Audit

Step

Task

Potential Hazards of Job Task

Recommended Abatement Action or Procedure

Appendix

Drawings

Drawing
Drawings

Photos

Photo
Photos

JHA Cheat Sheet

Considerations for Working Safe Pic.jpg

The signatures of the workers and supervisors/superintendent indicate they have reviewed, understand and will follow the above outlined procedures. It further indicates that the employees have received appropriate training for the activities associated with this task. Any questions by employees regarding the contents of this JHA, the task(s) and safe execution of all associated activities should be addressed with the Supervisor, Competent Person or Safety Manager.

Supervisor/Superintendent or Competent Person(s)

Signature
Add signature

Employees

Signature
Add signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.