Information

  • Client / Site

  • Conducted on

  • Location
  • Personnel Involved In Completing JHA (please list)

Task Requirements

TASK REQUIREMENTS

  • JHA NUMBER

  • Task Description

  • Minimum Persons Required

EQUIPMENT Description of Equipment (Tools, Vehicles and Machinery) to be used for the duration of this JHA.

  • Required Equipment

  • Equipment
  • Tools/Plant/Machinery

  • Please specify

  • Qualification/Certificate to operate the Equipment (if required)

  • Please specify

  • Details of Special Precautions to be taken (including environmental/heritage considerations)

  • Pre-Task Training/Instruction Required (permit training, clearing training, etc.)

Type of Permit/Special Procedures Required for this JHA (Please indicate by selecting at least one option from the lists below) NOTE: Associated paperwork or permits are to be attached

  • Please indicate all responses below

  • Please Specify

PPE/Other Requirements (Please indicate by selecting at least one option from the lists below)

  • Select All That Apply

  • Please specify

Once this section is complete, move onto the 'Job Steps' section.

Job Steps

JOB STEPS AND RISK ANALYSIS Refer to the Risk Matrix below to evaluate the 'Risk' and 'Residual Risk' for each hazard and control.

  • Basic Job Steps

  • Step
  • Job Step

  • Hazard and Control

  • Hazard
  • Existing/Potential Hazard

  • Recommended Corrective Measure

  • Residual Risk

  • Reviewed by - Contractor Supervisor

  • Approved by - Senior Manager

Once signed off by both parties, move onto the next section for employees to sign onto the JHA.

Sign On

SIGN ON SHEET

  • Persons Working Under the Direction of this JHA

  • Employee
  • In signing this form, I understand the work procedures/methods as described in the JHA, and have been given the opportunity to ask questions.

  • Full Name and Signature (date will update automatically once signed)

REMEMBER to undertake a Take 5 before commencing any new task.

Email a copy of this JHA to the Safety Department team on site.

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.