JHA

• Type of report?

  JHA

• Project Number

• Conducted on

  Date

• Prepared by

• Location
  Address

Potential Hazards (Check all that apply)

• Impact

• Person(s) can strike an object, or be struck by a moving or flying/falling object (e.g., fragments, chips, particles, sand, dirt/debris).

• Task Performed?

  Select Abrasive Blasting Power Tool Use Hand Tool Use Machine Operation Rigging Cleaning Pressure Washing Working At Heights Chemical Handling Handling Lead Material Painting (Airless Spray) Painting (Brush & Roller) Repair (Equipment) Climbing Welding Cutting Trenching Sanding Scraping Excavation (Hand Tools) Excavation (Machine Use) Traffic Maintenance

  • Abrasive Blasting
  • Power Tool Use
  • Hand Tool Use
  • Machine Operation
  • Rigging
  • Cleaning
  • Pressure Washing
  • Working At Heights
  • Chemical Handling
  • Handling Lead Material
  • Painting (Airless Spray)
  • Painting (Brush & Roller)
  • Repair (Equipment)
  • Climbing
  • Welding
  • Cutting
  • Trenching
  • Sanding
  • Scraping
  • Excavation (Hand Tools)
  • Excavation (Machine Use)
  • Traffic Maintenance

• Elevated Noise

• Crushing or Pinching

• An object(s) or equipment/machine may crush or pinch a body or body part.

• Hazardous Chemical or Harmful Dust

• Exposure to chemicals (i.e., hazardous substances and harmful physical agents), infectious agents from spills, splashing, physical contact, and/or exposure to dusts, vapors, fumes, or gases that could cause illness, irritation, burns, asphyxiation, breathing/vision difficulty, sensitization, infection, or other toxic health effects (i.e., acute or chronic).
  Note: "May also have or create ignition potential."

• Sharp Edges or Hot/Cold Surfaces

• Person(s) can strike an object, be struck by an object, or fall upon an object or tool that would cut or otherwise break the skin.

• Heat

• Exposure to radiant heat sources, sparks, and splashes or spills of hot material.

• Light

• Exposure to strong light sources, glare, or intense light exposure which is a byproduct or a process. Note: "This category may also include hazards presented from lack of light (e.g., working in dark spaces/areas)."

• Fall Potential

• Exposure to work at heights above 6 feet. Serious injury or death may occur.

• Injection

• Potential injection of hazardous materials to skin/body. Serious injury or death may occur.

• Fire or Explosion Potential

• An object or behavior that causes an increase in either the likelihood of a fire or injury due to fire. Sparks or open flame.

• Material Handling

• Water (Drowning/Flooding)

• Confined Space

• Excavation

• Elevated Load or Work

• Potential Release of Energy

• Injury caused by blasting operations, High velocity blast media, Injuries caused by unintentional discharge of blast media or blast hose failure and/or detachment. Cable(s) snapping under load.

• Lead or Other Heavy Metal Exposure

• Electrical Shock / Energized Equipment

• Vehicle Traffic

• Collisions between vehicles and vehicles, vehicles and workers, and vehicles and pedestrians.

Hazard Analysis

• Task Description

• Sequence of steps or activities

• Specific hazards or potential hazards

• How to minimize or eliminate hazards?

Additional remarks

• Please list any additional remarks:

• General Conditions of Work:

Signatures

• Signature of preparer:

  Sign

EH&S Review

• Signature

  Sign

• Date Reviewed

  Date