Loading...

Job Safety Analysis Form

Scope of Work: Scissor Lift Operations

Location: PayPal Park

JSA Reference Number:

Date Revised: 5/8/2023



Steps:

1. Perform pre-operational safety and equipment check.

Hazard: Leaking, worn or damaged components that could cause faulty operation resulting in Impact or Compression to operator or bystander

Control: If deficiencies are noted, do not operate the unit until all problems have been corrected

2. Loading the lift

Hazard: Exceeding load lift weight capacity

Unstable load Using lift with other workers (Worker injury)

Loading lift while in motion (Worker struck by equipment)

Control: Do not exceed the scissor dock’s load ratings. Do not exceed a rate of two feet per second when moving load across platform Ensure the load is stable prior to operating lift. Use equipment brakes, chocks, etc. to stabilize load.

Keep all personnel clear of the lift while it is in operation. Be certain no part of any person or object is under any part of the lift before lowering the platform. Always carefully watch the platform and any load on it when the lift is in operation.

Barricade the work area so that bystanders are not in the work zone. Do not load the lift while it is moving.

3. Operating the lift

Hazard: Impact (including struck by as a result of tip‐ over, running into obstacles and objects falling onto the operator and bystanders, as well as running into bystanders)

Pinch points

Electrocution

Control: All loads must be centered on the deck. Make sure the lift is on level ground. Never work under load deck. Keep clear of moving scissor leg mechanism. Do not put hands, feet or objects under deck.

ALWAYS Yield to all other traffic and pedestrians. No passengers outside the deck. Check clearance to ensure that you have enough—overhead, right, left, in front and behind.

Keep your hands, arms and head inside operating deck. Do not drive up to anyone standing in front of a fixed object. Keep it slow—move at a speed of approximately 5 mph. Never turn around on a slope. Slow down for turns. Stay well away from the edge of ramps and loading docks.

Stay clear of pinch points created as the lift raises and lowers.

Maintain mandatory clearances from overhead power lines. Barricade work areas. Insulate power lines. Look up and live (before and during operation

3. Unloading the lift

Hazard: Unstable load

Dock traffic, pedestrians, PIT and distractions

Control: Ensure load is stable prior to unloading. Keep clear of plate guard when unloading the lift. Get assistance if necessary. Maintain control of lift at all times. Be alert to Powered Industrial Equipment and trucks. Be alert to pedestrians, dock traffic and the movement of equipment across the dock

 

 

 




First Employee Name

First Name*

Middle Name

Last Name*

Phone*
First Employee Date of Birth*
First Employee Signature*
Second Employee Name

First Name*

Middle Name

Last Name*
Second Employee Date of Birth*
Third Employee Name

First Name*

Middle Name

Last Name*
Third Employee Date of Birth*
Fourth Employee Name

First Name*

Middle Name

Last Name*
Fourth Employee Date of Birth*
Fifth Employee Name

First Name*

Middle Name

Last Name*
Fifth Employee Date of Birth*
Sixth Employee Name

First Name*

Middle Name

Last Name*
Sixth Employee Date of Birth*
Seventh Employee Name

First Name*

Middle Name

Last Name*
Seventh Employee Date of Birth*
Eighth Employee Name

First Name*

Middle Name

Last Name*
Eighth Employee Date of Birth*
Ninth Employee Name

First Name*

Middle Name

Last Name*
Ninth Employee Date of Birth*
Tenth Employee Name

First Name*

Middle Name

Last Name*
Tenth Employee Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!