Concept Job Hazard Analysis (JHA)

• JHA Number:

• Company:

  ACME Co

  Be Company

  Sea Company

• Audit Title

• Conducted on

  Date

• Team Leader:

• Add signature

  Sign
• Tank Location
  Address

• Job Description:

• Names and Signatures of all team members involved at start of job
  (certifying that they understand the details of the JHA and their responsibility in implementing assigned controls):

• Enter Names and Signatures

Names & Signatures

• Name:

• Add signature

  Sign

• Please tick additional requirements to undertake this work in addition to mandatory items already checked

• PERMITS OF WORK

  Pump Concrete

  Confined Space Entry

  Hot Work

  Excavate

  Lift Using Crane (Telehandler)

• MINIMUM PPE

  Yes

  No

  N/A

• EQUIPMENT / TOOLS

  Yes

  No

  N/A

HAZARD CHECKLIST

• Have you identified the top 5 causes of injury and implemented control measures?

• Manual Tasks

  Yes

  No

  N/A

• Pinchpoints

  Yes

  No

  N/A

• Injury from Tool

  Yes

  No

  N/A

• Slip and Trips

  Yes

  No

  N/A

• Hit by Moving Object

  Yes

  No

  N/A

Energy Source

• Electrical Hazards

• AC/DC Power

  Yes

  No

  N/A

• Static Electricity

  Yes

  No

  N/A

• Lightning

  Yes

  No

  N/A

• CHEMICAL HAZARDS

• Enter Hazard Matrix

Hazard Matrix

• Job Step (break the job down into steps)

• Potential Hazards (what can harm you and others)

• Inherent Risk (likelihood x consequence)

  Low

  Medium

  High

• Controls & Checks Required

• Who is responsible to ensure controls are implemented?

  Select Project Leader Site Manager Leading Hand

  • Project Leader
  • Site Manager
  • Leading Hand

• Monitor & Review

• Residual Risk