Job Hazard Analysis (JHA)

• Employee Name - (JHA) - Name of Project (Written just like this):

• Document No.

• W.C. Spratt, Inc.

• Conducted on

  Date

• Prepared by:

  Select Mark A. Davis Mark D. Davis Richard Dickinson Anthony Beverly Hugh French Scott Taylor Michael Wright James Brown Lee Ratliff Jason Corbin Michael Dwyer Joe Bailey Chuck Ayers James Shifflett Christopher M. Cole

  • Mark A. Davis
  • Mark D. Davis
  • Richard Dickinson
  • Anthony Beverly
  • Hugh French
  • Scott Taylor
  • Michael Wright
  • James Brown
  • Lee Ratliff
  • Jason Corbin
  • Michael Dwyer
  • Joe Bailey
  • Chuck Ayers
  • James Shifflett
  • Christopher M. Cole
• Location
  Address

• Personnel (All persons working today):

Project site information

• Project name:

• Task activity:

• Date:

  Date

• Work being performed for:

  W.C. Spratt, Inc.

Check applicable anticipated or potential hazards

• Demolition:

  Safe

  At Risk

  N/A

• Underground tank removal/disposable/high vapors:

  Safe

  At Risk

  N/A

• Activities in or near traffic areas:

  Safe

  At Risk

  N/A

• Concrete cutting or coring:

  Safe

  At Risk

  N/A

• Mobile heavy equipment activity (excavators, dump trucks, vacuum and hydovac trucks):

  Safe

  At Risk

  N/A

• Pile driving / shoring:

  Safe

  At Risk

  N/A

• Work affecting integrity of critical controls:

  Safe

  At Risk

  N/A

• Welding, cutting, grinding:

  Yes

  No

  N/A

• Hydoblasting / sand blasting:

  Yes

  No

  N/A

• Trenching (Mechanical or by hand):

  Yes

  No

  N/A

• Clearing:

  Yes

  No

  N/A

• Rigging:

  Yes

  No

  N/A

• Airborne contaminants:

  Yes

  No

  N/A

• Other (specify) :

  Yes

  No

  N/A

Critical procedures: where work involves any of the following hazards must be incorporated into JHA

• Work at heights above 6ft:

  Yes

  No

  N/A

• Confined space entry (includes tank cleaning):

  Yes

  No

  N/A

• Electrical or mechanical lockout (live, isolation, lock out / tag out:

  Yes

  No

  N/A

• Heavy equipment lifting (cranes, boom trucks, excavators):

  Yes

  No

  N/A

• Drilling borehole / excavations (Sub-surface clearance, locates):

  Yes

  No

  N/A

• Entry into excavations/Trenches (4ft) deep:

  Yes

  No

  N/A

• Hot work (in potentially explosive atmosphere):

  Yes

  No

  N/A

Ensure all hazards identified are addressed in JHA below

• Hazard 1: Sequence of job, Steps in order, breaking job into manageable pieces:

• Potential hazards. (Ex. underground services, hazard zone etc.):

• Safety controls to reduce or eliminate hazard:

• Hazard 2: Sequence of job, Steps in order, breaking job into manageable pieces:

• Potential hazards. (Ex. underground services, hazard zone etc.)

• Safety controls to reduce or eliminate hazard:

• Hazard 3: Sequence of job, Steps in order, breaking job into manageable pieces:

• Potential hazards. (Ex. underground services, hazard zone etc.):

• Safety controls to reduce or eliminate hazard:

• Hazard 4: Sequence of job, Steps in order, breaking job into manageable pieces:

• Potential hazards. (Ex. underground services, hazard zone etc.):

• Safety controls to reduce or eliminate hazard:

• Hazard 5: Sequence of job, Steps in order, breaking job into manageable pieces:

• Potential hazards. (Ex. underground services, hazard zone etc.):

• Safety controls to reduce or eliminate hazard:

Tools / Equipment ( list of tools and equipment and their storage on site, if relevant to safety

• List

  Yes

  No

  N/A

Required PPE ( minimum requirement: hard hat, spoggles, gloves, hearing band, type 2 vest).

• Eye protection:

  Yes

  No

  N/A

• Hearing protection:

  Yes

  No

  N/A

• Fall protection:

  Yes

  No

  N/A

• Hand protection:

  Yes

  No

  N/A

• Head protection:

  Yes

  No

  N/A

• Type 2 or 3 reflective vest (Required when working near a roadway or moving vehicles and equipment):

  Yes

  No

  N/A

• Foot protection:

  Yes

  No

  N/A

• Portable gas monitor:

  Yes

  No

  N/A

• Airborne particulate monitor:

  Yes

  No

  N/A

• Other (fire retardant coveralls, breathing apparatus, etc) specify :

Outside authorities:

• Outside authorities

  Sign

Disposal of designated substances, surplus, or impacted materials (disposal details, e.g when, where, how?)

• Add signature

  Sign

Inspector & Support

• Prepared by

  Sign

• Date

  Date

• Person carrying out work

  Sign

• Date

  Date

• Person carrying out work

  Sign

• Date

  Date

• Person carrying out work

  Sign

• Date

  Date

Site Foreman:

• JHA approved associate signature

  Sign

• Date

  Date