JHA Job Hazard Analysis

• Conducted on

  Date

• Prepared by

• Location
  Address

• Is all task specific PPE utilized?

  Yes

  No

  N/A

• Have equipment inspections been completed?

  Yes

  No

  N/A

• Has work area been inspected for hazards?

  Yes

  No

  N/A

• Have all energy sources been identified?

  Yes

  No

  N/A

• Is LOTO required?

  Yes

  No

  N/A

Hazards

• Electrical shock

  Safe

  At Risk

  N/A

• Working at hights

  Safe

  At Risk

  N/A

• Hoisting or rigging

  Safe

  At Risk

  N/A

• House Keeping

  Safe

  At Risk

  N/A

• Pinch points

  Safe

  At Risk

  N/A

• Vehicle traffic

  Safe

  At Risk

  N/A

• Heat/Cold Stress

  Safe

  At Risk

  N/A

• Noise above 85db

  Safe

  At Risk

  N/A

• Ergonomics

  Safe

  At Risk

  N/A

• All workers fit for duty

  Yes

  No

  N/A

Check all that apply.

• Fall protection

  Yes

  No

  N/A

• Safety glasses

  Yes

  No

  N/A

• Hard hat

  Yes

  No

  N/A

• Safety boots

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• High visibility vest

  Yes

  No

  N/A

• Other

Procedures/Permits

• Crane Lift Plan

  Yes

  No

  N/A

• Lock Out Tag Out

  Yes

  No

  N/A

• Signs/Barriers

  Yes

  No

  N/A

• Rescue protocol

  Yes

  No

  N/A

• Confined Space

  Yes

  No

  N/A

• Hot work permit

  Yes

  No

  N/A

Employee Certification

• Trade specific License

  Yes

  No

  N/A

• Vehicle License

  Yes

  No

  N/A

• Tele-handler

  Yes

  No

  N/A

• Man Lift

  Yes

  No

  N/A

• Working at hights

  Yes

  No

  N/A

• First Aid Cert

  Yes

  No

  N/A

• All tasks completed

  Yes

  No

  N/A

• House Keeping

  Safe

  At Risk

  N/A

• Was job completed with out incident.

  Yes

  No

  N/A

• Signature

  Sign