Information

  • Operation Type

  • Client / Site

  • Address
  • Conducted on

  • New

  • Revised

  • Competent Person(s) - Phone Number(s)

  • Prepared by

  • Approved By

  • Personnel

    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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.