available at each terminal. They are bound in a pad, individually numbered, and have provide a carbonless copy when completed.
Field Work Permit
Expected Length (time) for Job
Type of Job
Description of work to be performed
PLEASE BE SPECIFIC!!
Equipment Preparation and
Identification of Energy Sources
NOTE if LOTO is required!
Note Job Hazards and any
Hazardous materials that will be used
If “HOT WORK” will be performed,
Special Approval must be given here.
Names of each Individual who will
work on the project must be Identified here.
Also – Note Individuals responsible for
Fire-watch or other Safety Standby
The site must be physically
Inspected to insure it is safe to begin
Personal Protective Equipment
And area safety devices must
Also be checked
If this job includes work within a Confined
space or other area where the
atmosphere may be questionable..
This information must detail the requirements.
Include Emergency Contact Information
MUST BE SIGNED & Operator Informed
Contractor must accept and sign.
Permit is returned at the end of the job.
Must be accepter and signed by the
Terminal person responsible for the
Work and the job site phisically checked.
10/30/2019