Job Hazard Analysis (JHA)

• Site conducted

  Select

• Date

  Date

• Branch

• Project Name

• Site Safety Representative

• Department

• Supervisor

• Location
  Address

Field Conditions

• Electrical Systems Active

  Yes

  No

  N/A

• Electrical Systems LOTO (if applicable)

  Yes

  No

  N/A

• Fall Protection Hazards

  Yes

  No

  N/A

• Personal Fall Arrest Systems (if required)

  Yes

  No

  N/A

• Confined Space/Continual Monitor

  Yes

  No

  N/A

• Respiratory Hazards/ Facial Hair

  Yes

  No

  N/A

• Scaffold Inspected (green tag & dated)

  Yes

  No

  N/A

• Hazard Comunication/ GHS Labels, SDS

  Yes

  No

  N/A

• Adequate Housekeeping

  Yes

  No

  N/A

• First Aid Kit /Adequately Stocked

  Yes

  No

  N/A

• Hand tools / Power tools/Ladders

  Yes

  No

  N/A

PANDEMIC COMPLIANCE

• PPE-task specific (i.e. respirators, gloves)

  Yes

  No

  N/A

• Pre-task Social Distance discussed & preserved

  Yes

  No

  N/A

• Pre-task Jobsite Tailgate Huddle (sign-in)

  Yes

  No

  N/A

• Pandemic SOPs reviewed & readily available

  Yes

  No

  N/A

• Hand Washing Station (Soap & Water)

  Yes

  No

  N/A

• Sanitary Facilities available

  Yes

  No

  N/A

• Entry & Exit decon point

  Yes

  No

  N/A

• Post-Shift Safety Tailgate Huddle

  Yes

  No

  N/A

• Potable Water / Shade available

  Yes

  No

  N/A

• First Aid/CPR trained personnel on site

  Yes

  No

  N/A

• Other/Job Specific

  Yes

  No

  N/A

Completion

• Problem description, resolution and comments

• Supervisor's Signature

  Sign