Information
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JOB HAZARD ANALYSIS
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Conducted on
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JOB #
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Foreman
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Operation:
STEP BY STEP PLAN
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Steps
Access Identification:
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Location
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Type
JOB HAZARD ANALYSIS
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Steps:
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STEP
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WHAT IS THE WORST THAT COULD HAPPEN?
- Slips
- Trips
- Falls
- Pinch Points
- Muscle
- Dehydration
- Abrasions / Lacerations
- Crush / Pinch Points
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If other explain
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PREVENTION PLAN? (Focus on Behavior)
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HOW ARE YOU MOST LIKELY TO GET HURT?
- Slips
- Trips
- Falls
- Pinch Points
- Muscle
- Dehydration
- Abrasions / Lacerations
- Crush / Pinch Points
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If other explain
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PREVENTION PLAN? (Focus on Behavior)
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OTHER RISKS TO BE AWARE OF?
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PREVEN TION PLAN? (Focus on Behavior)
ERGONOMIC RISKS
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Ergonomic Risk:
- Lifting
- Repetitive Motion
- Vibration
- Awkward Position
STRATEGIC RISKS
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Equipment
- Evident Risk
- Needs Special Planning
- Needs Addition Safety Training
- Crane
- Forklift
- Aerial Lift
- Rail Equipment
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Exposure to Falls
- Evident Risk
- Needs Special Planning
- Fall Protection
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Vehicle Traffic
- Evident Risk
- Needs Special Planning
- Flagger
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Night Work
- Evident Risk
- Needs Special Planning
- Flagger
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Lock-Out / Tag-out
- Evident Risk
- Needs Special Planning
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Power Tools
- Evident Risk
- Needs Special Planning
- Needs Additional Safety Training
- Cut-off Saw
- Circular
- Grinder
- Jack Hammer
- Chain Saw
- Chipping Gun
- Sawzall
- Other:
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Underground Utilities
- Evident Risk
- Needs Special Planning
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Trench / Excavation
- Evident Risk
- Needs Special Planning
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Confined Spaces
- Evident Risk
- Needs Special Planning
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Overhead Powerlines
- Evident Risk
- Needs Special Planning
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Electrical
- Evident Risk
- Needs Special Planning
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Hazardous Materials
- Evident Risk
- Needs Special Training
- Needs Additional Safety Training
- Respiratory Protection
- Silica Awareness
- Lead Awareness
- HAZWOPER
- Other:
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Other:
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MSDS Attached?
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Public Safety
- Evident Risk
- Needs Special Planning
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Other Safety Risks?
UNIQUE PPE
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REQUIRED PPE
- Harness / Lanyard
- Face Shield / Goggles
- Leather / Kevlar Chaps
- Toe / Foot Guards
- Ear Plugs / Muffs
- Respiratory Protection
- Cutting Googles
- Welding Hood
- Welding Leathers
- Life Vest
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Other:
PERMITS
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Permits Required
- Traffic Control
- RWP / Track Access
- Excavation / Dig
- One-Call (Utility locates)
- Confined Space
- Hot Work
- Scaffolding
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Other:
REVIEWED BY (please print name legibly): DO NOT SIGN IF REVERSE SIDE IS BLANK!
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Signature
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Name