Integrated Facility Services-JHA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Identify What can go wrong Mind on Task Focus Eyes on Task On the Hazards in Your Surroundings Secure Tools & Equipment Body Position-Out of the Line of Fire

Think through the job tasks; No answers must be mitigated/corrected prior to start of work.

• Do you know and understand the scope of work and how to do it safely?

  Yes

  No

  N/A

• Do you know the proper and safe method to execute job from start to finish?

  Yes

  No

  N/A

• Do you have all the necessary PPE?

  Yes

  No

  N/A

• Do you have the needed work permits?

  Yes

  No

  N/A

Identify the Hazard-Yes answers indicate hazards exist and are addressed. If unsafe conditions can't be mitigated/corrected contact your supervisor for assistance.

• Access; Can you access the work area safely?<br>1. Roof hatch<br>2. Ladder<br>3. Scissor lift

  Yes

  No

  N/A

• Will Lock Out/Tag Out be performed?<br>1. Notify contact person<br>2. Shut down equipment<br>3. Isolate energy source<br>4. Apply lock and tag<br>5. Verify ZERO energy

  Yes

  No

  N/A

• Does the task require work over 6 feet?<br>1. Guardrails<br>2. Fall Arrest-Anchor point must support 5000 pounds<br>3. Fall Restraint-Anchor point 2 times anticipated load and restricts travel to the fall hazard

  Yes

  No

  N/A

• Will you be exposed to 50 volts or greater?<br>1. Arc Flash PPE required when exposed to 50 volts or greater.

  Yes

  No

  N/A

• Material Handling; Will you be lifting 50 pounds or greater?<br>1. Use mechanical means; cart, dolly, chain fall<br>2. May need additional manpower.<br>

  Yes

  No

  N/A

• Ergonomics/Body Position; Does the job require working in a long term stooping, bending, or awkward position?<br>1. Stretch to warm up muscles.<br>2. Take extra small breaks.<br>3. Rotate work force.

  Yes

  No

  N/A

• Slips or Trips; Are there any liquids, ice, loose or fixed items in the working area?<br>1. Cleanup oil or water.<br>2. Add ice melt or remove snow and ice.<br>3. Remove trip hazards; if fixed identify/mark.

  Yes

  No

  N/A

• Ladders; Step or extension ladder needed to perform the job?<br>1. Correct ladder for the job.<br>2. Inspect before use.<br>3. Secure ladder to prevent moving.

  Yes

  No

  N/A

• HazCom; Will chemicals be used?<br>1. Chemical SDS on site?<br>2. Safety and first aid steps reviewed?<br>3. Proper PPE worn?

  Yes

  No

  N/A