JHA / Job Hazard Analysis

• Department / Area

• Task being performed

• Conducted on

  Date

• Prepared by

Step by Step Hazard Evaluation

Steps

• Describe the overall job task or job title being performed.

• Describe what happens during the first step of the task.

• Describe what happens during the next step of the task.

• Describe what happens during the next step of the task.

• Describe what happens during the next step of the task.

• Describe what happens during the next step of the task.

• List the type of Hazard(s)

  Select Impact Hazard Chemical Hazard Penetration Hazard Compression Hazard Electrical Hazard Thermal Hazard Ergonomic Hazard Other Hazard

  • Impact Hazard
  • Chemical Hazard
  • Penetration Hazard
  • Compression Hazard
  • Electrical Hazard
  • Thermal Hazard
  • Ergonomic Hazard
  • Other Hazard

• Impact hazard?

  Select No Hazard Exist Chipping Grinding Sawing Drilling Sanding Flying particles Falling or dropping objects Other

  • No Hazard Exist
  • Chipping
  • Grinding
  • Sawing
  • Drilling
  • Sanding
  • Flying particles
  • Falling or dropping objects
  • Other

• Chemical hazard?

  Select No Hazard Exist Splash contact Irritating mist Thermal Harmful Dust Acid / Caustic Solvent Oil/Fuel Gases Other

  • No Hazard Exist
  • Splash contact
  • Irritating mist
  • Thermal
  • Harmful Dust
  • Acid / Caustic
  • Solvent
  • Oil/Fuel
  • Gases
  • Other

• Penetration hazard?

  Select No Hazard exist Sharp Objects Metal Shavings Propelled devices Grinding Fracture Other

  • No Hazard exist
  • Sharp Objects
  • Metal Shavings
  • Propelled devices
  • Grinding
  • Fracture
  • Other

• Compression hazard?

  Select No Hazard Exist Heavy Pipes Gas Cylinders Hydraulic Presses Drums Tanks Other

  • No Hazard Exist
  • Heavy Pipes
  • Gas Cylinders
  • Hydraulic Presses
  • Drums
  • Tanks
  • Other

• Electrical hazard?

  Select No Hazard Exist Energized switch Energized Equipment Energized Lines Other

  • No Hazard Exist
  • Energized switch
  • Energized Equipment
  • Energized Lines
  • Other

• Thermal hazard?

  Select No Hazard Exist Welding Brazing Cutting Flame Steam Chemical Gases Extreme Weather Other

  • No Hazard Exist
  • Welding
  • Brazing
  • Cutting
  • Flame
  • Steam
  • Chemical
  • Gases
  • Extreme Weather
  • Other

• Ergonomic hazards?

  Select No Hazard Exist Body Motion (Strain, Sprain) Lifting (Back) RMI Other

  • No Hazard Exist
  • Body Motion (Strain, Sprain)
  • Lifting (Back)
  • RMI
  • Other

• Misc. hazards?

  Select No Other Hazards Exist Engulfment Heat/Cold Light/Dark Hazardous or Toxic Waste Noise Fall Hazard Slip, Trip Hazard

  • No Other Hazards Exist
  • Engulfment
  • Heat/Cold
  • Light/Dark
  • Hazardous or Toxic Waste
  • Noise
  • Fall Hazard
  • Slip, Trip Hazard

• Describe any other hazards not listed?

• Can the hazard(s) be reduced or eliminated without the use of PPE?

  Yes

  No

  N/A

• Describe how to reduce or eliminate the hazard.

Risk Evaluation

• What are the "Consequences"?

  1 - Insignificant - No injuries

  2 - Minor - First Aid or small Spill

  3 - Moderate - Medical treatment or large spill

  4 - Major - Recordable injuries or loss of production

  5 - Catastrophic - Death, Hospitalization or toxic chemical released

• What is the "Likelihood" of an unsafe event happening?

  1 - Rare

  2 - Unlikely

  3 - Possible

  4 - Likely

  5 - Almost Certain

• Overall Risk Level of this step (Consequence X Likelihood)

  1-2 Very Low

  3-4 Low

  5-14 Medium

  15-19 High

  20+ Critical

PPE Assessment

• PPE Requirements

  Select Hard hat / Bump cap Safety glasses goggles or foam padded glasses Face shield Welding hood Hearing Protection Respiratory Protection Dust mask Gloves Protective Sleeves Fire retardant clothing Safety Harness/ Fall protection Apron Full suit Steel toed boots

  • Hard hat / Bump cap
  • Safety glasses
  • goggles or foam padded glasses
  • Face shield
  • Welding hood
  • Hearing Protection
  • Respiratory Protection
  • Dust mask
  • Gloves
  • Protective Sleeves
  • Fire retardant clothing
  • Safety Harness/ Fall protection
  • Apron
  • Full suit
  • Steel toed boots

• Other PPE not listed above?

• Is the employee performing the task wearing the proper PPE?

  Yes

  No

  N/A

• If Not, Why?

Additional Safety Requirements

• Are there any additional Safety Requirements for this job task?

  Select Fire Extinguisher Fire shield or curtain Gas / Oxygen detection Standby Observer Spill containment LOTO Barricades / Warning signs Other

  • Fire Extinguisher
  • Fire shield or curtain
  • Gas / Oxygen detection
  • Standby Observer
  • Spill containment
  • LOTO
  • Barricades / Warning signs
  • Other

• Other?

Additional information about this JHA?

• Additional photos

  Media

• Contributing Factors that present a hazard or may cause this task to be unsafe?

  Select Housekeeping or cleanliness of the area Carts and/or Parts positioned improperly Weather conditions Machine guarding deficiencies Set up performed incorrectly

  • Housekeeping or cleanliness of the area
  • Carts and/or Parts positioned improperly
  • Weather conditions
  • Machine guarding deficiencies
  • Set up performed incorrectly

• Any other "Contributing Factors"

Signatures

• Employee signature

  Sign

• Lead signature

  Sign

• Supervisor signature

  Sign

• EHS Manager signature

  Sign